Diagnostic performance of intravoxel incoherent motion diffusion-weighted imaging and dynamic contrast-enhanced MRI for assessment of anal fistula activity

Lefrançois, Pascale; Zummo-Soucy, Mathieu; Olivié, Damien; Billiard, Jean-Sébastien; Gilbert, Guillaume; Garel, Juliette; Visée, E.; Manchec, P.; Tang, An

doi:10.1371/journal.pone.0191822

Cited by 9 publications

(11 citation statements)

References 41 publications

(52 reference statements)

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“…However, we were underpowered to split the data by responder status and are therefore unable to confirm this observation. The values we calculated across our cohort were lower than those of Ziech; however, this may have been due to different assumptions in the modelling process, including the definition of Arterial Input Function, and the use of an assumed blood T1 by Ziech Lefrancois et al [36] also evaluated semi-quantitative DCE parameters in a retrospective study of 43 patients. This study investigated the ability of intravoxel incoherent motion (IVIM)-DWI sequences combined with DCE parameters to differentiate between active and inactive fistulas and found improved diagnostic capability with the inclusion of the DCE parameters compared to IVIM-DWI alone.…”

Section: Discussionmentioning

confidence: 77%

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Quantitative Magnetic Resonance Imaging in Perianal Crohn’s Disease at 1.5 and 3.0 T: A Feasibility Study

et al. 2021

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Perianal Crohn’s Disease (pCD) is a common manifestation of Crohn’s Disease. Absence of reliable disease measures makes disease monitoring unreliable. Qualitative MRI has been increasingly used for diagnosing and monitoring pCD and has shown potential for assessing response to treatment. Quantitative MRI sequences, such as diffusion-weighted imaging (DWI), dynamic contrast enhancement (DCE) and magnetisation transfer (MT), along with T2 relaxometry, offer opportunities to improve diagnostic capability. Quantitative MRI sequences (DWI, DCE, MT and T2) were used in a cohort of 25 pCD patients before and 12 weeks after biological therapy at two different field strengths (1.5 and 3 T). Disease activity was measured with the Perianal Crohn’s Disease Activity index (PDAI) and serum C-reactive protein (CRP). Diseased tissue areas on MRI were defined by a radiologist. A baseline model to predict outcome at 12 weeks was developed. No differences were seen in the quantitative MR measured in the diseased tissue regions from baseline to 12 weeks; however, PDAI and CRP decreased. Baseline PDAI, CRP, T2 relaxometry and surgical history were found to have a moderate ability to predict response after 12 weeks of biological treatment. Validation in larger cohorts with MRI and clinical measures are needed in order to further develop the model.

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Section: Discussionmentioning

confidence: 77%

“…From these variables, the T2 and the surgical history had the largest statistical effect sizes. 36). There was no correlation between any of the other MRI parameters.…”

Section: A Baseline Model To Predict Response At Week 12mentioning

confidence: 80%

Quantitative Magnetic Resonance Imaging in Perianal Crohn’s Disease at 1.5 and 3.0 T: A Feasibility Study

et al. 2021

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“…It usually requires advanced imaging modalities, MRI, or transrectal ultrasound (TRUS), to diagnose these fistulas[ 17 - 21 ]. Both MRI and 3D-TRUS are very effective in delineating various parameters of these fistulas, including the internal opening, primary tracts, and secondary extensions[ 17 - 20 , 22 ], though MRI has a slight edge over TRUS. It is really impressive that in the pre-MRI era, doyens in the field like Parks et al [ 8 ] could describe these deep fistulas with a reasonably high level of accuracy.…”

Section: Challenges In Managing These Fistulasmentioning

confidence: 99%

Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas

Garg¹,

Yagnik²,

Dawka³

et al. 2022

WJG

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Supralevator, suprasphincteric, extrasphincteric, and high intrarectal fistulas (high fistulas in muscle layers of the rectal wall) are well-known high anal fistulas which are considered the most complex and extremely challenging fistulas to manage. Magnetic resonance imaging has brought more clarity to the pathophysiology of these fistulas. Along with these fistulas, a new type of complex fistula in high outersphincteric space, a fistula at the roof of ischiorectal fossa inside the levator ani muscle (RIFIL), has been described. The diagnosis, management, and prognosis of RIFIL fistulas is reported to be even worse than supralevator and suprasphincteric fistulas. There is a lot of confusion regarding the anatomy, diagnosis, and management of these five types of fistulas. The main reason for this is the paucity of literature about these fistulas. The common feature of all these fistulas is their complete involvement of the external anal sphincter. Therefore, fistulotomy, the simplest and most commonly performed procedure, is practically ruled out in these fistulas and a sphincter-saving procedure needs to be performed. Recent advances have provided new insights into the anatomy, radiological modalities, diagnosis, and management of these five types of high fistulas. These have been discussed and guidelines formulated for the diagnosis and treatment of these fistulas for the first time in this paper.

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“…Newer advancements like contrast-enhanced MRI and three-dimensional modelling are being evaluated for anal fistulas[ 9 , 17 - 22 ]. These have been utilized more in Crohn’s disease rather than cryptoglandular fistulas.…”

Section: Other Advancementsmentioning

confidence: 99%

Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula: Experience from 2404 scans

Garg¹,

Kaur²,

Yagnik³

et al. 2021

WJG

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Magnetic resonance imaging (MRI) is considered the gold standard for the evaluation of anal fistulas. There is sufficient literature available outlining the interpretation of fistula MRI before performing surgery. However, the interpretation of MRI becomes quite challenging in the postoperative period after the surgery of fistula has been undertaken. Incidentally, there are scarce data and no set guidelines regarding analysis of fistula MRI in the postoperative period. In this article, we discuss the challenges faced while interpreting the postoperative MRI, the timing of the postoperative MRI, the utility of MRI in the postoperative period for the management of anal fistulas, the importance of the active involvement and experience of the treating clinician in interpreting MRI scans, and the latest advancements in the field.

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Diagnostic performance of intravoxel incoherent motion diffusion-weighted imaging and dynamic contrast-enhanced MRI for assessment of anal fistula activity

Cited by 9 publications

References 41 publications

Quantitative Magnetic Resonance Imaging in Perianal Crohn’s Disease at 1.5 and 3.0 T: A Feasibility Study

Quantitative Magnetic Resonance Imaging in Perianal Crohn’s Disease at 1.5 and 3.0 T: A Feasibility Study

Guidelines to diagnose and treat peri-levator high-5 anal fistulas: Supralevator, suprasphincteric, extrasphincteric, high outersphincteric, and high intrarectal fistulas

Guidelines on postoperative magnetic resonance imaging in patients operated for cryptoglandular anal fistula: Experience from 2404 scans

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