What is the Van Assche score used for in pelvic MRI assessment of CD

What is known

- Introduced by van Assche in 2003 for CD-related fistula, scoring tract location, abscesses, proctitis, and T2 signal intensity (original range 0–22). ^1–3 - The 2011/2017 modified version added T1 hyperintensity and infiltrate for more detailed classification (range 0–19.5). ^1–3 - Widely adopted in clinical trials and longitudinal studies to monitor response to anti-TNF therapy, with a lower score indicating positive response. ^2,4 - MRI score may uncover clinically relevant severity overlooked by clinical evaluation alone, potentially informing prognosis of durable response. ³

What is unknown / caveats

- Score change can be discordant with clinical response — in one cohort it did not drop in ~1/3 of responders and did drop in 43% of non-responders - Insensitive to specific changes such as extent of inflammatory tissue within tracts; may lag internal healing - Routine everyday use is variable; validated cut-offs for clinically relevant change are not established - Newer indices (modified van Assche, MAGNIFI-CD) aim to improve sensitivity to change, and the added value over cheaper clinical assessment remains debated.

## References

1. Wang WG, Lu WZ, Yang CM, Yu KQ, He HB. Modified Van Assche magnetic resonance imaging-based score for assessing the clinical status of anal fistulas. Medicine (Baltimore). 2020;99(19):e20075. PMID: 32384475.

2. Arkenbosch JHC, van Ruler O, de Vries AC, van der Woude CJ, Dwarkasing RS. The role of MRI in perianal fistulizing disease: diagnostic imaging and classification systems to monitor disease activity. Abdom Radiol (NY). 2025;50(2):589-597. PMID: 39180667.

3. van Rijn KL, Lansdorp CA, Tielbeek JAW, Nio CY, Buskens CJ, D'Haens GRAM, Löwenberg M, Stoker J. Evaluation of the modified Van Assche index for assessing response to anti-TNF therapy with MRI in perianal fistulizing Crohn's disease. Clin Imaging. 2020;59(2):179-187. PMID: 31821976.

4. Maccioni F, Busato L, Bottino L, Longhi A, Valenti A, Zippi M, Catalano C. Comprehensive Imaging Evaluation and Staging of Crohn's Disease: When and Why to Use Intestinal Ultrasound, MRE, or CTE: Current Guidelines and Future Directions. Diagnostics (Basel). 2026;16(6). PMID: 41897617.

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_Draft — generated by the IBDology RAG and not yet clinician-reviewed. Answers are grounded in the retrieved literature listed above; a high faithfulness score means the answer matches its sources, not that the sources are correct._