Response of fistulating Crohn's disease to infliximab treatment assessed by magnetic resonance imaging

Abstract

SUMMARYAims: To assess fistula track healing after infliximab treatment using magnetic resonance imaging. Methods: Magnetic resonance imaging and clinical evaluation were performed before and after three infliximab infusions given over a 6-week period. Magnetic resonance images were evaluated for abscesses and fistula tracks. Paired magnetic resonance image examinations were rated 'better', 'unchanged' or 'worse'. Magnetic resonance imaging and clinical outcomes were then compared.

MR colonography without bowel purgation for the assessment of inflammatory bowel diseases: Diagnostic accuracy and patient acceptance

“…[32][33][34][35][36] Most strategies have focused on MRI due to its excellent soft-tissue contrast, which ensures the depiction of extraluminal pathologies including abscesses or fistulae. [37][38][39] Furthermore, MRI lacks ionizing radiation, which is advantageous particularly for young patients.…”

Imaging techniques and combined medical and surgical treatment of perianal Crohn’s disease

“…It is based on evaluation of drainage from the external orifice of the fistula upon gentle compression [1,14]. FDA is widely used in clinical trials assessing response to medical treatment, but numerous studies have demonstrated that cessation of drainage is not necessarily associated with complete regression of the track on imaging studies, and may also conversely be a sign of abscess formation [15][16][17][18]. Diagnostic imaging is therefore now considered to be an essential complementary tool to clinical assessment in the evaluation of perianal disease activity.…”

“…A basic fact has emerged from numerous studies reported in the literature, particularly in the early years following the introduction of biological therapy, namely that clinical response to therapy is often not in agreement with radiological or ultrasound outcome. Even if fistula drainage is improved or the orifice is closed, MRI and EUS frequently show persistent fistula tracts with a varying degree of activity [15][16][17][18]122] ( Fig. 10).…”

MRI of Crohn?s Anoperineal Disease

“…In particular, MRI has been shown to be of value to study complex perianal fistulae, being able to detect sepsis outside the anal sphincter and their relationship with the sphincter and levator ani muscle [21]. Besides an accurate morphological evaluation of the perianal space, MRI has been demonstrated to provide information about perianal disease activity, assessing inflammatory changes in fistula tracks in response to treatment with infliximab [22][23][24][25][26].…”