Objective validation of the Crohn's Anal Fistula Quality of Life questionnaire using quantitative MRI fistula volume in perianal fistulising Crohn's disease.

Authors

Easan Anand, Theo Pelly, Uday Patel, Rory Callan, Reshma Kanani, Ailsa Hart, Phil Tozer, Phillip Lung

Published in

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland. Volume 28. Issue 10. Pages e70653.

Abstract

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.
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.
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).
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.

PMID:
42888942
Bibliographic data and abstract were imported from PubMed on 17 Oct 2026.

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