MRI of perianal fistulas in Crohn’s disease
Main Article Content
Magnetic Resonance Imaging, Crohn, Fistula in ano, Perianal disease
Perianal fistulas represent one of the most critical complications of Crohn’s disease (CD). Management and treatment need a multidisciplinary approach with an accurate description of imaging findings. Aim. This study aspires to assess the significative role of Magnetic Resonance Imaging (MRI) in the study of perianal fistulas, secondary extensions, and abscess in patients with CD. Therefore it is essential to standardize an appropriate protocol of sequences that allow the correct evaluation of disease activity and complications. Methods: We selected and reviewed ten recent studies among the most recent ones present in literature exclusively about pelvic MRI imaging and features in CD. We excluded studies that weren’t in the English language. Conclusions: MRI has a crucial role in the evaluation and detection of CD perianal fistulas because, thanks to its panoramic and multiplanar view, it gives excellent anatomic detail of the anal sphincters. Today MRI is the gold standard imaging technique for the evaluation of perianal fistulas, mainly because this technique shows higher concordance with surgical findings than does any other imaging evaluation. Surgical treatment is often required in the management of perianal fistula in patients with CD, which often have complex perineal findings.
2. Tang LY, Rawsthorne P, Bernstein CN. Are perineal and luminal fistulas associated in Crohn’s disease? A population- based study. Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association 2006; 4: 1130-4.
3. Schwartz DA, Loftus EV, Jr., Tremaine WJ, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology 2002; 122: 875-80.
4. Eglinton TW, Barclay ML, Gearry RB, Frizelle FA. The spectrum of perianal Crohn’s disease in a population-based cohort. Diseases of the colon and rectum 2012; 55: 773-7.
5. Hellers G, Bergstrand O, Ewerth S, Holmstrom B. Occur
rence and outcome after primary treatment of anal fistulae in Crohn’s disease. Gut 1980; 21: 525-7.
6. Ingle SB, Loftus EV, Jr. The natural history of perianal Crohn’s disease. Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver 2007; 39: 963-9.
7. Maconi G, Gridavilla D, Viganò C, et al. Perianal disease is associated with psychiatric co-morbidity in Crohn’s disease in remission. International journal of colorectal disease 2014; 29:
8. Silva FAR, Rodrigues BL, Ayrizono MdLS, Leal RF. The Immunological Basis of Inflammatory Bowel Disease. Gastroenterology research and practice 2016; 2016: 2097274.
9. Scharl M, Rogler G. Pathophysiology of fistula formation in Crohn’s disease. World J Gastrointest Pathophysiol 2014; 5: 205-212.
10. Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. The British journal of surgery 1976; 63: 1-12.
11. Agostini A, Kircher MF, Do R, et al. Magnetic Resonance Imaging of the Liver (Including Biliary Contrast Agents) Part 1: Technical Considerations and Contrast Materials. Seminars in roentgenology 2016; 51: 308-316.
12. Agostini A, Kircher MF, Do RK, et al. Magnetic Resonanance Imaging of the Liver (Including Biliary Contrast Agents)-Part 2: Protocols for Liver Magnetic Resonanance Imaging and Characterization of Common Focal Liver Lesions. Seminars in roentgenology 2016; 51: 317-333.
13. Somma F, Faggian A, Serra N, et al. Bowel intussusceptions in adults: the role of imaging. La Radiologia medica 2015; 120: 105-17.
14. Dionigi G, Dionigi R, Rovera F, et al. Treatment of high output entero-cutaneous fistulae associated with large abdominal wall defects: single center experience. International journal of surgery (London, England) 2008; 6: 51-6.
15. Maggialetti N, Capasso R, Pinto D, et al. Diagnostic value of computed tomography colonography (CTC) after incomplete optical colonoscopy. International journal of surgery (London, England) 2016; 33 Suppl 1: S36-44.
16. Reginelli A, Russo A, Iasiello F, et al. [Role of diagnostic imaging in the diagnosis of acute appendicitis: a comparison between ultrasound and computed tomography]. Recenti progressi in medicina 2013; 104: 597-600.
17. de Miguel Criado J, del Salto LG, Rivas PF, et al. MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics : a review publication of the Radiological Society of North America, Inc 2012; 32: 175-94.
18. Morris J, Spencer JA, Ambrose NS. MR imaging classification of perianal fistulas and its implications for patient management. Radiographics : a review publication of the Radiological Society of North America, Inc 2000; 20: 623- 35; discussion 635-7.
19. O’Donovan AN, Somers S, Farrow R, Mernagh JR, Sridhar S. MR imaging of anorectal Crohn disease: a pictorial essay. Radiographics : a review publication of the Radiological Society of North America, Inc 1997; 17: 101-7.
20. Vernuccio F, Picone D, Midiri F, Salerno S, Lagalla R, Lo Re G. MR Imaging of Perianal Crohn Disease: The Role of Contrast- enhanced Sequences. Radiology 2017; 284: 921-922.
21. Ziech ML, Hummel TZ, Smets AM, et al. Accuracy of abdominal ultrasound and MRI for detection of Crohn disease and ulcerative colitis in children. Pediatric radiology 2014; 44: 1370-8.
22. Oliveira IS, Kilcoyne A, Price MC, Harisinghani M. MRI features of perianal fistulas: is there a difference between Crohn’s and non-Crohn’s patients? Abdominal radiology (New York) 2017; 42: 1162-1168.
23. O’Malley RB, Al-Hawary MM, Kaza RK, Wasnik AP, Liu PS, Hussain HK. Rectal imaging: part 2, Perianal fistula evaluation on pelvic MRI--what the radiologist needs to know. AJR. American journal of roentgenology 2012; 199: W43-53.
24. Beets-Tan RG, Beets GL, van der Hoop AG, et al. Preoperative MR imaging of anal fistulas: Does it really help the surgeon? Radiology 2001; 218: 75-84.
25. Monnier L, Dohan A, Amara N, et al. Anoperineal disease in Hidradenitis Suppurativa : MR imaging distinction from perianal Crohn’s disease. European radiology 2017; 27: 4100-4109.
26. Berra-Romani R, Raqeeb A, Torres-Jacome J, et al. The mechanism of injury-induced intracellular calcium concentration oscillations in the endothelium of excised rat aorta. Journal of vascular research 2012; 49: 65-76.
27. Moccia F, Zuccolo E, Poletto V, et al. Targeting Stim and Orai Proteins as an Alternative Approach in Anticancer Therapy. Current medicinal chemistry 2016; 23: 3450-3480.
28. Marzo M, Felice C, Pugliese D, et al. Management of perianal fistulas in Crohn’s disease: an up-to-date review. World journal of gastroenterology 2015; 21: 1394-1403.
29. Ciccocioppo R, Bernardo ME, Sgarella A, et al. Autologous bone marrow-derived mesenchymal stromal cells in the treatment of fistulising Crohn’s disease. Gut 2011; 60: 788-98.