Rouen University Hospital, Radiology Department, Rouen, France.
Inflamm Bowel Dis. 2011 Aug;17(8):1751-8. doi: 10.1002/ibd.21568. Epub 2010 Nov 29.
The aim of the study was to assess perianal fistulas by magnetic resonance imaging (MRI) in patients with severe fistulizing Crohn's disease (CD) using maintenance antitumor necrosis factor alpha (TNF-α) therapy and to correlate MRI changes with clinical outcome.
Perineal MRI before and after a 1-year scheduled anti-TNF-α maintenance therapy was performed in 20 patients (14 females; mean age = 33.7). The Van Assche score (i.e., number of fistulas, localization, and extension, importance of T2 hyperintensity, presence of abscess) was calculated. Fistula track contrast enhancement was also used. Clinical outcome was defined as no response, response, or remission.
Response and remission were observed in respectively 40% and 35% of cases. The Van Assche score varied from 13.8 (7-20) to 6.13 (0-12) in patients with a response or remission (P < 0.05). The T2 hyperintensity follow-up value decreased in patients in response or remission (P < 0.01). T2 hyperintensity disappeared or decreased in 14 out of 15 patients in clinical response or remission as compared to one among the five nonresponding patients (P < 0.01). The decrease in Van Assche score and hyperintensity value was not significantly different in patients in remission compared to those with response. Only one patient in clinical remission had a persisting contrast enhancement on MRI, whereas contrast enhancement persisted in all other patients not in remission (P = 0.002).
The clinical benefit of maintenance anti-TNF-α therapy in perianal CD is associated with a significant improvement of the Van Assche score, particularly T2 hyperintensity. The disappearance of contrast enhancement was the only semiological MR feature associated with remission.
本研究旨在通过磁共振成像（MRI）评估接受抗 TNF-α 维持治疗的重度瘘管性克罗恩病（CD）患者的肛周瘘管，并将 MRI 变化与临床结果相关联。
对 20 例（14 例女性；平均年龄=33.7 岁）接受 TNF-α 维持治疗的患者进行肛周 MRI 检查。计算 Van Assche 评分（即瘘管数量、定位和延伸、T2 高信号的重要性、脓肿的存在）。还评估了瘘管轨迹的对比增强。临床结果定义为无反应、反应或缓解。
分别有 40%和 35%的患者观察到反应和缓解。在有反应或缓解的患者中，Van Assche 评分从 13.8（7-20）降至 6.13（0-12）（P＜0.05）。在反应或缓解的患者中，T2 高信号的随访值降低（P＜0.01）。与无反应的 5 例患者中的 1 例相比，在临床反应或缓解的 15 例患者中有 14 例 T2 高信号消失或减少（P＜0.01）。在缓解的患者中，Van Assche 评分和高信号值的降低与反应患者相比没有显著差异。只有 1 例临床缓解的患者 MRI 上仍存在对比增强，而所有未缓解的患者仍存在对比增强（P=0.002）。
抗 TNF-α 维持治疗在肛周 CD 中的临床获益与 Van Assche 评分的显著改善相关，特别是 T2 高信号。对比增强的消失是与缓解相关的唯一 MRI 特征。
