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Ultrasound Features Associated with Activity of Perianal Fistulas in Pediatric Patients with Crohn's Disease
Ok Jeong Yu1, Hee Mang Yoon1,2, Ah Young Jung1
1Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, ASAN Medical Center Children's Hospital, Seoul, Republic of Korea.
Insights
Transperineal ultrasonography (TPUS) is useful for assessing pediatric Crohn's disease (CD) perianal fistulas. Fistula length and vascularity on TPUS correlate with the MAGNIFI-CD score and treatment response.
Area of Science:
- Pediatric Gastroenterology
- Radiology
- Inflammatory Bowel Disease
Background:
- Perianal fistulas are a common complication of Crohn's disease (CD) in children.
- Accurate assessment of fistula activity is crucial for effective treatment and monitoring.
- Magnetic Resonance Imaging (MRI) is a standard tool, but novel indices like MAGNIFI-CD require validation with other modalities.
Purpose of the Study:
- To evaluate the utility of transperineal ultrasonography (TPUS) in assessing perianal fistula activity in pediatric CD patients.
- To explore the association between specific TPUS features and the MAGNIFI-CD score.
- To determine if TPUS can monitor treatment response in these patients.
Main Methods:
- A retrospective study of pediatric patients (<19 years) with known or suspected CD who underwent both pelvic MRI and TPUS.
- Exclusion criteria included absence of perianal fistula or a >1-week interval between MRI and TPUS.
- TPUS features evaluated included fistula length, vascularity, abscess presence, and proctitis; multivariable regression analyzed associations with MAGNIFI-CD score.
Main Results:
- Forty-four pediatric patients were included. TPUS findings of fistula length (p=0.004) and vascularity (p=0.007) were significantly associated with the MAGNIFI-CD score.
- In patients with clinical follow-up, changes in fistula vascularity on TPUS were significantly greater in the clinical responder group (p=0.02).
Conclusions:
- Transperineal ultrasonography is a feasible imaging technique for evaluating pediatric Crohn's disease perianal fistulas.
- Fistula length and vascularity measured by TPUS are valuable indicators of disease severity and correlate with the MAGNIFI-CD index.
- TPUS can effectively monitor treatment response, serving as a useful adjunct to MRI in managing pediatric perianal fistulas.
Objectives:
To evaluate the usefulness of transperineal ultrasonography (TPUS) for assessing the activity of perianal fistulas by exploring features associated with the magnetic resonance novel index for fistula imaging in Crohn's disease (MAGNIFI-CD).
Methods:
This single-center retrospective study included pediatric patients (age <19 years) who were admitted for an initial evaluation for known or suspected Crohn's disease (CD) and underwent both pelvic MRI and TPUS between September 2021 and October 2023. Patients without perianal fistula or with an interval between pelvic MRI and TPUS >1 week were excluded. Following US features were evaluated: location, longitudinal length of the fistula, extension, diameter perpendicular to longitudinal axis, branching, vascularity, abscess, dominant feature, and proctitis. Multivariable linear regression analysis was performed to identify US features associated with MAGNIFI-CD score. Changes in TPUS features were compared between responder and non-responder groups.
Results:
A total of 44 patients were included (median age [interquartile range], 14 [13-16] years, boys:girls, 36:8). Multivariable linear regression analysis showed that fistula length (regression coefficient [standard error], 1.48 [0.48]; p = .004) and vascularity (regression coefficient [standard error], 2.87 [1.00]; p = .007) on TPUS were associated with MAGNIFI-CD score. In 25 patients with clinical follow-up data, the extent of change in vascularity was significantly higher in the clinical responder group (change in vascularity treated as an ordinal variable, 0.94 ± 0.77 versus 0.11 ± 0.78; p = .02).
Conclusion:
TPUS, especially through measurement of fistula length and vascularity, is a feasible adjunct to pelvic MRI for evaluating the severity and monitoring the treatment response of perianal fistulas in pediatric patients with CD.
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