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Master Thesis

Précision diagnostique des séquences non injectées en IRM dans l’évaluation de l’atteinte périnéale de la maladie de Crohn

Abstract : Patients with perineal Crohn’s disease need repeated MRI. Current protocols use injection of gadolinium. Repeated injections are responsible for deposit of gadolinium in the body. Our objective is to analyze diagnostic accuracy of non-contrast enhanced sequences in MRI to assess perianal Crohn disease. METHODS: From November 2016 to November 2019, all patients evaluated by MRI for assessment of perineal fistulas in Crohn disease at Rouen University Hospital, were retrospectively included. Two groups were formed: « Acute symptoms » and « Asymptomatic patients ». MRI standard evaluation was performed, and the Van Assche MRI severity score was calculated. Five objective criteria were selected: type of fistula, position to sphincter, extension of fistula, activity signs and abscesses, to obtain a specific report. Two junior radiologists each performed two readings, blindly from the final report of examination: using non-contrast enhanced sequences only and using standard protocol with injection, and specify if there was a revision in the final diagnosis of perineal involvement between the two readings, defined by the modification of at least one of the five criteria. In contentious cases, the decision was made in consensus with an experienced senior gastro-intestinal radiologist. RESULTS: 136 perineal MRI were studied (90 patients). There was no fistula in 16,2%. Fistula were simple in 37,7% and complex in 62,3%, mainly trans-sphincteric in 69,3%, with supra-levatoric extension in 29,8%. Abscesses occurred in 31,6%. Non-contrast enhanced sequences correctly described perineal involvement in 91,9% of MRI examination and failed to do so in 8,1% IC95% [4-14%]. Statistical agreement between non-contrast enhanced sequences and standard protocol was ĸ = 0,91 IC95% [0,77-0,96] for the diagnosis of active fistula, and ĸ = 0,94 IC95% [0,85-0,98] for the abscesses. CONCLUSIONS: Non-contrast enhanced sequences on MRI are efficient for the routine assessment of perianal fistulas in CD, especially for the diagnosis of abscesses and activity signs of fistula.
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Master Thesis
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Antonin Derinck. Précision diagnostique des séquences non injectées en IRM dans l’évaluation de l’atteinte périnéale de la maladie de Crohn. Médecine humaine et pathologie. 2020. ⟨dumas-02962790⟩



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