{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T08:56:25Z","timestamp":1794300985401,"version":"4.9.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,11,29]],"date-time":"2025-11-29T00:00:00Z","timestamp":1764374400000},"content-version":"vor","delay-in-days":28,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"TOpCLASS"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The TOpClass classification for perianal fistulizing Crohn\u2019s disease (pfCD) facilitates tailored treatment to clinical state and patient goals. MRI is central to pfCD assessment, but existing indices are limited in predicting disease classification and trajectory. This study evaluated MRI fistula volume as a radiological biomarker and its longitudinal association with pfCD class.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study of 51 consecutive pfCD patients who underwent a baseline pelvic MRI in 2010 with\u2009\u22651 follow-up MRI. pfCD class was assigned at baseline, short- and long-term follow-up (median 10\u2009years). A gastrointestinal radiologist, blinded to clinical data, measured active MRI fistula volume on T2-weighted axial sequences at each timepoint using ITK-Snap. The primary outcome was the association between volume and pfCD Class. Secondary outcomes included identification of volume thresholds discriminating clinical state\/class via ROC analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 51 included patients (mean age 34.5), the majority had complex fistulae (92.1%) and 71% patients were TOpClass 2b, with 35% changing class during follow-up. MRI fistula volume measurement was feasible (median acquisition time 207\u2009seconds, IQR 116-250). Volume was associated with disease severity, increasing across TOpClass strata (P\u2009&amp;lt; .001). ROC-derived volume thresholds effectively differentiated classes (AUROC 0.69-0.80). A\u2009\u2265 27% volume reduction was associated with clinical improvement (AUROC 0.78; sensitivity 64%, specificity 84%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MRI fistula volume is associated with pfCD class and disease trajectory. Volume thresholds are associated with classification shifts and clinical response, supporting their potential as objective quantitative tools. Prospective multicenter validation is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjaf216","type":"journal-article","created":{"date-parts":[[2025,11,28]],"date-time":"2025-11-28T13:08:09Z","timestamp":1764335289000},"source":"Crossref","is-referenced-by-count":11,"title":["Real-world evaluation of MRI fistula volume as a radiological biomarker of disease activity in perianal fistulizing Crohn\u2019s disease"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0852-5931","authenticated-orcid":false,"given":"Easan","family":"Anand","sequence":"first","affiliation":[{"name":"St Mark\u2019s, The National Bowel Hospital , Central Middlesex, Acton Lane , London NW10 7NS,","place":["United Kingdom"]},{"name":"Department of Surgery & Cancer, Imperial College London , Exhibition Rd, South Kensington , London SW7 2AZ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulak","family":"Anandabaskaran","sequence":"additional","affiliation":[{"name":"St Mark\u2019s, The National Bowel Hospital , Central Middlesex, Acton Lane , London NW10 7NS,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theo","family":"Pelly","sequence":"additional","affiliation":[{"name":"St Mark\u2019s, The National Bowel Hospital , Central Middlesex, Acton Lane , London NW10 7NS,","place":["United Kingdom"]},{"name":"Department of Surgery & Cancer, Imperial College London , Exhibition Rd, South Kensington , London SW7 2AZ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ailsa","family":"Hart","sequence":"additional","affiliation":[{"name":"St Mark\u2019s, The National Bowel Hospital , Central Middlesex, Acton Lane , London NW10 7NS,","place":["United Kingdom"]},{"name":"Department of Metabolism, Digestion & Reproduction, Imperial College London , Exhibition Rd, South Kensington , London SW7 2AZ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2532-7267","authenticated-orcid":false,"given":"Phil","family":"Tozer","sequence":"additional","affiliation":[{"name":"St Mark\u2019s, The National Bowel Hospital , Central Middlesex, Acton Lane , London NW10 7NS,","place":["United Kingdom"]},{"name":"Department of Surgery & Cancer, Imperial College London , Exhibition Rd, South Kensington , London SW7 2AZ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillip","family":"Lung","sequence":"additional","affiliation":[{"name":"St Mark\u2019s, The National Bowel Hospital , Central Middlesex, Acton Lane , London NW10 7NS,","place":["United Kingdom"]},{"name":"Department of Surgery & Cancer, Imperial College London , Exhibition Rd, South Kensington , London SW7 2AZ,","place":["United 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