Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging

Koelbel, Gerhard; Schmiedl, Udo P.; Mc, Majer; Weber, P; Jenss, H; Kueper, K; Hess, CF

doi:10.2214/ajr.152.5.999

Cited by 153 publications

(56 citation statements)

References 13 publications

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“…The location of the internal opening with respect to a clock face (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12), the presence or absence of sinus tracks, abscesses, a horseshoe component and coexisting inflammation and the distance of the internal opening to the anal orifice (in mm) were noted for each of the MRI sequences listed above. It was also noted if no decision could be made.…”

Section: Resultsmentioning

confidence: 99%

“…These findings are consistent with the results of Spencer et al (6), who suggested that axial and coronal contrast-enhanced T1W and axial T2W sequences should provide adequate information to guide surgery. In our study, however, we evaluated a more detailed classification of fistulas and internal openings, the positions of which were indicated by reference to a clock face (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Also, additional findings, such as the presence of a horseshoe extension or inflammation, were evaluated separately.…”

Section: Images (C)mentioning

confidence: 99%

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Ideal combination of sequences for perianal fistula classification and evaluation of additional findings for readers with varying experience

Yıldırım

Gökalp²,

Öztürk³

et al. 2011

Diagn Interv Radiol

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Perianal fistula is a common disease that most commonly originates from anal gland infections. Medical therapy has little treatment value, and patients eventually undergo surgery. The success of the surgery is closely associated with the preoperative evaluation (1). Therefore, it is of utmost importance to evaluate the course of the fistula and the presence of associated findings before surgical intervention because it can influence the surgical approach (2). Also, because recurrence is one of the most important problems following surgery, identification of the extensions of the disease with imaging methods aids in the surgical elimination of all sources of infection and ultimately decreases the percentage of recurrent disease (3).The preoperative evaluation of a fistula track by a surgeon includes inspection, palpation, probing, and the injection of colored dyes (2). The imaging methods employed to evaluate perianal fistulas are fistulography, computed tomography (CT), three dimensional (3D) endoanal ultrasonography (EAUS) (with or without the instillation of hydrogen peroxide into the track), and magnetic resonance imaging (MRI) with endoanal or pelvic coils or both. The description and classification of the primary track, the location of the internal opening (the radial site and the level), the presence of extensions (especially horseshoe extensions) and the presence of an abscess formation are the critical parameters for a complete evaluation of a fistula and should be implicated in the radiological reports. MRI is reported to be the most sensitive imaging method because it allows for the evaluation of secondary tracks and the detection of any possible extension to the supralevator fossa. Previous investigations performed to determine the role of MRI in this problem have indicated the value of the technique (2, 4-11). A concordance rate of 86%-88% between MRI and surgical findings was reported for the detection and classification of fistulas (12,13).To the best of our knowledge, no previous reports have evaluated the value of each sequence for assessing the specific surgical parameters in addition to fistula classification. The purpose of our study was to assess the contribution of different MRI sequences in determining the perianal fistula type and in obtaining critical information for surgical decisions, as well as to define the optimal combination of sequences for readers with varying levels of experience. Materials and methods Patient selectionThirty-three MRI examinations in 26 patients, obtained between 2007 and 2010, were included in the study. Fifteen of the patients were male, and 11 were female. The ages of the patients ranged from 30 to 84 years (mean age, 48 years). Three patients were known to have underlying inflammatory bowel disease. There was no evidence of diabetes melli- ABDOMINAL IMAGING ORIGINAL ARTICLE Ideal combination of MRI sequences for perianal fistula classification and the evaluation of additional findings for readers with varying levels of experienceNalan Yıldırım, Gökhan Gökalp...

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Section: Resultsmentioning

confidence: 99%

Section: Images (C)mentioning

confidence: 99%

Ideal combination of sequences for perianal fistula classification and evaluation of additional findings for readers with varying experience

Yıldırım

Gökalp²,

Öztürk³

et al. 2011

Diagn Interv Radiol

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“…Conventional fistulography, ultrasonography and computed tomography have proved to be insufficient in correct assessment of the disease [6]. Role of MRI in evaluation of fistulain-ano was first studied by Koelbel et al, [7] and was followed by many studies till date.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistulae with Surgical Correlation

Singh¹,

Singh

Thukral³

et al. 2014

JCDR

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Aims:The purpose of the study was to evaluate the role of Magnetic Resonance Imaging in detection and characterization of perianal fistulae and correlating it with surgical findings.Methods: Fifty consecutive patients with suspected perianal fistulae having one or more external openings were prospectively selected for MRI evaluation. Previously operated or patients with recurrent perianal disease were excluded from the study. MRI findings were recorded according to "St. James's University Hospital MR Imaging Classification of Perianal Fistulae" and correlated with surgical observations. Finally, comparison between T2-weighted fat saturated and postcontrast T1-weighted fat saturated sequences was done.Results: Amongst the total of 50 patients, per-operative findings confirmed perianal fistulae in 45 patients. The sensitivity and specificity of MRI in correctly detecting and grading the primary tract was found to be 95.56% and 80% respectively; for abscess, it was 87.50% and 95.24% respectively. High sensitivity was also discerned in identification of secondary tract (93.75%), correct localization of internal opening (95.83%) and for correctly detecting the horse-shoeing (87.50%). Our assumption of null hypothesis was accepted on comparing results of T2-weighted fat saturated sequences and postcontrast T1-weighted fat saturated sequences. Conclusion:Magnetic Resonance Imaging (MRI) was highly accurate in assessment of surgically important parameters (primary tract and its grading, internal opening, secondary tract, abscess, horseshoeing) of perianal fistulae. Comparison of results of imaging findings on T2-weighted and postcontrast T1-weighted fat saturated sequences were statistically similar, so contrast study can be omitted, particularly while evaluating primary / previously unoperated perianal fistulae.

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“…Moreover, MRI technology can be very useful for assessing small bowel disease and perianal disease in CD patients. [93,94] For optimization of anti-TNF therapy, point-of-care tests that measure serum drug concentrations in (capillary) blood seem to be a valuable tool as they would allow for rapid treatment adjustments, thereby avoiding unnecessary treatment delay. A quick test for fecal calprotectin is already available for 'on the spot' assessment of disease activity.…”

Section: Individualized Treatment Strategiesmentioning

confidence: 99%

Optimization of anti-TNF therapy in patients with Inflammatory Bowel Disease

Strik

Bots

D’Haens

et al. 2016

Expert Review of Clinical Pharmacology

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After the introduction of anti-tumor necrosis factor (anti-TNF) agents, the clinical outcome of patients with Inflammatory Bowel Disease (IBD) has improved significantly. However, use of anti-TNF therapy is complicated by loss of response. In order to maintain remission, adequate serum levels are required. Hence, therapeutic drug monitoring (TDM) is important in order to optimize serum drug levels, especially in patients with loss of response to these agents. Optimization of anti-TNF therapy by applying TDM enables clinicians to regain response to TNF blockers in a significant proportion of patients. It is important to use anti-TNF agents in their most optimal way, since these therapeutic agents are expensive and the medical options after failing anti-TNF therapy are limited. Here, we will discuss how to optimize treatment with anti-TNF agents in IBD patients in order to improve treatment efficacy, prevent anti-drug antibody formation, reduce side effects, discontinue unnecessary treatment and manage costs. ARTICLE HISTORY

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Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging

Cited by 153 publications

References 13 publications

Ideal combination of sequences for perianal fistula classification and evaluation of additional findings for readers with varying experience

Ideal combination of sequences for perianal fistula classification and evaluation of additional findings for readers with varying experience

Magnetic Resonance Imaging (MRI) Evaluation of Perianal Fistulae with Surgical Correlation

Optimization of anti-TNF therapy in patients with Inflammatory Bowel Disease

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