MRI characteristics of proctitis in Crohn's disease on perianal MRI.

Charlotte J. Tutein Nolthenius,Cyriel Y. Ponsioen,Banafsche Mearadji,Jaap Stoker,Alexander D. Montauban van Swijndregt,Shandra Bipat,Anje M. Spijkerboer

doi:10.1007/s00261-016-0802-z

Charlotte J. Tutein Nolthenius, Cyriel Y. Ponsioen + Show 5 more

Open Access

https://doi.org/10.1007/s00261-016-0802-z

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Abstract

Purpose Multiple features have been described for assessing inflammation in Crohn’s disease (CD) in MR enterography, but have not been validated in perianal magnetic resonance imaging (MRI). Retrospectively, we studied which MRI features are valuable in assessing proctitis.Materials and methodsCD patients (≥18 years) who underwent colonoscopy (reference standard) and perianal fistula MRI within 8 weeks were included. Seventeen MRI features were blindly scored by three observers and correlated to endoscopy (regression analysis). Reproducibility (multirater kappa, intraclass correlation coefficient) was determined for all three observer pairs. MRI features were considered relevant when significantly correlated to endoscopy for ≥2 observers, and reproducibility was ≥0.40 for ≥2 observer pairs.ResultsPerianal MRI of 58 CD patients were included. Wall thickness, rectal mural fat, creeping fat, and size of mesorectal lymph nodes showed a significant correlation with endoscopy for ≥2 observers (p = 0.000–0.023, p = 0.011–0.172, p = 0.007–0.011 and p = 0.000–0.005, respectively) with a kappa/intraclass correlation coefficient of ≥0.60 for ≥2 observer pairs. Perimural T2 signal and perimural enhancement significantly correlated to endoscopy (all p values ≤0.05) for all three observers and the reproducibility was ≥0.40 for ≥2 observer pairs. Mural T2 signal and degree and pattern of T1 enhancement showed significant correlation to endoscopy for two observers, but with poor to moderate reproducibility.Conclusion Wall thickness, mural fat, and mesorectal features (perimural T2 signal, perimural enhancement, creeping fat, and size of mesorectal lymph nodes) had significant correlation to endoscopy and were reproducible in diagnosing proctitis. Some established luminal features in MRE were considered not useful.

Highlights

Multiple features have been described for assessing inflammation in Crohn’s disease (CD) in MR enterography, but have not been validated in perianal magnetic resonance imaging (MRI)
Tutein Nolthenius et al.: MRI characteristics of proctitis been assessed on MR enterography or MR colonography, and have not been tested in dedicated pelvic MRI, which is limited by a different scan protocol and the absence of luminal contrast
As many patients with perianal fistulas will undergo a pelvic MRI before start of treatment, diagnosing the presence and degree of proctitis on this MRI could be of additional value [2, 3]

Summary

Introduction

Multiple features have been described for assessing inflammation in Crohn’s disease (CD) in MR enterography, but have not been validated in perianal magnetic resonance imaging (MRI). Preoperative MRI has shown to reveal additional and clinically relevant information, thereby reducing recurrence rates after fistula surgery [1, 4] Another important issue in treatment planning is the concomitant presence of proctitis. Extensive research revealed multiple MRI features and scoring systems able to accurately assess inflammation in luminal Crohn’s disease [7,8,9]. As many patients with perianal fistulas will undergo a pelvic MRI before start of treatment, diagnosing the presence and degree of proctitis on this MRI could be of additional value [2, 3]. We aimed to identify the MRI features of proctitis on a dedicated pelvic MRI, and to determine the reproducibility of the different MRI features

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