Magnetic resonance imaging of the effects of infliximab on perianal fistulizing Crohn’s disease

• Published in: The American journal of gastroenterology Vol. 98; no. 2; pp. 332 - 339
• Main Authors: Van Assche, Gert, Vanbeckevoort, Dirk, Bielen, Didier, Coremans, Georges, Aerden, Isolde, Noman, Maya, D’Hoore, Andre, Penninckx, Freddy, Marchal, Guy, Cornillie, Freddy, Rutgeerts, Paul
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Inc 01.02.2003; Blackwell Publishing
• Subjects: Adult; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Crohn Disease - complications; Crohn Disease - drug therapy; Crohn Disease - pathology; Female; Gastroenterology. Liver. Pancreas. Abdomen; Gastrointestinal Agents - therapeutic use; Humans; Infliximab; Magnetic Resonance Imaging; Male; Medical sciences; Other diseases. Semiology; Prospective Studies; Rectal Fistula - etiology; Rectal Fistula - pathology; Rectum - pathology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Human; Evaluation scale; Anorectal; Fistula; Nuclear magnetic resonance imaging; Biological activity; Inflammatory disease; Crohn disease; Chemotherapy; Infliximab; Surveillance; Anticytokine; Digestive diseases; Medical imagery; Intestinal disease; Complication; Severity score; Anorectal disease
• ISSN: 0002-9270; 1572-0241
• DOI: 10.1016/S0002-9270(02)05909-9

Although the clinical efficacy of infliximab as measured by closure of fistulas in Crohn’s disease has been demonstrated, its influence on the inflammatory changes in the fistula tracks is less clear. The aim of the present study was to assess the behavior of perianal fistulas before and after infliximab treatment. Magnetic resonance imaging (MRI) and clinical evaluation were performed in a total of 18 patients before and after treatment with infliximab. An MRI-based score of perianal Crohn’s disease severity was developed using both criteria of local extension of fistulas (complexity, supralavetoric extension, relation to the sphincters and of active inflammation (T2 hyperintensity, presence of cavities/abscesses, and rectal wall involvement). The MRI score was reliable in assessing the fistula tracks, with a good interobserver concordance ( p < 0.001). Fistula tracks with signs of active inflammation were found in all 18 patients at baseline and collections in seven. After short-term infliximab treatment, active tracks persisted in eight of 11 patients who had clinically responded to infliximab. After long-term (46 wk) infliximab therapy, MRI signs of active track inflammation had resolved in three of six patients. We have developed an MRI-based score of perianal Crohn’s disease severity to assess the anatomical evolution of Crohn’s fistulas. Our study demonstrates that despite closure of draining external orifices after infliximab therapy, fistula tracks persist with varying degrees of residual inflammation, which may cause recurrent fistulas and pelvic abscesses. Whether complete fistula fibrosis occurs over time with repeated infliximab infusions needs further study.