Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2017; 23(23): 4285-4292
Published online Jun 21, 2017. doi: 10.3748/wjg.v23.i23.4285
Magnetic resonance imaging may predict deep remission in patients with perianal fistulizing Crohn's disease
Lucie Thomassin, Laura Armengol-Debeir, Cloé Charpentier, Valerie Bridoux, Edith Koning, Guillaume Savoye, Céline Savoye-Collet
Lucie Thomassin, Laura Armengol-Debeir, Cloé Charpentier, Guillaume Savoye, Department of Gastroenterology, Rouen University Hospital, University of Rouen, F-76031 Rouen, France
Cloé Charpentier, Edith Koning, Céline Savoye-Collet, Department of Radiology, Rouen University Hospital, University of Rouen, F-76031 Rouen, France
Valerie Bridoux, Department of Digestive Surgery, Rouen University Hospital, University of Rouen, F-76031 Rouen, France
Author contributions: Thomassin L, Armengol-Debeir L, Savoye G and Savoye-Collet C contributed to study conception and design; Thomassin L, Armengol-Debeir L, Charpentier C, Bridoux V, Koning E, Savoye G and Savoye-Collet C contributed to data acquisition; Thomassin L, Koning E, Savoye G and Savoye-Collet C contributed to data analysis and interpretation; Thomassin L and Savoye-Collet C wrote the paper; Thomassin L, Savoye G and Savoye-Collet C contributed to manuscript editing.
Conflict-of-interest statement: There are no conflict of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Celine Savoye-Collet, MD, PhD, Department of Radiology, Rouen University Hospital, University of Rouen, QUANTIF LITIS EA 4108, 1 rue de Germont, F-76031 Rouen, France. celine.savoye-collet@chu-rouen.fr
Telephone: +33-232-886496 Fax: +33-232-888235
Received: January 11, 2017
Peer-review started: January 12, 2017
First decision: March 16, 2017
Revised: April 3, 2017
Accepted: May 9, 2017
Article in press: May 9, 2017
Published online: June 21, 2017
Processing time: 159 Days and 18.6 Hours
Abstract
AIM

To evaluate the imaging course of Crohn’s disease (CD) patients with perianal fistulas on long-term maintenance anti-tumor necrosis factor (TNF)-α therapy and identify predictors of deep remission.

METHODS

All patients with perianal CD treated with anti-TNF-α therapy at our tertiary care center were evaluated by magnetic resonance imaging (MRI) and clinical assessment. Two MR examinations were performed: at initiation of anti-TNF-α treatment and then at least 2 years after. Clinical assessment (remission, response and non-response) was based on Present’s criteria. Rectoscopic patterns, MRI Van Assche score, and MRI fistula activity signs (T2 signal and contrast enhancement) were collected for the two MR examinations. Fistula healing was defined as the absence of T2 hyperintensity and contrast enhancement on MRI. Deep remission was defined as the association of both clinical remission, absence of anal canal ulcers and healing on MRI. Characteristics and imaging patterns of patients with and without deep remission were compared by univariate and multivariate analyses.

RESULTS

Forty-nine consecutive patients (31 females and 18 males) were included. They ranged in age from 14-70 years (mean, 33 years). MRI and clinical assessment were performed after a mean period of exposure to anti-TNF-α therapy of 40 ± 3.7 mo. Clinical remission, response and non-response were observed in 53.1%, 20.4%, and 26.5% of patients, respectively. Deep remission was observed in 32.7% of patients. Among the 26 patients in clinical remission, 10 had persisting inflammation of fistulas on MRI (T2 hyperintensity, n = 7; contrast enhancement, n = 10). Univariate analysis showed that deep remission was associated with the absence of rectal involvement and the absence of switch of anti-TNF-α treatment or surgery requirement. Multivariate analysis demonstrated that only the absence of rectal involvement (OR = 4.6; 95%CI: 1.03-20.5) was associated with deep remission.

CONCLUSION

Deep remission is achieved in approximately one third of patients on maintenance anti-TNF-α therapy. Absence of rectal involvement is predictive of deep remission.

Keywords: Crohn’s disease; Anal fistula; Magnetic resonance imaging; Anus disease/diagnosis; Biotherapy

Core tip: Assessment of perianal fistulas is essential to guide management in Crohn’s disease (CD). Magnetic resonance imaging (MRI) allows assessment of morphological and disease activity. Achieving both clinical remission and healing on MRI is a target in the management of perianal CD. In this study, we describe the clinical and radiological evolution of perianal CD in patients on long-term anti-tumor necrosis factor-α treatment. The period of follow-up was two times longer than those in previous studies. Deep remission is possible in one third of patients. Absence of rectal involvement is predictive of deep remission.