Résumé
Longtemps considérée comme secondaire et peu contributive, l’imagerie en proctologie a beaucoup évolué ces dix dernières années et contribué à améliorer la prise en charge des troubles de la continence anale et des suppurations anorectales. En particulier, l’échographie endocavitaire (EE) et l’imagerie par résonance magnétique (IRM) prennent une place grandissante dans le cadre de la maladie de Crohn anopérinéale (MAP). Elles ne sont pas indiquées de façon systématique mais s’avèrent utiles voire indispensables dans les situations difficiles: suppuration complexe et/ou multi-opérée, retard de cicatrisation ou persistance d’un écoulement postopératoire, suspicion ou notion avérée de doubles de la continence, douleurs anorectales inexpliquées. L’IRM semble globalement plus fiable que l’EE dans le repérage des orifices primaire(s) secondaire(s), des trajets fistuleux et des collection(s). Cela provient de sa meilleure résolution en contraste et de la possitilité d’une analyse tridimensionnelle sachant que de nombreuses améliorations techniques vont encore améliorer ses performances. Toutefois, l’EE est une technique fiable et bien codifiéc pour l’évaluation de l’appareil sphinctérien. En outre, elle présente l’avantage par raport à l’IRM d’être facile d’accès, bon marché, de courte durée et simple à mettre en œuvre. Finalement, ces deux techniques semblent complémentaires mais, s’il faut choisir, faire appel à un radiologue ayant une excellente connaissance de l’anatomie anorectale et de la maladie de Crohn importe actuellement davantage que le choix de la technique.
Summary
Considered for a long time as a secondary mater with little contribution of its own, imaging in proctology has much evolved during the last decade and has contributed to improve the management of faecal incontinence and anorectal sepsis. Especially, endosonography (ES) and magnetic resonance imaging (MRI) play an increasing role in the anoperineal forms of Crohn’s disease (APCD). They are not systematically indicated but they turn out to be useful and even indispensable in difficult situations; complex and/or multi-operated suppuration, healing delay or persistence of discharge after operation, suspicion or observation of faecal incontinence, unexplained anorectal pain. Overall, MRI seems more reliable than ES in the detection of primary and secondary opening(s), fistulous pathways and collection(s). This results form better contrast resolution and the possibility of tridimensional analysis, keeping in mind that numerous technical improvements will keep ameliorating its performances. ES, however, is a reliable and well codified technique for the evaluation of sphincters. In addition, it has the advantage over MRI of being easy to access, cost-effective and fast and easy to perform. Finally, these two techniques seem to be complementary but, if one has to make a choice, selecting a radiologist with an excellent knowledge of anorectal anatomy and Crohn’s disease is still more important than the technique.
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Abbreviations
- MAP:
-
maladie de Crohn anopérinéale
- EE:
-
échographie endocavitaire
- IRM:
-
imagerie par résonance magnétique
- APCD:
-
anoperineal Crohn’s disease
- ES:
-
endosonography
- MRI:
-
magnetic resonance imaging
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De Parades, V., Cuenod, C.A., Thomas, C. et al. L’imagerie dans la maladie de Crohn anopérinéale. Acta Endosc 30, 565–577 (2000). https://doi.org/10.1007/BF03026173
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DOI: https://doi.org/10.1007/BF03026173
Mots-clés
- diagnostic
- endosonographie
- imagerie par résonance magnétique
- maladie de Crohn
- manifestations anopérinéales
- traitement