In clinical practice, imaging techniques are used at the initial presentation to establish a diagnosis and to assess the exact location, extent, and severity of disease . These modalities are also used as follow-up, during and after treatment, to determine the optimal choice and dose of medication (e.g., systemically or topically active) [2, 3]. With the advent of new medication such as infliximab, an immunomodulatory drug with considerable side effects, follow-up to determine if medication is becoming increasingly important.
In Crohn's disease, formation of perianal fistulas and/or abscesses can be seen in a large percentage of patients. Nowadays, there is a tendency towards imaging of these fistulae, given that in Crohn's disease fistulae can be very extensive and complex, rendering the conventional gold standard (i.e., examination under anesthesia) not wholly accurate . As misclas-sification of fistulae can lead to severe, irreversible complications (e.g., fecal incontinence) or recurrent disease, the American Gastroenterology Association (AGA) has recently stated the importance of preoper-ative imaging. Another reason for performing imaging studies is the increasing use of infliximab, which has been associated not only with external closure of perianal fistulae but also with the persistence of tracks as can be visualized with MRI [5,6].
The earliest change caused by the disease occurs in the submucosa and consists of lymphoid hyperplasia and lymphedema. Radiologic findings at this (early) stage include subtle elevations and aphthoid ulcers. As the disease progresses, it extends transmurally to the serosa (transmural stage) and beyond to the mesentery and adjacent organs (extramural stage). Aphthoid ulcers develop into linear ulcers and fissures to produce an ulcero-nodular or "cobblestone" appearance. The bowel wall is thickened by a combination of fibrosis and inflammatory infiltrates. Bowel obstruction, strictures, abscesses or phlegmon, fistu-lae, and sinus tracts are common complications of advanced disease [1, 2].
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