Transcutaneous perianal sonography: a sensitive method for the detection of perianal inflammatory lesions in Crohn's disease.
OBJECTIVE
Pelvic magnetic resonance imaging (MRI) and endoanal ultrasound which are established imaging methods for perianal inflammatory lesions in patients with Crohn's disease require expensive specialized equipments and expertise. We investigated the feasibility and sensitivity of transcutaneous perianal ultrasound (PAUS) using regular ultrasound probes in the imaging of perianal inflammatory lesions. The sonographic findings were correlated to pelvic MRI-scans.


METHODS
We performed PAUS in 25 patients with Crohn's disease and clinical signs of perianal inflammatory disease. Within a median of 10 d (range 0-75) these patients underwent MRI of the pelvis. Regular convex and linear high resolution probes were used for PAUS. The sonographic findings were correlated to the MRI findings by blinded investigators.


RESULTS
The sonographic investigations were well tolerated by all patients. Fistulae typically presented as hypoechoic tracks. Twenty-nine fistulae were detected in 22 patients. Abscesses were detected in 7 patients and presented as hypo- or anechoic formations. Twenty-six of 29 fistulae and 6 of 7 abscesses could be confirmed by MRI. Kappa statistics showed an excellent agreement (kappa>0.83) between the two imaging methods.


CONCLUSIONS
PAUS is a simple, painless, feasible, real-time method that can be performed without specific patient preparation which is comparable in its sensitivity to pelvic MRI in the detection of perianal fistulae and/or abscesses. PAUS can especially be recommended as a screening tool in acute perianal disorders such as perianal abscess and for follow-up studies of perianal inflammatory disease.
Wedemeyer
Jochen
J
Department of Gastroenterology, Hepatology and Endocrinology, Medical School of Hannover, Carl Neuberg Str. 1, 30625 Hannover, Germany. wedemeyer.jochen@mh-hannover.de
Kirchhoff
Timm
T
Sellge
Gernot
G
Bachmann
Oliver
O
Lotz
Joachim
J
Galanski
Michael
M
Manns
Michael-P
MP
Gebel
Michael-J
MJ
Bleck
Jörg-S
JS
D001003:Anal Canal / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D001004:Anus Diseases / Q000000981:diagnostic imaging*; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D006801:Humans; D007249:Inflammation / Q000000981:diagnostic imaging*; D018615:Ultrasonography, Doppler, Color / Q000295:instrumentation / Q000379:methods