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Modified Van Assche magnetic resonance imaging-based score for assessing the clinical status of anal fistulas

Wei-Guo Wang1, Wen-Zhu Lu1, Chun-Mei Yang2

  • 1Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University.

Medicine
|May 9, 2020
PubMed

Insights

The modified magnetic resonance imaging (MRI)-based score effectively assesses anal fistula status in Crohn disease patients. A higher score indicates more severe disease and a longer recovery period, aiding clinical management.

Area of Science:

  • Gastroenterology
  • Radiology
  • Surgical Oncology

Background:

  • Anal fistulas (AFs) are a common complication of Crohn disease, significantly impacting patient quality of life.
  • Accurate assessment of AF severity and disease activity is crucial for effective treatment and management.
  • Current clinical assessment methods may lack objectivity, necessitating improved diagnostic tools.

Purpose of the Study:

  • To evaluate the modified Van Assche magnetic resonance imaging (MRI)-based score's association with clinical status in Crohn disease patients with AFs.
  • To determine the score's correlation with preoperative clinical grades and its predictive value for AF recurrence.
  • To identify independent risk factors for AF recurrence in this patient cohort.

Main Methods:

  • Retrospective analysis of 104 patients with AF who underwent contrast-enhanced pelvic MRI and surgery between 2011 and 2016.
  • Preoperative and postoperative (1, 3, 6 months) evaluation of the MRI-based score.
  • Univariate and multivariate analyses to identify risk factors for AF recurrence.

Main Results:

  • The preoperative MRI-based score significantly correlated with patients' preoperative clinical status grades (Pearson correlation: 0.547; P < .001).
  • Higher preoperative clinical grades were associated with lower MRI-based scores.
  • AF recurrence incidence decreased up to 1 month postoperatively with the MRI score, then increased; long disease duration, prior interventions, and high MRI scores were independent risk factors for recurrence.

Conclusions:

  • The modified Van Assche MRI-based score is a feasible and objective tool for assessing clinical status and disease activity in Crohn disease patients with AFs.
  • A high MRI-based score is associated with severe clinical status and prolonged recovery times.
  • The score aids in predicting AF recurrence and can inform clinical decision-making and patient counseling.

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