Prospective Comparison of Magnetic Resonance Imaging, Transrectal and Transperineal Sonography, and Surgical Findings in Complicated Perianal Crohn Disease

• DOI: 10.7863/ultra.15.09043
• Publication Date: 2016-09-15T02:48:43Z
• Authors: Renáta Bor; Klaudia Farkas; Anita Bálint; Mónika Szűcs; Szabolcs Ábrahám; Ágnes Milassin; Mariann Rutka; Ferenc Nagy; Péter Milassin; Zoltán Szepes; Tamás Molnár
• Keywords: Adult; Male; Adolescent; Rectum; Reproducibility of Results; Middle Aged; Perineum; Magnetic Resonance Imaging; Endosonography; 3. Good health; Young Adult; 03 medical and health sciences; 0302 clinical medicine; Crohn Disease; Animals; Humans; Female; Prospective Studies; Child; Perianal Glands; Ultrasonography

ObjectivesMagnetic resonance imaging (MRI) and transrectal sonography are the two accepted imaging modalities for evaluation of perianal fistulas and abscesses. Transperineal sonography is a new technique that is easy to learn and can be performed at any time. The purpose of this study was to prospectively compare the diagnostic accuracy of MRI, transrectal sonography, and transperineal sonography with surgical findings in patients with perianal Crohn disease.MethodsAll patients with perianal Crohn disease underwent MRI, transrectal sonography, and transperineal sonography within a few days before surgery. Fistulas were classified as simple (43.8%) or complex (52.2%) based on surgical findings.ResultsTwenty‐three patients with active perianal Crohn disease (12 women and 11 men; mean age, 29.9 years; current therapy: antibiotics, 69.6%; azathioprine, 56.5%; and biologics, 73.9%; previous surgery, 26.1%; and proportion of smokers, 39.1%) were included. Sensitivity values for MRI, transrectal sonography, and transperineal sonography for diagnosis of fistulas were 84.6%, 84.6%, and 100%, respectively. Transperineal sonography was more sensitive for diagnosis of perianal abscesses than MRI and transrectal sonography (100%, 58.8%, and 92.8%).ConclusionsTransperineal sonography is a very accurate diagnostic method with outstanding sensitivity compared with MRI and transrectal sonography for evaluation of complicated perianal Crohn disease. Due to its simplicity and low cost, it is recommended that transperineal sonography be the first diagnostic modality in these cases.