Imaging modalities for perianal Crohn's disease

Area of Science:

• Gastroenterology
• Colorectal Surgery
• Diagnostic Imaging

Background:

• Perianal Crohn's disease (CD) affects one-third of patients, presenting with varied lesions from skin tags to complex fistulas and abscesses.
• Management of perianal CD is challenging, often requiring combined medical and surgical approaches for optimal outcomes.
• Accurate preoperative disease assessment is critical to prevent irreversible damage from incomplete or inaccurate interventions.

Purpose of the Study:

• To review and compare the performance of various imaging modalities for assessing anorectal involvement in Crohn's disease.
• To guide clinicians in selecting the most appropriate imaging technique for individual patient management.
• To highlight the role of imaging in diagnosis, disease classification, treatment planning, and outcome monitoring.

Main Methods:

• Review of available data on imaging modalities including Endoscopic Ultrasonography (EUS), pelvic Magnetic Resonance Imaging (MRI), Transperineal Ultrasonography (TPUS), Computed Tomography (CT), and fistulography.
• Comparison of sensitivity, specificity, pros, and cons of each modality.
• Emphasis on the importance of integrating imaging findings with expert surgical evaluation (Evaluation Under Anesthesia - EUA).

Main Results:

• EUS and pelvic MRI demonstrate superior sensitivity and specificity for diagnosing and classifying perianal CD, significantly influencing treatment decisions.
• TPUS serves as a viable alternative when EUS is contraindicated or not tolerated.
• CT and fistulography are generally disfavored due to lower performance and radiation exposure concerns.

Conclusions:

• EUS and pelvic MRI are the optimal imaging modalities for preoperative assessment of perianal Crohn's disease.
• Comprehensive imaging, combined with expert surgical evaluation, is essential for effective management and improved patient outcomes.
• Careful selection of imaging techniques based on individual patient factors and modality performance is crucial for successful treatment planning.