Prospective Comparison of Magnetic Resonance Imaging, Transrectal and Transperineal Sonography, and Surgical Findings in Complicated Perianal Crohn Disease

Bor, Renáta; Farkas, Klaudia; Bálint, Anita; Szűcs, Mónika; Ábrahám, Szabolcs; Milassin, Ágnes; Rutka, Mariann; Nagy, Ferenc; Milassin, Péter; Szepes, Zoltán; Molnár, Tamás

doi:10.7863/ultra.15.09043

Cited by 21 publications

(18 citation statements)

References 22 publications

(45 reference statements)

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“…Several studies suggest that PNUS should be used as a preliminary tool in patients with suspected perianal fistulas and abscesses 120 121 122 123 . PNUS is also useful for monitoring patients with perianal fistulizing Crohn's disease under treatment with biologics.…”

Section: Perineal Ultrasoundmentioning

confidence: 99%

EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

Nuernberg

Săftoiu

Barreiros

et al. 2019

Ultrasound Int Open

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This article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). PNUS sometimes is more flexible and convenient compared to ERUS. However, the technique of ERUS is quite well established, especially for the staging of rectal cancer. EAUS also gained ground in the evaluation of perianal diseases like fistulas, abscesses and incontinence. For the staging of perirectal tumors, the use of PNUS in addition to conventional ERUS could be recommended. For the staging of anal carcinomas, PNUS can be a good option because of the higher resolution. Both ERUS and PNUS are considered excellent guidance methods for invasive interventions, such as the drainage of fluids or targeted biopsy of tissue lesions. For abscess detection and evaluation, contrast-enhanced ultrasound (CEUS) also helps in therapy planning.

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Section: Perineal Ultrasoundmentioning

confidence: 99%

EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

Nuernberg

Săftoiu

Barreiros

et al. 2019

Ultrasound Int Open

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“…All modalities have been shown to correctly classify Crohn’s perianal fistulae in over 85% of patients and when two modalities are used, the accuracy approaches 100%[ 14 ]. Transperineal ultrasound, which is a non-invasive and relatively cheaper modality of imaging, has also been shown to have similar accuracy to TRUS and MRI pelvis in diagnosing perianal fistulae[ 15 ]. If available, pelvic MRI provides the most comprehensive evaluation of the perianal region (Figure 1 ).…”

Section: What Modalities Should I Use To Evaluate Perianal Crohn’s Disease Prior To Commencing Anti-tnf Therapy?mentioning

confidence: 99%

Approach to medical therapy in perianal Crohn’s disease

Vasudevan¹,

Loftus²,

Faubion³

et al. 2021

WJG

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Perianal Crohn’s disease remains a challenging condition to treat and can have a substantial negative impact on quality of life. It often requires combined surgical and medical interventions. Anti-tumor necrosis factor (anti-TNF) therapy, including infliximab and adalimumab, remain preferred medical therapies for perianal Crohn’s disease. Infliximab has been shown to be efficacious in improving fistula closure rates in randomized controlled trials. Clinicians can be faced with a number of questions relating to the optimal use of anti-TNF therapy in perianal Crohn’s disease. Specific issues include evaluation for the presence of perianal sepsis, the treatment target of therapy, the ideal time to commence treatment, whether additional medical therapy should be used in conjunction with anti-TNF therapy, and the duration of treatment. This article will discuss key studies which can assist clinicians in addressing these matters when they are considering or have already commenced anti-TNF therapy for the treatment of perianal Crohn’s disease. It will also discuss current evidence regarding the use of vedolizumab and ustekinumab in patients who are failing to achieve a response to anti-TNF therapy for perianal Crohn’s disease. Lastly, new therapies such as local injection of mesenchymal stem cell therapy will be discussed.

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“…However, although it was first described some years ago, it is only performed in a few centres. Bor et al [ 10 ] stated that for patients with PCD, the accuracy of transperineal US is identical to that of MRI or endoanal sonography.…”

Section: Imaging Studiesmentioning

confidence: 99%

Role of magnetic resonance imaging in the management of perianal Crohn’s disease

Gallego

Echarri

2017

Insights Imaging

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Perianal fistulas are a major problem in many patients with Crohn’s disease. These are usually complex fistulas that adversely affect patients’ quality of life, and their clinical management is difficult. Medical treatment sometimes achieves cessation of discharge and closure of the external opening; however, it is difficult to assess the status of the rest of the fistula tract. Magnetic resonance imaging is the method of choice with which to evaluate the condition of perianal fistulas and allows for assessment of the status of inaccessible areas. Magnetic resonance imaging also allows the clinician to evaluate other perianal manifestations of Crohn’s disease that differ from the fistulas. This imaging technique is therefore a fundamental means of patient monitoring. When used in conjunction with assessment of the patient’s morphological findings, it provides information that allows for both quantification of disease severity and evaluation of the response to treatment. New types of magnetic resonance sequences are emerging, such as diffusion, perfusion, and magnetisation transfer. These sequences may serve as biomarkers because they provide information reflecting the changes taking place at the molecular level. This will help to shape a new scenario in the early assessment of the response to treatments such as anti-tumour necrosis factor drugs.Teaching points• MRI is the method of choice with which to evaluate perianal fistulas. • In perianal Crohn’s disease, MRI is a fundamental means of patient monitoring. • The usefulness of the Van Assche score for patient monitoring remains unclear. • New MRI sequences' diffusion, perfusion, and magnetisation transfer may serve as biomarkers.

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Prospective Comparison of Magnetic Resonance Imaging, Transrectal and Transperineal Sonography, and Surgical Findings in Complicated Perianal Crohn Disease

Cited by 21 publications

References 22 publications

EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

Approach to medical therapy in perianal Crohn’s disease

Role of magnetic resonance imaging in the management of perianal Crohn’s disease

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