Perianal disease in pediatric Crohn disease: a review of MRI findings

Abstract

Perianal complications of Crohn disease are a common occurrence in children and can result in significant morbidity when not accurately characterized prior to surgical intervention. MRI is an excellent imaging modality for the evaluation of perianal inflammatory bowel disease - allowing characterization and detailed description of perianal fistulas. MRI has many advantages over other imaging modalities for the pediatric patient. Radiologists will benefit from a sophisticated understanding of perianal anatomy, the classification of perianal fistulas, the advantages MRI offers in characterization of perianal fistulas as well as the common and incidental findings that are important in the MRI evaluation of perianal inflammatory bowel disease in children. Perianal fistulas are found at a high rate in pediatric referrals and are more commonly found in male patients.

Can MR enterography screen for perianal disease in pediatric inflammatory bowel disease?

“…2 With that, intersphincteric PAF were found to occur as frequently as transsphincteric PAF in our cohort, with similar incidences of both in the TP group. For PAF, NPV on MRE was also low.…”

“…Park's classification of fistulae was used, being the standard descriptor at our center, and considered more applicable in children given their anal canal is shorter than in adults. 2 With that, intersphincteric PAF were found to occur as frequently as transsphincteric PAF in our cohort, with similar incidences of both in the TP group. The time interval between P-MRI and MRE and technical factors such as imaging planes and FOV may contribute to the MRE FN rate.…”

“…1 CD has a known association with perianal fistulous disease, which may be the first presentation of CD or may develop later. 2,3 Keljo et al 3 found 10% of pediatric patients with CD to have perianal fistulae (PAF) or abscesses (PAA) within 30 days of initial diagnosis, similar to Tolia's 4 findings. In the largest pediatric cohort to date, perianal disease (PAD)-including skin tags and fissures-developed in 21% of patients during their disease course.…”

ACR Appropriateness Criteria® Crohn Disease-Child

“…Unlike ulcerative colitis, Crohn disease is characterized by transmural granulomatous inflammation as well as discontinuous or skip lesions that can occur anywhere in the gastrointestinal tract. Any portion of the gastrointestinal tract may be involved, most frequently the small bowel and colon, yet perianal Crohn disease is another common manifestation occurring in 15% to 25% of pediatric patients with Crohn disease [5,6]. Crohn disease diagnosis and treatment depend upon a combination of clinical, laboratory, endoscopic, histological, The imaging procedure or treatment is indicated in the specified clinical scenarios at a favorable risk-benefit ratio for patients.…”

Australia, the forgotten continent, hitting above its weight in research

“…Despite this, we are regular contributors to Pediatric Radiology. In the current edition, the review article of perianal disease in pediatric Crohn disease [3] and original article analysing MRI compliance in young children [4] are both Australian. This is not an isolated occurrence.…”