Imaging in perianal fistulising Crohn’s disease: A practical guide for the gastroenterologist

Table 2 Scenario specific imaging choices in perianal Crohn’s disease¹

Clinical scenario	Preferred imaging modality	Rationale
Initial evaluation at diagnosis	MRI	Designated gold standard imaging modality capable of facilitating comprehensive assessment of complex perianal anatomy
Anal stenosis or severe anal pain	MRI	Avoids discomfort associated with EAUS
Fistula with suspected abscess	MRI or TPUS	MRI provides superior soft tissue contrast for deep abscess detection, however, TPUS may also be suitable for assessment of superficial pathology
Assessment of sphincter complex	EAUS	Provides high resolution images of internal and external sphincter
Point-of-care re-evaluation	TPUS	Suitable for serial point-of-care evaluation in view of being minimally invasive
Post-treatment follow-up	MRI or TPUS	MRI for deep healing, TPUS for superficial closure
Contraindication to MRI	EAUS or TPUS	Ultrasound is safe with few absolute contraindications

¹The information presented in this table reflects the authors’ interpretation and views based on the available evidence. It may not represent a consensus or official position of affiliated institutions.

MRI: Magnetic resonance imaging; TPUS: Transperineal ultrasounds; EAUS: Endoanal ultrasound.