Abstract
Background
Magnetic resonance imaging (MRI) is considered the imaging standard for diagnosis and characterization of perianal complications associated with Crohn disease in children and adults.
Objective
To define MRI criteria that could act as potential predictors of treatment response in fistulizing Crohn disease in children, in order to guide more informed study interpretation.
Materials and methods
We performed a retrospective database query to identify all children and young adults with Crohn disease who underwent serial MRI studies for assessment of perianal symptoms between 2003 and 2010. We examined imaging features of perianal disease including fistula number, type and length, presence and size of associated abscess, and disease response/progression on follow-up MRI. We reviewed imaging studies and electronic medical records. Statistical analysis, including logistic regression, was performed to associate MR imaging features with treatment response and disease progression.
Results
We included 36 patients (22 male, 14 female; age range 8–21 years). Of these, 32 had a second MRI exam and 4 had clinical evidence of complete response, obviating the need for repeat imaging. Of the parameters analyzed, presence of abscess, type of fistula according to the Parks classification, and multiplicity were not predictors of treatment outcome. Maximum length of the dominant fistula and aggregate fistula length in the case of multiple fistulae were the best predictors of treatment outcome. Maximum fistula length <2.5 cm was a predictor of treatment response, while aggregate fistula length ≥2.5 cm was a predictor of disease progression.
Conclusion
Perianal fistula length is an important imaging feature to assess on MRI of fistulizing Crohn disease.
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References
Langer M, Modi BP, Johnson S et al (2008) Benign perianal lesions. In: Kleinman RE, Goulet OJ, Mieli-Vergani G (eds) Walker’s pediatric gastrointestinal disease. BC Decker Inc., Hamilton, Canada, pp 367–371
Villa C, Pompili G, Franceschelli G et al (2012) Role of magnetic resonance imaging in evaluation of the activity of perianal Crohn’s disease. Eur J Radiol 81:616–622
Sahni VA, Ahmad R, Burling D (2008) Which method is best for imaging of perianal fistula? Abdom Imaging 33:26–30
Essary B, Kim J, Anupindi S et al (2007) Pelvic MRI in children with Crohn disease and suspected perianal involvement. Pediatr Radiol 37:201–208
Szurowska E, Wypych J, Izycka-Swieszewska E (2007) Perianal fistulas in Crohn’s disease: MRI diagnosis and surgical planning: MRI in fistulazing perianal Crohn’s disease. Abdom Imaging 32:705–718
Parks AG, Gordon PH, Hardcastle JD (1976) A classification of fistula-in-ano. Br J Surg 63:1–12
Schwartz DA, Pemberton JH, Sandborn WJ (2001) Diagnosis and treatment of perianal fistulas in Crohn disease. Ann Intern Med 135:906–918
Horsthuis K, Lavini C, Bipat S et al (2009) Perianal Crohn disease: evaluation of dynamic contrast-enhanced MR imaging as an indicator of disease activity. Radiology 251:380–387
Ng SC, Plamondon S, Gupta A et al (2009) Prospective evaluation of anti-tumor necrosis factor therapy guided by magnetic resonance imaging for Crohn’s perineal fistulas. Am J Gastroenterol 104:2973–2986
Van Assche G, Vanbeckevoort D, Bielen D et al (2003) Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn’s disease. Am J Gastroenterol 98:332–339
Akaike H (1974) A new look at the statistical model identification. IEEE Trans Autom Control 19:716–723
Core Team R (2013) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna
Sandborn WJ, Fazio VW, Feagan BG et al (2003) AGA technical review on perianal Crohn’s disease. Gastroenterology 125:1508–1530
Sciaudone G, Di Stazio C, Limongelli P et al (2010) Treatment of complex perianal fistulas in Crohn disease: infliximab, surgery or combined approach. Can J Surg 53:299–304
Lewis RT, Maron DJ (2010) Efficacy and complications of surgery for Crohn’s disease. Gastroenterol Hepatol 6:587–596
Thornton M, Solomon MJ (2005) Long-term indwelling seton for complex anal fistulas in Crohn’s disease. Dis Colon Rectum 48:459–463
Tozer PJ, Burling D, Gupta A et al (2011) Review article: medical, surgical and radiological management of perianal Crohn’s fistulas. Aliment Pharmacol Ther 33:5–22
Chang KJ, Kamel IR, Macura KJ et al (2008) 3.0-T MR imaging of the abdomen: comparison with 1.5 T. Radiographics 28:1983–1998
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Shenoy-Bhangle, A., Nimkin, K., Goldner, D. et al. MRI predictors of treatment response for perianal fistulizing Crohn disease in children and young adults. Pediatr Radiol 44, 23–29 (2014). https://doi.org/10.1007/s00247-013-2771-5
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DOI: https://doi.org/10.1007/s00247-013-2771-5