Anuradha Samir Shenoy-Bhangle MD, Presenter: Nothing to Disclose

Katherine Nimkin MD, Abstract Co-Author: Nothing to Disclose

Esther Israel MD, Abstract Co-Author: Nothing to Disclose

Dana Goldner MD, Abstract Co-Author: Nothing to Disclose

Michael Stanley Gee MD, PhD, Abstract Co-Author: Nothing to Disclose

Magnetic resonance imaging (MRI) is considered the best imaging modality available for diagnosing and follow-up of perianal pathology associated with Crohn’s disease. The aim of this study is to evaluate MRI criteria which could act as potential predictors of treatment response in fistulizing Crohn’s disease.

We performed a retrospective database query to identify all pediatric patients with Crohn’s disease who underwent MRI for assessment of perianal symptoms between the years 2003 to 2010. All 37 patients except 4 had serial follow up MR study for assessment of treatment response. Various parameters including cumulative length of the fistula, presence of associated abscess, response or disease worsening on follow up MRI were analyzed in detail. Imaging studies and electronic medical records were retrieved.

Thirty-seven patients (23 male and 14 female; age range 8-21 years) were included. Of these, 33 patients had a follow up MRI while in 4 patients clinical response did not necessitate the need for repeat imaging. Of the parameters analyzed, presence of abscess; type of fistula according to Park’s classification and multiplicity were not predictors of treatment outcome. Maximum length of the dominant fistula and cumulative length of the fistulae in the case of multiple fistulae were the best predictors of treatment outcome. Single fistula length of ≤ 2.5cm and cumulative length of multiple fistulae of ≤ 2.5cm both had a positive association with treatment response.  

In our retrospective analysis of pediatric patients with fistulizing Crohn’s disease, presence of multiple fistulae or an associated abscess on MRI did not predict treatment outcome. Fistula length was the best predictor of subsequent treatment response and should be considered when reporting MRI studies in this population.

Perianal fistula length is an important imaging feature to assess on MRI of fistulizing Crohn’s disease.

Shenoy-Bhangle, A, Nimkin, K, Israel, E, Goldner, D, Gee, M, MRI Predictors of Treatment Response for Fistulizing Crohns Disease in Pediatric Patients.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11014065.html