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• Clinical Article •
Discrimination and diagnosis of between perianal-first-onset and non-perianal-first-onset fistulizing Crohn's disease based on Van Assche score and MAGNIFI-CD score
LI Yikun  YAO Yibo  ZHAO Qiufeng  XU Simin  WEN Feiyang  MA Kai  WANG Chen 

Cite this article as: LI Y K, YAO Y B, ZHAO Q F, et al. Discrimination and diagnosis of between perianal-first-onset and non-perianal-first-onset fistulizing Crohn's disease based on Van Assche score and MAGNIFI-CD score[J]. Chin J Magn Reson Imaging, 2024, 15(12): 131-137, 149. DOI:10.12015/issn.1674-8034.2024.12.019.


[Abstract] Objective To explore the difference in Van Assche scores and MAGNIFI-CD scores between perianal-first-onset and non-perianal-first-onset perianal fistulizing Crohn's disease (pfCD).Materials and Methods Retrospective analysis of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine Anorectal Department from June 2017 to August 2023 in hospital and surgical treatment of 81 cases of pfCD clinical data, according to the anal fistula lesion time and Crohn's disease (CD) diagnosis time, divided into the perianal-first-onset group (45 cases of CD diagnosis after anal fistula or perianal abscess) and the non-first-onset group (36 cases of anal fistula or perianal abscess after the diagnosis of CD). The indicators in both groups were analyzed [clinical characteristics: gender, age of diagnosis, duration of anal fistula lesions, history of perianal surgery, history of perianal surgery, number of perianal surgery, CD disease site, CD disease behavior, Crohn's disease activity index (CDAI) and perianal disease activity index (PDAI); classification of anal fistula; imaging score of anal fistula, etc] were included in the statistical analysis. The clinical characteristics, anal fistula classification and imaging scores of the two groups were analyzed, and the correlation of imaging scores, anal fistula classification, CDAI and PDAI of all patients was also analyzed.Results The duration of perianal lesions, the age of diagnosis of CD and the CDAI score of the first-onset group were less than those of the non-first group (P=0.023, 0.027, 0.004). In the first-onset group, the intestinal tract was mainly ileocolon (P=0.004), and the disease behavior was mainly non-narrow and non-penetrating type (P<0.001). The fistula characteristics were different in MAGNIFI-CD score, and the fistula horseshoe type and levator or levator type in the first group were less than the non-first-onset group (P=0.005); the pus diameter was different in Van Assche score, and the non-first-onset group was significantly larger than the first-onset group (P=0.011). Good agreement between Van Assche score and MAGNIFI-CD score in all patients (ICC=0.87, P<0.001); St-James score showed the highest correlation with imaging score with strong correlation (Van Assche score r=0.82, MAGNIFI-CD score r=0.80, P<0.001).Conclusions The patients of perianal-first-onset pfCD, which has younger age of diagnosis, the perianal course was short, and the disease site was mainly ileocolic,and disease behavior is non-stenosis and non-penetration,and low CDAI score. Van Assche score and MAGNIFI-CD score were used for the diagnosis of anal fistula with CD. MAGNIFI-CD score of non-first-onset group has more translevator or superlevator muscle, and Van Assche score had large pus diameter. St-James classification is more suitable for pfCD.
[Keywords] perianal fistulizing Crohn's disease；imaging score；characteristics；magnetic resonance imaging

LI Yikun1   YAO Yibo2   ZHAO Qiufeng3   XU Simin1   WEN Feiyang1   MA Kai1   WANG Chen2*  

1 Longhua Clinical Medical College, Shanghai University of TCM, Shanghai200032, China

2 Department of Analrectal, Longhua Hospital of Shanghai University of TCM, Shanghai200032, China

3 Department of Radiology, Longhua Hospital of Shanghai University of TCM, Shanghai200032, China

Corresponding author: WANG C, E-mail: wangchen_longhua@163.com

Conflicts of interest   None.

Received  2024-07-10
Accepted  2024-12-10
DOI: 10.12015/issn.1674-8034.2024.12.019
Cite this article as: LI Y K, YAO Y B, ZHAO Q F, et al. Discrimination and diagnosis of between perianal-first-onset and non-perianal-first-onset fistulizing Crohn's disease based on Van Assche score and MAGNIFI-CD score[J]. Chin J Magn Reson Imaging, 2024, 15(12): 131-137, 149. DOI:10.12015/issn.1674-8034.2024.12.019.

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