Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. May 27, 2023; 15(5): 882-891
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.882
Diagnostic performance of texture analysis in the differential diagnosis of perianal fistulising Crohn’s disease and glandular anal fistula
Xin Zhu, Dan-Dan Ye, Jian-Hua Wang, Jing Li, Shao-Wei Liu
Xin Zhu, Jian-Hua Wang, Jing Li, Shao-Wei Liu, Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu Province, China
Dan-Dan Ye, Department of Radiology, Quanzhou Orthopedic-Traumatological Hospital, Quanzhou 362000, Fujian Province, China
Author contributions: Zhu X designed the research study; Ye DD, Li J, and Liu SW performed the research; Zhu X and Wang JH analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Institutional review board statement: This study was approved by the institutional review board of the Affiliated Hospital of Nanjing University of Chinese Medicine; informed consent was waived owing to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All datasets generated for this study are included in the manuscript and/or the supplementary files.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: Https://
Corresponding author: Xin Zhu, Doctor, MD, Chief Doctor, Department of Radiology, Affiliated Hospital of Nanjing University of Chinese Medicine, No. 155 Hanzhong Road, Nanjing 210029, Jiangsu Province, China.
Received: December 12, 2022
Peer-review started: December 12, 2022
First decision: January 2, 2023
Revised: January 16, 2023
Accepted: March 30, 2023
Article in press: March 30, 2023
Published online: May 27, 2023
Research background

Perianal fistulising Crohn's disease (PFCD) and glandular anal fistula have many similarities on conventional magnetic resonance imaging (MRI); therefore, it is difficult to differentiate these conditions in the early stages with conventional MRI. Texture analysis based on conventional MRI images can quantitatively analyze image pixel information and reflect the internal heterogeneity and pathological characteristics of the lesion.

Research motivation

This study aimed to analyze the texture of the rectum and anal canal wall in the PFCD group and glandular anal fistula group to explore whether the texture feature parameters are valuable in identifying and differentiating these two lesions, which provides a non-invasive method for preoperatively differentiating these two entities.

Research objectives

Therefore, the purpose of this study is to differentiate PFCD from glandular anal fistula using MRI texture analysis.

Research methods

Patients with rectal water sac implantation were screened from the first part of this study (48 patients with PFCD and 22 patients with glandular anal fistula). Open-source software ITK-SNAP (Version 3.6.0, was used to delineate the region of interest (ROI) of the entire rectum and anal canal wall on every axial section, and then the ROIs were input in the Analysis Kit software (version V3.0.0.R, GE Healthcare) to calculate the textural feature parameters. Textural feature parameter differences were compared between the two groups and selected for further analysis.

Research results

In all, 385 textural parameters were obtained, including 37 parameters with statistically significant differences between the PFCD and glandular anal fistula groups. Then, 16 texture feature parameters remained after bivariate Spearman correlation analysis, including one histogram parameter; four grey level co-occurrence matrix (GLCM) parameters; four texture parameters; five grey level run-length matrix (RLM) parameters; and two form factor parameters. The AUC, sensitivity, and specificity of the model of textural feature parameters were 0.917, 85.42%, and 86.36%, respectively.

Research conclusions

The model of textural feature parameters showed good diagnostic performance for PFCD. The texture feature parameters of the rectum and anal canal in fat suppression T2-weighted imaging are helpful to distinguish PFCD from glandular anal fistula.

Research perspectives

This study provides a non-invasive method (MRI texture analysis) to preoperatively differentiate PFCD from glandular anal fistula, which has a profound clinical significance in guiding treatment strategy and predicting prognosis for patients with PFCD and anal fistula.