Share this content in WeChat
Research progress of MRI in activity evaluation and follow-up of perianal fistulizing Crohn's disease
YANG Miyang  QI Wan  SHI Rong 

Cite this article as: YANG M Y, QI W, SHI R. Research progress of MRI in activity evaluation and follow-up of perianal fistulizing Crohn's disease[J]. Chin J Magn Reson Imaging, 2023, 14(4): 181-187. DOI:10.12015/issn.1674-8034.2023.04.032.

[Abstract] Crohn's disease (CD) is a chronic nonspecific inflammatory bowel disease of unknown etiology. Perianal fistulizing Crohn's disease (pfCD) is the most common complication of CD and frequently occurs in both adults and children. With the continuous development of medical technology, a variety of imaging-assisted examination techniques came into being, such as endoscopy, fistula angiography, examination under anesthesia, endoscopic ultrasonography, MRI etc., can assist in diagnosis. MRI has become the gold standard for the imaging diagnosis of pfCD due to its non-invasive, rapid and accurate characteristics. This paper reviews the diagnostic value, differential diagnosis and efficacy evaluation of pelvic MRI in pfCD. Considering the complexity of pfCD, this paper also discussed the MRI inflammatory activity score, imaging indicators and new MRI based technology of CD, in order to provide theoretical basis for further optimization of diagnosis and treatment strategies for patients with pfCD.
[Keywords] Crohn's disease;perianal fistula;perianal disease;magnetic resonance imaging;inflammatory activity index;diagnosis

YANG Miyang1   QI Wan2*   SHI Rong3  

1 The First Clinical Medical College, Fujian University of Traditional Chinese Medicine, Fuzhou 350122, China

2 Department of Radiotherapy, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China

3 Department of Anorectal, People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350004, China

Corresponding author: Qi W, E-mail:

Conflicts of interest   None.

ACKNOWLEDGMENTS National Natural Science Foundation of China (No. 81973852).
Received  2022-11-23
Accepted  2023-04-11
DOI: 10.12015/issn.1674-8034.2023.04.032
Cite this article as: YANG M Y, QI W, SHI R. Research progress of MRI in activity evaluation and follow-up of perianal fistulizing Crohn's disease[J]. Chin J Magn Reson Imaging, 2023, 14(4): 181-187. DOI:10.12015/issn.1674-8034.2023.04.032.

Experts group of consensus on perianal fistulizing Crohn's disease. Experts consensus on the diagnosis and treatment of perianal fistulizing Crohn's disease[J]. Chin J Inflamm Bowel Dis, 2019, 3(2): 105-110. DOI: 10.3760/cma.j.issn.2096-367X.2019.02.001.
PANES J, REINISCH W, RUPNIEWSKA E, et al. Burden and outcomes for complex perianal fistulas in Crohn's disease: systematic review[J]. World J Gastroenterol, 2018, 24(42): 4821-4834. DOI: 10.3748/wjg.v24.i42.4821.
FAN K, XIONG Q, WU H X, et al. Research progress of mesenchymal stem cells and their treatment of Crohn's disease anal fistula[J]. Chin J Coloproctology, 2022, 42(8): 78-80. DOI: 10.3969/j.issn.1000-1174.2022.08.029.
SCHWARTZ D A, PEMBERTON J H, SANDBORN W J. Diagnosis and treatment of perianal fistulas in Crohn disease[J]. Ann Intern Med, 2001, 135(10): 906-918. DOI: 10.7326/0003-4819-135-10-200111200-00011.
SCHWARTZ D A, LOFTUS E V, TREMAINE W J, et al. The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota[J]. Gastroenterology, 2002, 122(4): 875-880. DOI: 10.1053/gast.2002.32362.
LAPIDUS A, BERNELL O, HELLERS G, et al. Clinical course of colorectal Crohn's disease: a 35-year follow-up study of 507 patients[J]. Gastroenterology, 1998, 114(6): 1151-1160. DOI: 10.1016/s0016-5085(98)70420-2.
SICA G S, DI CARLO S, TEMA G, et al. Treatment of peri-anal fistula in Crohn's disease[J]. World J Gastroenterol, 2014, 20(37): 13205-13210. DOI: 10.3748/wjg.v20.i37.13205.
XU F, LIU Y, WHEATON A G, et al. Trends and factors associated with hospitalization costs for inflammatory bowel disease in the United States[J]. Appl Health Econ Health Policy, 2019, 17(1): 77-91. DOI: 10.1007/s40258-018-0432-4.
TAO R, HUANG X L, GONG T Y, et al. Research progress of traditional Chinese medicine in the treatment of anal fistula in Crohn's disease[J]. Shaanxi J Tradit Chin Med, 2022, 43(5): 666-669. DOI: 10.3969/j.issn.1000-7369.2022.05.029.
FEUERSTEIN J D, HO E Y, SHMIDT E, et al. AGA clinical practice guidelines on the medical management of moderate to severe luminal and perianal fistulizing Crohn's disease[J]. Gastroenterology, 2021, 160(7): 2496-2508. DOI: 10.1053/j.gastro.2021.04.022.
SINGH S, PROCTOR D, SCOTT F I, et al. AGA technical review on the medical management of moderate to severe luminal and perianal fistulizing Crohn's disease[J/OL]. Gastroenterology, 2021, 160(7): 2512-2556.e9 [2022-11-21]. DOI: 10.1053/j.gastro.2021.04.023.
Inflammatory Bowel Disease Group-Pediatric Group of Chinese Society of Gastroenterology of Chinese Medical Association. Chinese expert consensus on anti-tumor necrosis factor-αmonoclonal in pediatric Crohn′s disease[J]. Chin J Inflamm Bowel Dis, 2021(2): 114-124. DOI: 10.3760/cma.j.cn101480-20210105-00001.
GREER M C, CYTTER-KUINT R, PRATT L T, et al. Clinical-stage approaches for imaging chronic inflammation and fibrosis in Crohn's disease[J]. Inflamm Bowel Dis, 2020, 26(10): 1509-1523. DOI: 10.1093/ibd/izaa218.
HADDOW J B, MUSBAHI O, MACDONALD T T, et al. Comparison of cytokine and phosphoprotein profiles in idiopathic and Crohn′s disease-related perianal fistula[J]. World J Gastrointest Pathophysiol, 2019, 10(4): 42-53. DOI: 10.4291/wjgp.v10.i4.42.
NI G H, ZHAO H W, QI C Z, et al. Comparative analysis of MR imaging findings of perianal fistulas in patients with and without Crohn disease[J]. Chin J Radiol, 2019, 53(4): 305-309. DOI: 10.3760/cma.j.issn.1005?1201.2019.04.012.
SAVOYE-COLLET C, SAVOYE G, KONING E, et al. Fistulizing perianal Crohn′s disease: contrast-enhanced magnetic resonance imaging assessment at 1 year on maintenance anti-TNF-alpha therapy[J]. Inflamm Bowel Dis, 2011, 17(8): 1751-1758. DOI: 10.1002/ibd.21568.
NG S C, PLAMONDON S, GUPTA A, et al. Prospective evaluation of anti-tumor necrosis factor therapy guided by magnetic resonance imaging for Crohn's perineal fistulas[J]. Am J Gastroenterol, 2009, 104(12): 2973-2986. DOI: 10.1038/ajg.2009.509.
SPRADLIN N M, WISE P E, HERLINE A J, et al. A randomized prospective trial of endoscopic ultrasound to guide combination medical and surgical treatment for Crohn's perianal fistulas[J]. Am J Gastroenterol, 2008, 103(10): 2527-2535. DOI: 10.1111/j.1572-0241.2008.02063.x.
GUIDI L, RATTO C, SEMERARO S, et al. Combined therapy with infliximab and Seton drainage for perianal fistulizing Crohn's disease with anal endosonographic monitoring: a single-centre experience[J]. Tech Coloproctol, 2008, 12(2): 111-117. DOI: 10.1007/s10151-008-0411-0.
ZHOU J, GUO M Y, ZHOU Z Y. Applications and progress of magnetic resonance imaging in fistulizing perianal Crohn′s disease[J]. Chin J Inflamm Bowel Dis, 2019, 3(4): 316-320. DOI: 10.3760/cma.j.issn.2096-367X.2019.04.009.
SIDDIQUI M R, ASHRAFIAN H, TOZER P, et al. A diagnostic accuracy meta-analysis of endoanal ultrasound and MRI for perianal fistula assessment[J]. Dis Colon Rectum, 2012, 55(5): 576-585. DOI: 10.1097/DCR.0b013e318249d26c.
WISE P E, SCHWARTZ D A. The evaluation and treatment of Crohn perianal fistulae: EUA, EUS, MRI, and other imaging modalities[J]. Gastroenterol Clin North Am, 2012, 41(2): 379-391. DOI: 10.1016/j.gtc.2012.01.009.
WHITEFORD M H, KILKENNY J, HYMAN N, et al. Practice parameters for the treatment of perianal abscess and fistula-in-ano (revised)[J]. Dis Colon Rectum, 2005, 48(7): 1337-1342. DOI: 10.1007/s10350-005-0055-3.
VOGEL J D, JOHNSON E K, MORRIS A M, et al. Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula[J]. Dis Colon Rectum, 2016, 59(12): 1117-1133. DOI: 10.1097/DCR.0000000000000733.
MAASER C, STURM A, VAVRICKA S R, et al. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: initial diagnosis, monitoring of known IBD, detection of complications[J]. J Crohns Colitis, 2019, 13(2): 144-164. DOI: 10.1093/ecco-jcc/jjy113.
HAGGETT P J, MOORE N R, SHEARMAN J D, et al. Pelvic and perineal complications of Crohn's disease: assessment using magnetic resonance imaging[J]. Gut, 1995, 36(3): 407-410. DOI: 10.1136/gut.36.3.407.
VAN ASSCHE G, VANBECKEVOORT D, BIELEN D, et al. Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn′s disease[J]. Am J Gastroenterol, 2003, 98(2): 332-339. DOI: 10.1111/j.1572-0241.2003.07241.x.
SAMAAN M A, PUYLAERT C A J, LEVESQUE B G, et al. The development of a magnetic resonance imaging index for fistulising crohn′s disease[J]. Aliment Pharmacol Ther, 2017, 46(5): 516-528. DOI: 10.1111/apt.14190.
HINDRYCKX P, JAIRATH V, ZOU G Y, et al. Development and validation of a magnetic resonance index for assessing fistulas in patients with crohn′s disease[J/OL]. Gastroenterology, 2019, 157(5): 1233-1244.e5 [2022-11-21]. DOI: 10.1053/j.gastro.2019.07.027.
CHOSHEN S, TURNER D, PRATT L T, et al. Development and validation of a pediatric MRI-based perianal crohn disease (PEMPAC) index-a report from the ImageKids study[J]. Inflamm Bowel Dis, 2022, 28(5): 700-709. DOI: 10.1093/ibd/izab147.
PARKS A G, GORDON P H, HARDCASTLE J D. A classification of fistula-in-ano[J]. Br J Surg, 2023, 63(1): 1-12. DOI: 10.1002/bjs.1800630102.
MORRIS J, SPENCER J A, AMBROSE N S. MR imaging classification of perianal fistulas and its implications for patient management[J]. Radiographics, 2000, 20(3): 623-635. DOI: 10.1148/radiographics.20.3.g00mc15623.
CHIN KOON SIW K, ENGEL J, VISVA S, et al. Strategies to distinguish perianal fistulas related to Crohn's disease from cryptoglandular disease: systematic review with meta-analysis[J]. Inflamm Bowel Dis, 2022, 28(9): 1363-1374. DOI: 10.1093/ibd/izab286.
TRUONG A, ZAGHIYAN K, FLESHNER P. Anorectal Crohn's disease[J]. Surg Clin North Am, 2019, 99(6): 1151-1162. DOI: 10.1016/j.suc.2019.08.012.
PANÉS J, RIMOLA J. Perianal fistulizing Crohn's disease: pathogenesis, diagnosis and therapy[J]. Nat Rev Gastroenterol Hepatol, 2017, 14(11): 652-664. DOI: 10.1038/nrgastro.2017.104.
ALYAMI A, HOAD C L, TENCH C, et al. Quantitative magnetic resonance imaging in perianal Crohn's disease at 1.5 and 3.0 T: a feasibility study[J/OL]. Diagnostics (Basel), 2021, 11(11): 2135 [2022-11-21]. DOI: 10.3390/diagnostics11112135.
BOUHNIK Y, LE BERRE C, ZAPPA M, et al. Development of a new index to assess small bowel inflammation severity in crohn′s disease using magnetic resonance enterography[J/OL]. Crohns Colitis 360, 2022, 4(1): otac004 [2023-03-12]. DOI: 10.1093/crocol/otac004.
DECKERS I E, BENHADOU F, KOLDIJK M J, et al. Inflammatory bowel disease is associated with hidradenitis suppurativa: results from a multicenter cross-sectional study[J]. J Am Acad Dermatol, 2017, 76(1): 49-53. DOI: 10.1016/j.jaad.2016.08.031.
YADAV S, SINGH S, EDAKKANAMBETH VARAYIL J, et al. Hidradenitis suppurativa in patients with inflammatory bowel disease: a population-based cohort study in Olmsted County, Minnesota[J]. Clin Gastroenterol Hepatol, 2016, 14(1): 65-70. DOI: 10.1016/j.cgh.2015.04.173.
VAN DER ZEE H H, VAN DER WOUDE C J, FLORENCIA E F, et al. Hidradenitis suppurativa and inflammatory bowel disease: are they associated? Results of a pilot study[J]. Br J Dermatol, 2010, 162(1): 195-197. DOI: 10.1111/j.1365-2133.2009.09430.x.
SRISAJJAKUL S, PRAPAISILP P, BANGCHOKDEE S. Magnetic resonance imaging of hidradenitis suppurativa: a focus on the anoperineal location[J]. Korean J Radiol, 2022, 23(8): 785-793. DOI: 10.3348/kjr.2022.0215.
MONNIER L, DOHAN A, AMARA N, et al. Anoperineal disease in Hidradenitis Suppurativa: MR imaging distinction from perianal Crohn's disease[J]. Eur Radiol, 2017, 27(10): 4100-4109. DOI: 10.1007/s00330-017-4776-1.
IRVINE E J. Usual therapy improves perianal Crohn's disease as measured by a new disease activity index. McMaster IBD Study Group[J]. J Clin Gastroenterol, 1995, 20(1): 27-32.
YE S S, LIU Q Q, PAN Y B. MRI image analysis of Crohn's disease anal fistula (perianal abscess)[J]. Zhejiang Clin Med J, 2022, 24(1): 105-106. DOI: 10.3760/cma.j.issn.0578-1426.2012.10.024.
CHAMBAZ M, VERDALLE-CAZES M, DESPREZ C, et al. Deep remission on magnetic resonance imaging impacts outcomes of perianal fistulizing Crohn's disease[J]. Dig Liver Dis, 2019, 51(3): 358-363. DOI: 10.1016/j.dld.2018.12.010.
VAN RIJN K L, LANSDORP C A, TIELBEEK J A W, et al. Evaluation of the modified Van Assche index for assessing response to anti-TNF therapy with MRI in perianal fistulizing Crohn's disease[J]. Clin Imaging, 2020, 59(2): 179-187. DOI: 10.1016/j.clinimag.2019.10.007.
VAN RIJN K L, MEIMA-VAN PRAAG E M, BOSSUYT P M, et al. Fibrosis and MAGNIFI-CD activity index at magnetic resonance imaging to predict treatment outcome in perianal fistulizing Crohn's disease patients[J]. J Crohns Colitis, 2022, 16(5): 708-716. DOI: 10.1093/ecco-jcc/jjab168.
KARMIRIS K, BIELEN D, VANBECKEVOORT D, et al. Long-term monitoring of infliximab therapy for perianal fistulizing Crohn's disease by using magnetic resonance imaging[J]. Clin Gastroenterol Hepatol, 2011, 9(2): 130-136. DOI: 10.1016/j.cgh.2010.10.022.
TOUGERON D, SAVOYE G, SAVOYE-COLLET C, et al. Predicting factors of fistula healing and clinical remission after infliximab-based combined therapy for perianal fistulizing Crohn's disease[J]. Dig Dis Sci, 2009, 54(8): 1746-1752. DOI: 10.1007/s10620-008-0545-y.
TOZER P, NG S C, SIDDIQUI M R, et al. Long-term MRI-guided combined anti-TNF-α and thiopurine therapy for Crohn's perianal fistulas[J]. Inflamm Bowel Dis, 2012, 18(10): 1825-1834. DOI: 10.1002/ibd.21940.
THOMASSIN L, ARMENGOL-DEBEIR L, CHARPENTIER C, et al. Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease[J]. World J Gastroenterol, 2017, 23(23): 4285-4292. DOI: 10.3748/wjg.v23.i23.4285.
HAGMANN P, JONASSON L, MAEDER P, et al. Understanding diffusion MR imaging techniques: from scalar diffusion-weighted imaging to diffusion tensor imaging and beyond[J]. Radiographics, 2006, 26(Suppl 1): S205-S223. DOI: 10.1148/rg.26si065510.
WANG S J, TANG X W, WANG Z Q, et al. Value of magnetic resonance diffusion-weighted imaging for evaluating the inflammatory activity of perianal Crohn's fistula[J]. J Central South Univ Med Sci, 2019, 44(2): 173-179. DOI: 10.11817/j.issn.1672-7347.2019.02.009.
BORUAH D K, HAZARIKA K, AHMED H, et al. Role of diffusion-weighted imaging in the evaluation of perianal fistulae[J]. Indian J Radiol Imaging, 2021, 31(1): 91-101. DOI: 10.1055/s-0041-1729673.
CAVUSOGLU M, DURAN S, SÖZMEN CILIZ D, et al. Added value of diffusion-weighted magnetic resonance imaging for the diagnosis of perianal fistula[J]. Diagn Interv Imaging, 2017, 98(5): 401-408. DOI: 10.1016/j.diii.2016.11.002.
CATTAPAN K, CHULROEK T, KORDBACHEH H, et al. Contrast- vs. non-contrast enhanced MR data sets for characterization of perianal fistulas[J]. Abdom Radiol (NY), 2019, 44(2): 446-455. DOI: 10.1007/s00261-018-1761-3.
BAIK J, KIM S H, LEE Y, et al. Comparison of T2-weighted imaging, diffusion-weighted imaging and contrast-enhanced T1-weighted MR imaging for evaluating perianal fistulas[J]. Clin Imaging, 2017, 44: 16-21. DOI: 10.1016/j.clinimag.2017.03.019.
LEE S, CHOI Y H, CHO Y J, et al. Quantitative evaluation of Crohn's disease using dynamic contrast-enhanced MRI in children and young adults[J]. Eur Radiol, 2020, 30(6): 3168-3177. DOI: 10.1007/s00330-020-06684-1.
GRASSI G, LAINO M E, FANTINI M C, et al. Advanced imaging and Crohn's disease: an overview of clinical application and the added value of artificial intelligence[J/OL]. Eur J Radiol, 2022, 157: 110551 [2022-11-21]. DOI: 10.1016/j.ejrad.2022.110551.
ZHU J G, ZHANG F M, ZHOU J F, et al. Assessment of therapeutic response in Crohn's disease using quantitative dynamic contrast enhanced MRI (DCE-MRI) parameters: a preliminary study[J/OL]. Medicine (Baltimore), 2017, 96(32): e7759 [2022-11-21]. DOI: 10.1097/MD.0000000000007759.
ZIECH M L, LAVINI C, BIPAT S, et al. Dynamic contrast-enhanced MRI in determining disease activity in perianal fistulizing Crohn disease: a pilot study[J]. AJR Am J Roentgenol, 2013, 200(2): W170-W177. DOI: 10.2214/AJR.11.8276.
LEFRANÇOIS P, ZUMMO-SOUCY M, OLIVIÉ D, et al. Diagnostic performance of intravoxel incoherent motion diffusion-weighted imaging and dynamic contrast-enhanced MRI for assessment of anal fistula activity[J/OL]. PLoS One, 2018, 13(1): e0191822 [2022-11-21]. DOI: 10.1371/journal.pone.0191822.
LIANG Y Y, LI G D, HE R X, et al. Advances in quantitative MRI of hereditary myopathies[J]. Chin J Contemp Neurol Neurosurg, 2021, 21(6): 448-453. DOI: 10.3969/j.issn.1672-6731.2021.06.004.
PINSON C, DOLORES M, CRUYPENINCK Y, et al. Magnetization transfer ratio for the assessment of perianal fistula activity in Crohn's disease[J]. Eur Radiol, 2017, 27(1): 80-87. DOI: 10.1007/s00330-016-4350-2.
FOTAKI A, VELASCO C, PRIETO C, et al. Quantitative MRI in cardiometabolic disease: from conventional cardiac and liver tissue mapping techniques to multi-parametric approaches[J]. Front Cardiovasc Med, 2022, 9: 991383 [2023-03-12]. DOI: 10.3389/fcvm.2022.991383.
LAM D, YONG E, D'SOUZA B, et al. Three-dimensional modeling for Crohn's fistula-in-ano: a novel, interactive approach[J]. Dis Colon Rectum, 2018, 61(5): 567-572. DOI: 10.1097/DCR.0000000000001084.
GUZ W, OŻÓG Ł, AEBISHER D, et al. The use of magnetic resonance imaging technique and 3D printing in order to develop a three-dimensional fistula model for patients with Crohn's disease: personalised medicine[J]. Prz Gastroenterol, 2021, 16(1): 83-88. DOI: 10.5114/pg.2020.101629.

PREV Research progress of magnetic resonance elastography in liver focal lesions
NEXT Research progress of radiomics in endometrial cancer

Tel & Fax: +8610-67113815    E-mail: