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Which magnetic resonance imaging feature is associated with treatment response in perianal fistulizing Crohn’s disease?

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Abstract

Purpose

Perianal fistulae are disabling complications of Crohn’s Disease. Magnetic resonance imaging features could predict treatment response. This study aimed to determine which magnetic resonance imaging features were predictive of long-term clinical outcome in real life.

Methods

Consecutive patients with magnetic resonance imaging performed in a tertiary center were retrospectively analyzed. Clinical outcome was defined as a need for surgical drainage of perianal fistulae or hospitalization. Clinical data and magnetic resonance imaging features (MAGNIFI-CD and Van Assche indices, degree of fibrosis) were studied.

Results

Fifty-two patients were included between 2016 and 2019 with a mean follow-up of 38 months [29;48]. A higher MAGNIFI-CD index (17/25 versus 11/25; p < 0.01) was associated with an unfavorable long-term clinical outcome. The MAGNIFI-CD index showed an area under the curve of 0.74 (p = 0.006) to predict the clinical outcome of perianal Crohn’s disease, compared to 0.67 (p < 0.05) for the Van Assche index. At a threshold of 13 for the MAGNIFI-CD index, sensitivity was 75% (CI95% [59%; 86%]) and specificity was 69% (CI95% [44%; 86%]). No association was found between the degree of fibrosis and clinical outcome, but the association of a high degree of fibrosis (≥ 80%) and of a low MAGNIFI-CD index (≤ 13) was predictive of clinical outcome (p < 0.01).

Conclusion

The MAGNIFI-CD index could be used to predict clinical outcome in perianal Crohn’s disease. In combination with a high degree of fibrosis, a low MAGNIFI-CD index, may help to identify patients with the best prognosis.

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Abbreviations

Anti-TNF:

Anti-tumor necrosis factor

CD:

Crohn’s disease

IBD:

Inflammatory bowel disease

MRI:

Magnetic resonance imaging

TGF β:

Transforming growth factor β

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Acknowledgements

The authors are grateful to Nikki Sabourin-Gibbs, CHU Rouen, for her help in editing the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Gastroenterology, CHU Rouen, INSERM, ADEN UMR1073, Nutrition, Inflammation and microbiota-gut-brain axis, Univ Rouen Normandie, 76000, Rouen, France

    Nicolas Richard & Guillaume Savoye

  2. Department of Radiology, CHU Rouen, 76000, Rouen, France

    Antonin Derinck

  3. Department of Digestive Surgery, CHU Rouen, 76000, Rouen, France

    Valérie Bridoux

  4. Department of Gastroenterology, CHU Rouen, 76000, Rouen, France

    Cloé Charpentier

  5. Department of Radiology, CHU Rouen, QUANTIF-LITIS EA 4108, Univ Rouen Normandie, 76000, Rouen, France

    Céline Savoye Collet

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  1. Nicolas Richard
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  3. Valérie Bridoux
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  4. Cloé Charpentier
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  5. Céline Savoye Collet
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  6. Guillaume Savoye
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Contributions

GS and CS: realized the conception and the design of the study. NR, AD and CS: performed the acquisition of data. NR and NR: performed the analysis and the interpretation of data. NR: wrote the draft of the manuscript. GS, CC, VB and CS: revised the manuscript.

Corresponding author

Correspondence to Nicolas Richard.

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This work was presented during the United European Gastroenterology Week in Vienna in 2022.

Supplementary Information

Below is the link to the electronic supplementary material.

261_2024_4238_MOESM1_ESM.png

Supplementary file1 Intersphincteric fistula tract (indicated by the arrow) in a 67-year-old woman with perianal Crohn’s disease. Initial MAGNIFI-CD index: 11 and Van Assche index: 7. The patient showed a favorable clinical outcome after 31 months of follow-up. A: Axial T2-weighted image; B: Sagittal T2-weighted image; C: Coronal T2-weighted image; D: Axial T2-weighted image with fat suppression; E: T1-weighted post-contrast image after intravenous injection of gadolinium. (PNG 3991 KB)

Supplementary file2 Calculation of the MAGNIFI-CD and of the Van Assche indices (DOCX 16 KB)

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Richard, N., Derinck, A., Bridoux, V. et al. Which magnetic resonance imaging feature is associated with treatment response in perianal fistulizing Crohn’s disease?. Abdom Radiol (2024). https://doi.org/10.1007/s00261-024-04238-3

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  • DOI: https://doi.org/10.1007/s00261-024-04238-3

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