Abstract
BackgroundStructured evaluation of magnetic resonance imaging (MRI) is important to guide clinical decisions of perianal fistulas in Crohn's disease (CD) patients. PurposeTo evaluate the recently developed modified Van Assche index to assess clinical responses to anti-tumor necrosis factor (TNF) therapy in patients with perianal fistulizing CD. MethodsA search of medical records identified patients with fistulizing perianal CD who underwent baseline and follow-up MRI while receiving anti-TNF treatment. Patients were divided into clinical responders and non-responders based on physician's assessment. MRI-scans were scored using the original and modified Van Assche index and scores between baseline and follow-up were compared within clinical responders and non-responders. ResultsThirty cases were included (48% female, median age 27 years). Clinical responders (n = 16) had a median modified Van Assche score of 9.6 (IQR 5.8–12.7) at baseline and 5.8 (IQR 3.5–8.5) at follow-up (p = 0.008). In non-responders (n = 14), corresponding scores were 7.7 (IQR 5.8–13.5) and 8.2 (IQR 5.8–11.5) (p = 0.624). In clinical responders, 6/16 showed no drop in modified Van Assche score at follow-up. Scores obtained with the original Van Assche index dropped between baseline and follow-up in clinical responders (13.0 vs. 9.6, p = 0.011), whereas no decrease was observed in non-responders (11.5 vs. 11.5, p = 0.324). ConclusionsWhile the modified Van Assche index overall decreases significantly in patients with perianal fistulas responding to anti-TNF treatment, one third of responders had unaltered scores at follow-up. Also, outcomes were comparable to the original Van Assche index. Further optimization of the modified Van Assche index is needed before application in larger studies.
Highlights
Perianal fistulas are seen in up to one-third of Crohn's disease (CD) patients [1,2]
Eligible patients with perianal CD receiving anti-tumor necrosis factor (TNF) therapy that underwent at least one pelvic magnetic resonance imaging (MRI) examination were identified between January 1st 2008 and July 1st 2018
Out of 116 patients, 25 patients were eligible for inclusion, four of these patients had more than two pelvic MRI's with different treatment events between MRI's
Summary
Perianal fistulas are seen in up to one-third of Crohn's disease (CD) patients [1,2]. Structured evaluation of magnetic resonance imaging (MRI) is important to guide clinical decisions of perianal fistulas in Crohn's disease (CD) patients. Purpose: To evaluate the recently developed modified Van Assche index to assess clinical responses to anti-tumor necrosis factor (TNF) therapy in patients with perianal fistulizing CD. MRI-scans were scored using the original and modified Van Assche index and scores between baseline and follow-up were compared within clinical responders and non-responders. Scores obtained with the original Van Assche index dropped between baseline and follow-up in clinical responders (13.0 vs 9.6, p = 0.011), whereas no decrease was observed in non-responders (11.5 vs 11.5, p = 0.324). Conclusions: While the modified Van Assche index overall decreases significantly in patients with perianal fistulas responding to anti-TNF treatment, one third of responders had unaltered scores at follow-up. Further optimization of the modified Van Assche index is needed before application in larger studies
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