@article{01K5P6TJRNTHXGPVJMH88M67EF,
  abstract     = {{Background & Aims
Perianal fistulising Crohn’s disease (pfCD) affects one-fifth of patients with Crohn’s disease (CD), significantly affecting their quality of life. Magnetic resonance imaging is the gold standard for evaluating fistula healing in pfCD, but variability in radiological definitions hampers meaningful clinical interpretation and consistent trial design. This study aimed to establish an international consensus on the definition of radiological healing in pfCD.
Methods
The study was conducted in 2 phases. Phase 1 involved a systematic review to identify magnetic resonance imaging-based variables and indices used to define healing in pfCD, assessing methodological quality using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) framework. Phase 2 utilized a 2-round online Delphi consensus process with 84 international experts, followed by a stakeholder meeting to achieve consensus (agreement threshold >80%). Results were reported as per Accurate Consensus Reporting Document (ACCORD) guidelines.
Results
A radiologically healed fistula can be defined by the absence of T2-weighted hyperintensity, a completely fibrotic fistula tract and, when contrast is used, the absence of contrast enhancement on post-contrast T1-weighted images (95% consensus). Radiological improvement of a fistula can be defined (80% consensus) by the presence of a least one essential criterion: an increasingly fibrotic fistula tract, an unequivocal reduction in one or more of the following: T2-weighted hyperintensity, fistula diameter, fistula length, abscess size, or contrast enhancement of the fistula tract.
Conclusion
This international Delphi consensus standardizes radiological endpoints in pfCD, improving consistency in clinical and research settings. Future studies will validate this definition and assess how radiological changes predict long-term clinical outcomes and quality of life improvements.}},
  author       = {{Anand, Easan and Devi, Jalpa and Ballard, David H. and Joshi, Shivani and Tozer, Phil and Hart, Ailsa and Antoniou, Anna and Deepak, Parakkal and Stoker, Jaap and Lung, Phillip and Ahuja, Vineet and Altinmakas, Emre and Anandabaskaran, Sulak and Ballard, David H. and Banerjee, Rupa and Behrenbruch, Corina and Bemelman, Willem and Bermejo, Elena and Bhatnagar, Gauraang and Bislenghi, Gabriele and Bonifacio, Cristiana and Buskens, Christianne and Caron, Bénédicte and Carvello, Michele and Casanova, María José and Cohen, Ben and Connor, Susan and D'Hoore, Andre and Dane, Bari and Danese, Silvio and De Kock, Isabelle and de Parades, Vincent and Deepak, Parakkal and Dige, Anders and Dillman, Jonathan and Ding, Nik and Eberhardson, Michael and Fathallah, Nadia and Fletcher, Joel and Garcia-Gil, José Carlos and Gecse, Krisztina and Geldof, Jeroen and Greer, Mary-Louise and Gupta, Arun and Halligan, Steve and Harmath, Carla and Hart, Ailsa and Holubar, Stefan and Horsthuis, Karin and Huang, Chenchan and Iqbal, Nusrat and Khaitov, Sergey and Kotze, Paulo and Laghi, Andrea and LeBlanc, Jean-Frederic and Lightner, Amy and Lobatón Ortega, Triana and Lundby, Lilli and Lung, Phillip and Maccioni, Francesca and McCurdy, Jeffrey and McDonald, Benjamin and Moran, Gordon and Myrelid, Pär and Negård, Anne and Ng, Siew and Paolantonio, Pasquale and Parian, Alyssa and Pedersen, Bodil Ginnerup and Plumb, Andrew and Powell, Nick and Queiroz, Natalia and Rimola, Jordi and Carnero, Pablo Rodríguez and Rubin, David and Sahnan, Kapil and Scharitzer, Martina and Schwartz, David and Seale, Melanie and Sebastian, Shaji and Sharma, Vishal and Sood, Ajit and Spinelli, Antonino and Stoker, Jaap and Taylor, Stuart and Tielbeek, Jeroen and Tozer, Phil and Van de Putte, Dirk and Verstockt, Bram and Warusavitarne, Janindra and Winata, Leon Shin-han and Wong, Serre-Yu and Worley, Guy and on behalf of the TOpClass collaborative authors, [missing]}},
  issn         = {{1542-3565}},
  journal      = {{CLINICAL GASTROENTEROLOGY AND HEPATOLOGY}},
  keywords     = {{Fistula,Healing,MRI,Perianal Fistulising Crohn's Disease,Endpoints,PREDICTORS,THERAPY,INDEX}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{190--200}},
  title        = {{Defining radiological healing in perianal fistulizing Crohn’s disease : a TOpClass global expert Delphi consensus}},
  url          = {{http://doi.org/10.1016/j.cgh.2025.02.009}},
  volume       = {{24}},
  year         = {{2026}},
}

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