Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2026
Objective validation of the Crohn's Anal Fistula Quality of Life questionnaire using quantitative MRI fistula volume in perianal fistulising Crohn's disease.
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Anand Easan, Pelly Theo, Patel Uday, Callan Rory, Kanani Reshma, Hart Ailsa, Tozer Phil, Lung Phillip
Аннотация
BACKGROUND: The Crohn's Anal Fistula Quality of Life (CAF-QoL) questionnaire is the first disease-specific patient-reported outcome measure (PROM) for perianal fistulising Crohn's disease (pfCD). However, validation against objective measures of disease burden is limited. We evaluated the relationship between CAF-QoL and quantitative MRI fistula volume to determine whether MRI-derived disease burden supports the construct validity of this PROM.
METHODS: Adults with pfCD were prospectively recruited from a tertiary referral centre. Patients underwent pelvic MRI and completed CAF-QoL within 3 months of imaging. MRI fistula volume was independently quantified by two radiologists using ITK-SNAP, with concurrent scoring of the Van Assche Index (VAI). Clinical disease activity was assessed using the Perianal Disease Activity Index (PDAI). Associations between MRI measures, CAF-QoL and PDAI were evaluated cross-sectionally and longitudinally.
RESULTS: Thirty-eight patients were included. MRI fistula volume correlated with both CAF-QoL (ρ = 0.40, p = 0.03) and PDAI (ρ = 0.59, p < 0.001). Patients achieving CAF-QoL remission had significantly smaller fistula volumes than those with active disease (279 vs. 965 mm3, p = 0.04). Longitudinal changes in fistula volume correlated with changes in CAF-QoL (ρ = 0.61, p = 0.02) and PDAI (ρ = 0.74, p ≤ 0.01). There was no significant association between the VAI and either CAF-QoL or PDAI. Inter-observer agreement for MRI volume measurement was excellent (ICC = 0.995).
CONCLUSION: Quantitative MRI fistula volume provides objective construct validation of the CAF-QoL questionnaire and captures clinically meaningful disease burden in pfCD. Combined assessment of MRI fistula volume and CAF-QoL may provide complementary imaging and patient-reported endpoints for clinical practice and future therapeutic trials. Larger prospective multicentre studies are warranted.
METHODS: Adults with pfCD were prospectively recruited from a tertiary referral centre. Patients underwent pelvic MRI and completed CAF-QoL within 3 months of imaging. MRI fistula volume was independently quantified by two radiologists using ITK-SNAP, with concurrent scoring of the Van Assche Index (VAI). Clinical disease activity was assessed using the Perianal Disease Activity Index (PDAI). Associations between MRI measures, CAF-QoL and PDAI were evaluated cross-sectionally and longitudinally.
RESULTS: Thirty-eight patients were included. MRI fistula volume correlated with both CAF-QoL (ρ = 0.40, p = 0.03) and PDAI (ρ = 0.59, p < 0.001). Patients achieving CAF-QoL remission had significantly smaller fistula volumes than those with active disease (279 vs. 965 mm3, p = 0.04). Longitudinal changes in fistula volume correlated with changes in CAF-QoL (ρ = 0.61, p = 0.02) and PDAI (ρ = 0.74, p ≤ 0.01). There was no significant association between the VAI and either CAF-QoL or PDAI. Inter-observer agreement for MRI volume measurement was excellent (ICC = 0.995).
CONCLUSION: Quantitative MRI fistula volume provides objective construct validation of the CAF-QoL questionnaire and captures clinically meaningful disease burden in pfCD. Combined assessment of MRI fistula volume and CAF-QoL may provide complementary imaging and patient-reported endpoints for clinical practice and future therapeutic trials. Larger prospective multicentre studies are warranted.