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Perianal magnetic resonance imaging findings and their potential impact on outcome in children with perianal fistulizing Crohn disease

Abstract

Background

Children with perianal fistulizing Crohn disease require intensive medical management but also have a higher risk for subsequent surgical interventions.

Objective

We performed a retrospective study to identify patient factors and perianal anatomical features by pelvic MR that are associated with surgical interventions in these children.

Materials and methods

We included children with Crohn disease and perianal fistula who underwent pelvic MR with available, archived images and collected demographic, clinical and laboratory data. Radiologists reviewed pelvic MR exams and identified Park classification and additional anatomical features of perianal fistulas, including fistula branching, horseshoe ramifications, abscess, inflammatory mass, supralevator extension, anal sphincter damage, proctitis and posterior anal space involvement. We performed univariate and subsequent multivariate analysis to determine features associated with subsequent surgical intervention.

Results

Ninety-nine children with Crohn disease underwent pelvic MR. In this cohort, 69 children had no surgical interventions prior to baseline MRI, with subsequent median clinical follow-up of 5.5 years. Univariate analysis demonstrated that branching (P=0.009), supralevator extension (P=0.015) and anal sphincter damage (P=0.031) were significantly associated with subsequent surgical intervention. Age at baseline MRI was also associated with intervention (hazard ratio [HR] every 5 years: 2.13; 95% confidence interval [CI]: 1.18–3.83; P=0.012). A multivariable model identified only fistula branching (HR: 2.31; 95% CI: 1.28–4.15; P=0.005) and age (HR: 5.18; CI: 1.57–17.14; P=0.007) as independent predictors of subsequent surgery. No demographic, clinical or laboratory parameter predicted subsequent surgical intervention.

Conclusion

Age and anatomical MR features indicating fistula complexity (branching, supralevator extension) and sphincter damage confer a higher risk of subsequent surgical intervention in children with perianal Crohn disease.

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Correspondence to Muhammad Rehan Khan.

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Conflicts of interest

Dr. Fletcher is a consultant for Takeda, GlaxoSmithKline, Janssen and Boehringer Ingelheim, with funds paid to his institution. He has received grants to his instituion from the Helmsley Charitable Trust, Siemens Healthineers, Takeda and Pfizer.

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Khan, M.R., Ulrich, J.A., Hull, N.C. et al. Perianal magnetic resonance imaging findings and their potential impact on outcome in children with perianal fistulizing Crohn disease. Pediatr Radiol 51, 2481–2491 (2021). https://doi.org/10.1007/s00247-021-05158-w

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  • DOI: https://doi.org/10.1007/s00247-021-05158-w

Keywords

  • Children
  • Crohn disease
  • Inflammatory bowel disease
  • Magnetic resonance imaging
  • Park classification
  • Perianal fistula