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MRI features of perianal fistulas: is there a difference between Crohn’s and non-Crohn’s patients?

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Abstract

Purpose

Though perianal fistulas are commonly seen in patients with Crohn’s disease, they can also be seen in patients without inflammatory bowel disease. The purpose of this study was to evaluate MR imaging differences of perianal fistulas in patients with and without Crohn’s disease.

Methods

Our retrospective search from January 2012 to December 2015 of the Radiology database for perianal fistula yielded 207 patients. Only patients with dedicated MR fistula protocol studies were included, whereas patients with previous anal surgery or anastomosis, anorectal tumors, and equivocal findings that could not be definitely assessed as a fistula were excluded. The following features were assessed: anatomic type of fistula (Parks Classification), luminal origin (hour clock position), anal verge distance, signs of acute inflammation, circumference of anus involved by inflammation, presence of rectal inflammation. and abscess.

Results

One hundred and twenty six of 207 patients met inclusion criteria. Of these, 96 (76.2%) had Crohn’s disease and 30 (23.8%) did not. The most common fistulas identified were transphincteric (38.5% of Crohn’s and 50% of non-Crohn’s) and intersphincteric (33.3% of Crohn’s and 35.4% of non-Crohn’s). An abscess was associated in 41 cases, 32 (33.3%) in the Crohn’s group and 9 (30.0%) in the non-Crohn’s group. Rectal inflammation was present in 29 patients with Crohn’s disease (29.2%) and in 2 without Crohn’s (6.7%). This finding was statistically significant (p = 0.0009).

Conclusions

Our study demonstrates that while both groups can have similar MR imaging features, accompanying rectal inflammation was more commonly seen in Crohn’s disease.

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Acknowledgements

Aoife Kilcoyne would like to acknowledge the support of the Mac Erlaine Scholarship, from the Academic Radiology Research Trust, St. Vincent’s Radiology Group, Dublin, Ireland. Irai S Oliveira would like to acknowledge the support of the Instituto de Ensino e Pesquisa, from Hospital Sírio-Libanês, São Paulo, Brazil.

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Authors and Affiliations

  1. Division of Abdominal Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., White Building 270, Boston, MA, 02114, USA

    Irai S. Oliveira, Aoife Kilcoyne & Mukesh Harisinghani

  2. Division of Thoracic Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Melissa C. Price

Authors
  1. Irai S. Oliveira
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  2. Aoife Kilcoyne
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  3. Melissa C. Price
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  4. Mukesh Harisinghani
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Corresponding author

Correspondence to Irai S. Oliveira.

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Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Informed consent

This HIPAA compliant study was approved by Institutional Review Board (IRB) and a waiver of informed consented was obtained.

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Oliveira, I.S., Kilcoyne, A., Price, M.C. et al. MRI features of perianal fistulas: is there a difference between Crohn’s and non-Crohn’s patients?. Abdom Radiol 42, 1162–1168 (2017). https://doi.org/10.1007/s00261-016-0989-z

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  • DOI: https://doi.org/10.1007/s00261-016-0989-z

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