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NATURAL HISTORY AND MRI PREDICTIVE FACTORS OF RADIOLOGICAL HEALING IN FISTULIZING PERIANAL CD

Valentine Delmotte 1, Eleonore Defraigne-Peigneur 2, Paul Meunier 3, Edouard Louis 2, Romain Gillard 2, Catherine Reenaers 3

Affiliations

1 CHU Liège, Liège, Belgium

2 CHU Liege, Liege, Belgium

3 CHU Liege, Liège, Belgium

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Abstract

Introduction

Fistulizing perianal Crohn’s disease (CD) is a disabling condition affecting up to 30 % of patients. While mucosal healing is associated with a better clinical outcome in luminal CD, the objective of the management of perianal CD is less clear. Radiological parameters are rarely considered as an outcome in perianal CD. Some studies have suggested that a high degree of fibrosis of the fistula tract was associated with a better clinical outcome. The aim of this study was to describe the natural history of perianal CD including MRI parameters and to identify clinical and radiological factors of perianal CD relapse and radiological healing.

Aims & Methods

All pelvic MRI performed for fistulizing perianal CD in the CHU of Liège, Belgium, between 2018 and 2023 were collected. MRI examinations were performed according to the protocol of the institution, using a 1.5-T [Siemens Aera ou Sola] or 3-T [Siemens Vida] machine, including T2 turbospin- echo, T2 TSE fat-saturated, T1 TSE FS before contrast in the axial plane and T1 TSE FS after gadolinium. The MAGNIFI-CD index and the Van Assche index were evaluated for each patient. The degree of fibrosis of the fistula tract was evaluated by two radiologists, blinded for the clinical history. The first MRI was evaluated in all patients. Patients with perianal flare had only one MRI included in the analysis. The first and the last MRI performed during the study period were analyzed, if available, in patients without perianal flare. Parianal flare was defined by the drainage of an abscess or a stoma for active perianal CD. Radiological remission was defined by a fibrosis of the fistula tract of ³80% or a MAGNIFI CD score of 0.

Results

Seventy-five pelvic MRI from 60 patients were included in the study. The median age of the patients was 37.0 (30.0 - 48.5) years old, 37 (62%) patients were male, the median duration of perianal CD was 36.00 (0.60 - 123.00) months, 19 (31.7%) had a seton at the time of the first MRI, 23 patients (40%) were on anti-TNF. Nineteen (32%) patients, required abscess drainage in the follow-up period. Sixty-three % were on anti-TNF at the time of the drainage. No clinical nor radiological factors at baseline were predictive of perianal flare.
Fifteen patients without perianal flare had a second MRI during the follow-up. Seven patients (46,7%) had radiological healing at the end of the follow-up. One patient (6.7%) had radiological healing at the first MRI but not at the last MRI, 2 patients (13,3%) had radiological healing at both MRI 1 and 2 (13.3%), 5 patients (33,3%) had no radiological healing at MRI 1 but had radiological healing at MRI 2. Longer duration of perianal CD was associated with higher rates of radiological healing at the last MRI whereas high VA hyperintensity T2 (OR=0.13, p=0.099) and hyperintensity on postcontrast T1 (OR=0.11p=0.071) at the first MRI were predictive of absence of mucosal healing during the follow-up.

Conclusion

One third of the patients with perianal CD required abscess drainage whereas about half of the patient had radiological healing at the end of the follow-up. No clinical predictive factors were associated with perianal flare and few radiological factors were predictive of radiological healing. Predicting the outcome of perianal disease remains challenging in clinical practice. Radiological factors are promising and should be validated in a prospective cohort.

Disclosure

Speaking fees, consulting fees, travel fees, grant from: Abbvie, Alfa Sigma, Takeda, Janssen, BMS, Pfizer, Lilly, Roche, Fresenius Kabi, Biogen, celltrion, ferring

Conference

UEG Week Vienna 2024

Topics

IBD

Submission format

Abstract

Session

IBD (Posters)

Citation

United European Gastroenterology Journal 2024; 12 (Supplement 8)

Published

2024

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RADIOLOGICAL REMISSION IN PERIANAL FISTULIZING CROHN’S DISEASE: BASELINE MRI PREDICTORS AND IMPACT ON CLINICAL OUTCOMES

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