Skip to main content
Top
Published in: Abdominal Radiology 4/2017

01-04-2017

MRI features of perianal fistulas: is there a difference between Crohn’s and non-Crohn’s patients?

Authors: Irai S. Oliveira, Aoife Kilcoyne, Melissa C. Price, Mukesh Harisinghani

Published in: Abdominal Radiology | Issue 4/2017

Login to get access

Abstract

Purpose

Though perianal fistulas are commonly seen in patients with Crohn’s disease, they can also be seen in patients without inflammatory bowel disease. The purpose of this study was to evaluate MR imaging differences of perianal fistulas in patients with and without Crohn’s disease.

Methods

Our retrospective search from January 2012 to December 2015 of the Radiology database for perianal fistula yielded 207 patients. Only patients with dedicated MR fistula protocol studies were included, whereas patients with previous anal surgery or anastomosis, anorectal tumors, and equivocal findings that could not be definitely assessed as a fistula were excluded. The following features were assessed: anatomic type of fistula (Parks Classification), luminal origin (hour clock position), anal verge distance, signs of acute inflammation, circumference of anus involved by inflammation, presence of rectal inflammation. and abscess.

Results

One hundred and twenty six of 207 patients met inclusion criteria. Of these, 96 (76.2%) had Crohn’s disease and 30 (23.8%) did not. The most common fistulas identified were transphincteric (38.5% of Crohn’s and 50% of non-Crohn’s) and intersphincteric (33.3% of Crohn’s and 35.4% of non-Crohn’s). An abscess was associated in 41 cases, 32 (33.3%) in the Crohn’s group and 9 (30.0%) in the non-Crohn’s group. Rectal inflammation was present in 29 patients with Crohn’s disease (29.2%) and in 2 without Crohn’s (6.7%). This finding was statistically significant (p = 0.0009).

Conclusions

Our study demonstrates that while both groups can have similar MR imaging features, accompanying rectal inflammation was more commonly seen in Crohn’s disease.
Literature
1.
go back to reference Zanotti C, Martinez-Puente C, Pascual I, et al. (2007) An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis 22:1459–1462CrossRefPubMed Zanotti C, Martinez-Puente C, Pascual I, et al. (2007) An assessment of the incidence of fistula-in-ano in four countries of the European Union. Int J Colorectal Dis 22:1459–1462CrossRefPubMed
2.
go back to reference Sainio P (1984) Fistula-in-ano in a defined population: incidence and epidemiological aspects. Ann Chir Gynaecol 73(4):219–224PubMed Sainio P (1984) Fistula-in-ano in a defined population: incidence and epidemiological aspects. Ann Chir Gynaecol 73(4):219–224PubMed
3.
go back to reference Criado JM, del Salto LG, Rivas PF, et al. (2012) MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics 32:175–194CrossRef Criado JM, del Salto LG, Rivas PF, et al. (2012) MR imaging evaluation of perianal fistulas: spectrum of imaging features. Radiographics 32:175–194CrossRef
4.
go back to reference O’Malley RB, Al-Hawary MM, Kaza RK, et al. (2012) Rectal imaging: part 2, perianal fistula evaluation on Plevic MRI—what the radiologist needs to know. Am J Roentgenol 199:W43–W53CrossRef O’Malley RB, Al-Hawary MM, Kaza RK, et al. (2012) Rectal imaging: part 2, perianal fistula evaluation on Plevic MRI—what the radiologist needs to know. Am J Roentgenol 199:W43–W53CrossRef
5.
go back to reference Beets-Tan RGH, Beets GL, van der Hoop AG, et al. (2001) Preoperative MR imaging of anal fistulas: does it really help the surgeon. Radiology 218:75–84CrossRefPubMed Beets-Tan RGH, Beets GL, van der Hoop AG, et al. (2001) Preoperative MR imaging of anal fistulas: does it really help the surgeon. Radiology 218:75–84CrossRefPubMed
6.
7.
go back to reference Szurowska E, Wypych J, Izycka-Swieszewska E (2007) Perianal fistulas in Crohn’s disease: MRI diagnosis and surgical planning. Abdom Imaging 32:705–718CrossRefPubMed Szurowska E, Wypych J, Izycka-Swieszewska E (2007) Perianal fistulas in Crohn’s disease: MRI diagnosis and surgical planning. Abdom Imaging 32:705–718CrossRefPubMed
8.
go back to reference Villa C, Pompili G, Franceschelli G, et al. (2012) Role of magnetic resonance imaging in evaluation of the activity of perianal Crohn’s disease. Eur J Radiol 81:616–622CrossRefPubMed Villa C, Pompili G, Franceschelli G, et al. (2012) Role of magnetic resonance imaging in evaluation of the activity of perianal Crohn’s disease. Eur J Radiol 81:616–622CrossRefPubMed
9.
go back to reference Plumb AA, Halligan S, Bhatnagar G, Taylor SA (2015) Perianal sepsis in hematologic malignancy: MR imaging appearances and distinction from cryptoglandular infection in immunocompetent patients. Radiology 276:147–155CrossRefPubMed Plumb AA, Halligan S, Bhatnagar G, Taylor SA (2015) Perianal sepsis in hematologic malignancy: MR imaging appearances and distinction from cryptoglandular infection in immunocompetent patients. Radiology 276:147–155CrossRefPubMed
10.
go back to reference Vanbeckevoort D, Bielen D, Vanslembrouck R, Van Assche G (2014) Magnetic resonance imaging of perianal fistulas. Magn Reson Imaging Clin N Am 22:113–123CrossRefPubMed Vanbeckevoort D, Bielen D, Vanslembrouck R, Van Assche G (2014) Magnetic resonance imaging of perianal fistulas. Magn Reson Imaging Clin N Am 22:113–123CrossRefPubMed
11.
12.
go back to reference Sneider EB, Maykel JA (2013) Anal abscess and fistula. Gastroenterol Clin N Am 42:773–784CrossRef Sneider EB, Maykel JA (2013) Anal abscess and fistula. Gastroenterol Clin N Am 42:773–784CrossRef
13.
go back to reference Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. (2002) The natural history of fistulizing Crohn’s disease in Olmsted County. Minnesota. Gastroenterology 122:875–880CrossRefPubMed Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. (2002) The natural history of fistulizing Crohn’s disease in Olmsted County. Minnesota. Gastroenterology 122:875–880CrossRefPubMed
14.
go back to reference Morris J, Spencer JA, Ambrose NS (2000) MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 20:623–635CrossRefPubMed Morris J, Spencer JA, Ambrose NS (2000) MR imaging classification of perianal fistulas and its implications for patient management. Radiographics 20:623–635CrossRefPubMed
15.
go back to reference Ong EMW, Ghazi LJ, Schwartz DA, Mortele KJ (2015) Guidelines for imaging of Crohn’s perianal fistulizing disease. Inflamm Bowel Dis 21(4):731–736CrossRefPubMed Ong EMW, Ghazi LJ, Schwartz DA, Mortele KJ (2015) Guidelines for imaging of Crohn’s perianal fistulizing disease. Inflamm Bowel Dis 21(4):731–736CrossRefPubMed
16.
go back to reference Gecse KB, Bemelman W, Kamm MA, et al. (2014) A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut 63:1381–1392CrossRefPubMed Gecse KB, Bemelman W, Kamm MA, et al. (2014) A global consensus on the classification, diagnosis and multidisciplinary treatment of perianal fistulising Crohn’s disease. Gut 63:1381–1392CrossRefPubMed
17.
go back to reference Schwartz DA, Ghazi LJ, Regueiro M, et al. (2015) Guidelines for the multidisciplinary management of Crohn’s perianal fistulas: summary statement. Inflamm Bowel Dis 21(4):723–730CrossRefPubMed Schwartz DA, Ghazi LJ, Regueiro M, et al. (2015) Guidelines for the multidisciplinary management of Crohn’s perianal fistulas: summary statement. Inflamm Bowel Dis 21(4):723–730CrossRefPubMed
18.
go back to reference Rosa G, Lolli P, Piccinelli D, Mazzola F, Bonomo S (2006) Fistula-in-ano: anatomoclinical aspects, surgical therapy and results in 844 patients. Tech Coloproctol 10:215–221CrossRefPubMed Rosa G, Lolli P, Piccinelli D, Mazzola F, Bonomo S (2006) Fistula-in-ano: anatomoclinical aspects, surgical therapy and results in 844 patients. Tech Coloproctol 10:215–221CrossRefPubMed
19.
go back to reference Zbar AP, Horesh N, Bucholtz V, et al. (2013) Are there specific endosonographic features in Crohn’s patients with perianal fistulae? J Crohn’s Colitis 7:490–496CrossRef Zbar AP, Horesh N, Bucholtz V, et al. (2013) Are there specific endosonographic features in Crohn’s patients with perianal fistulae? J Crohn’s Colitis 7:490–496CrossRef
20.
go back to reference Lichtenstein GR, Hanauer SB, Sandborn W (2009) J and the Practice Parameters Committee of the American College of Gastroenterology. Management of Crohn’s disease in adults. Am J Gastroenterol 104:465–483CrossRefPubMed Lichtenstein GR, Hanauer SB, Sandborn W (2009) J and the Practice Parameters Committee of the American College of Gastroenterology. Management of Crohn’s disease in adults. Am J Gastroenterol 104:465–483CrossRefPubMed
Metadata
Title
MRI features of perianal fistulas: is there a difference between Crohn’s and non-Crohn’s patients?
Authors
Irai S. Oliveira
Aoife Kilcoyne
Melissa C. Price
Mukesh Harisinghani
Publication date
01-04-2017
Publisher
Springer US
Published in
Abdominal Radiology / Issue 4/2017
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-016-0989-z

Other articles of this Issue 4/2017

Abdominal Radiology 4/2017 Go to the issue

Classics in Abdominal Imaging

Falciform ligament sign