VALUTAZIONE DELL'ATTIVITA' E DELLE COMPLICANZE DELLA MALATTIA DI CROHN PERIANALE: CONFRONTO TRA ECOANGIOGRAFIA PERFUSIONALE, ELASTOGRAFIA ECOGRAFICA E RISONANZA MAGNETICA NUCLEARE.

Abstract Assessing perianal disease activity is important for the treatment and prognosis of Crohn’s disease (CD) patients. Transperineal ultrasound in a simple, painless, non invasive method to define the morphological features of fistulas and abscess and probably also to evaluate activity. TPUS results could be optimized using e.v. contrast enhancement and sonoelastography. Purpose The aim of this study was to determine the agreement of clinical scores, the Fistula Drainage Assessment (FDA) and Perianal Disease Activity Index (PDAI), pelvic MRI and transperineal ultrasound (TPUS) with contrast enhancement (CEUS) ad elastography, in defining the activity of perianal CD. Methods Thirty consecutive patients with CD and perianal fistulae underwent clinical, FDA and PDAI; only 28 underwent TPUS evaluation (traditional, with e.v. contrast enhancement and with elastography), and 23 pelvic MRI. Results MRI finding correlate with both PDAI (p=0.02) and PDAI (p=0.059) in defining active/inactive perianal fistulas. CEUS parameters show great variability and poor concordance with clinical index and MRI. Elastography TPUS correlate with FDA (p=0.039) but not with PDAI. Conclusions MRI still represents the gold standard in defining perianal CD activity. TPUS is an emerging technique in the study of perianal CD, with promising results in association with elastography. CEUS does not seem to provide additional advantages.