Learning objectives
Accurate evaluation of Crohn’s Disease (CD) related abscess/fistulas is mandatory for therapy management,
in order to adopt the best surgical strategy,
aiming to avoid recurrences and to preserve fecal continence.
MRI is the gold standard technic for perianal manifestations assessmentin CD patients.
The purpose of this poster is to provide to radiologists the main rules for a systematic,
precise and accurate radiological template,
in order to give surgeons all the information for guiding patient’s management.
Background
Perianal manifestations affect up to 50% of patients with CD,
and lead to important physical and psychological morbidity [1].
Evaluation of perianal manifestations of CD can be performed surgically,
by perianal inspection,
palpation and probing fistulas,
or by imaging (Fistulography,
CT,
Endoscopic US),
but all these technics actually underestimate the true extent and complexity of disease and its relation with anal sphincters [1,2].
MRI instead provides high resolution images of perianal anatomy,
and detailed assessment of any fistulous tract or abscess[2].
Anatomic overview of perianal...
Findings and procedure details
Imaging Planes must be correctly oriented to the anal canal.
For this reason,
FSE T2W sequence is performed at the beginning in order to define the orientation of the other sequences,
which must be aligned to the long axis of the anal canal,
obtaining “true” coronal and “true” axial images (fig 3)[4,5].
Sagittal planes may be used as well,
and they are particularly useful for the evaluation of fistulas which drain in vagina or bladder.
With patient in supine position,
protocol consists of axial and...
Conclusion
MRI has a sensitivity of 97% and specificity of 100% for detection of fistulas,
and provides accurate assessment of perianal lesions and their relation with anatomic structures,
essential for optimal surgical management [1-5].
The lack of ionizing radiation makes this technic reliable for patient follow up,
monitoring medical therapy [1-5].
The great importance of MRI is its ability of depicting hidden areas of sepsis and secondary extentions,
guiding the more appropriate surgical approach,
ensuring effective treatment - failure to detect and eradicate all lesions leads...
Personal information
Maria Chiara Terranova,
Chiara Tudisca,
Massimo Costanzo,
Laura Scopelliti,
Ambra Di Piazza,
Claudia Geraci,
Sergio Salerno,
Roberto Lagalla,
Giuseppe Lo Re.
Affiliation:
Department of Radiology,
University of Palermo.
Via del Vespro 127,
90127 Palermo
References
1.Gecse K,Khanna R,StokerJ,
et Al.Fistulizing Crohn's disease: Diagnosis and management.
United European GastroenterolJ.2013 Jun;1(3):206-13
2.de Miguel Criado J,del Salto LG,Rivas PF,
et Al.
MR imaging evaluation of perianal fistulas: spectrum of imaging features.
Radiographics.2012 Jan-Feb;32(1):175-94.
3.Morris J,Spencer JA,Ambrose NS MR imaging classification of perianal fistulas and its implications for patient management.
Radiographics.2000 May-Jun;20(3):623-35;
4.
Halligan S.
Imaging Fistula-in-ano. Clinical Radiology (1998) 53,
85-95
5.
Lo Re G,
Midiri M,
et Al.
Crohn’s Disease.
Radiological Features and Clinical-Surgical Correlations.
2016 Cap 13: 115-126
6.
Lo Re...
