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Sono gli immunosoppressori convenzionali i farmaci di prima scelta nel trattamento delle malattie infiammatorie croniche intestinali?
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VALUTAZIONE DELL'ATTIVITA' E DELLE COMPLICANZE DELLA MALATTIA DI CROHN PERIANALE: CONFRONTO TRA ECOANGIOGRAFIA PERFUSIONALE, ELASTOGRAFIA ECOGRAFICA E RISONANZA MAGNETICA NUCLEARE.
Full text linkAbstract
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
L'ecografia transperineale
No full textTransperineal ultrasound is a simple, non-invasive, and widely available inexpensive tool. It is an useful imaging method for assessing perianal inflammatory lesions, integrity of anal sphincters, any perianal organic lesions and can evaluate pelvic and anorectal disorders in patients with constipation and evacuatory difficulty. In these patients, transperineal ultrasound can accurately image the deep pelvic and anorectal region with static and dynamic investigations during straining and squeezing, providing useful information similar to that of defecography
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