Diagnostic performance of texture analysis in the differential diagnosis of perianal fistulising Crohn’s disease and glandular anal fistula

Core Tip

Core Tip: Crohn's disease (CD) is a localized, segmental chronic granulomatous inflammation that can affect the digestive tract from the oral cavity to the anus, and its pathophysiology is non-caseous necrotic granuloma. Nearly 10% of patients with CD have an anal fistula before presenting gastrointestinal symptoms. At the same time, perianal fistulising CD (PFCD) and glandular anal fistula have many similarities on conventional magnetic resonance imaging (MRI); therefore, it is difficult to differentiate between these conditions in the early stages with conventional MRI. Texture analysis based on conventional MRI images can quantitatively analyze image pixel information and reflect the internal heterogeneity and pathological characteristics of the lesion. Currently, this approach is widely used to distinguish between benign and malignant tumors, predict tumor stage, and evaluate treatment efficacy. In addition to the application of texture analysis in the study of tumors or substantial organs, some studies have applied texture analysis to hollow organs such as the intestine. Many patients with PFCD show concomitant active proctitis, but only few patients with glandular anal fistula have active proctitis. Based on this theory, we analyzed the texture of the rectum and anal canal wall in the PFCD group and glandular anal fistula group in this study to explore whether the texture feature parameters are valuable in identifying and differentiating these two lesions.