Gastroenterology

Gastroenterology

Volume 137, Issue 1, July 2009, Pages 43-52
Gastroenterology

Imaging and Advanced Technology
Contrast-Enhanced Ultrasonographic Evaluation of Inflammatory Activity in Crohn's Disease

https://doi.org/10.1053/j.gastro.2009.03.062Get rights and content

Background & Aims

We sought to test the diagnostic accuracy of ultrasound (US), color Doppler US (CD-US), and contrast-enhanced US (CE-US) in the evaluation of inflammatory activity in patients with Crohn's disease (CD), and to correlate the findings of these sonographic studies with inflammatory activity, as scored by the CD activity index (CDAI).

Methods

Patients with CD were enrolled in the study. Radiologists performing the scans were blinded to clinical status. Baseline US, CD-US, and CE-US examinations were conducted with high-frequency probes (8–14 and 5–7 MHz) before and after injection of sulfur hexafluoride-filled microbubbles. The diagnostic accuracy of baseline US, CD-US, and CE-US were calculated by using the endoscopic and histologic findings as reference standards and correlated with the CDAIs by using the Pearson linear correlation coefficient.

Results

Forty-seven patients (20 men; 27 women; mean age ± SD, 38 ± 14 years) with a CDAI > 150 (n = 30) or < 150 (n = 17), were recruited. CE-US showed the highest performance, with 93.5% sensitivity, 93.7% specificity, and 93.6% overall accuracy. CE-US revealed 3 bowel wall perfusion patterns after microbubble injection: submucosal enhancement and inward and outward transparietal enhancement. The linear correlation coefficient for CE-US versus CDAI was 0.74 (P < .0001); for baseline US (assessing thickness, length, and multilayer appearance of the diseased bowel) versus the CDAI, the coefficients were 0.68 (P < .0001), 0.47 (P = .0009), and 0.60 (P < .0001), respectively; and for CD-US versus CDAI the coefficient was 0.73 (P < .0001).

Conclusions

CE-US has a high sensitivity and specificity in detecting inflammatory activity and a strong correlation with the CDAI.

Section snippets

Patients

This was a single-center study. Consecutive patients with Crohn's disease were enrolled. Clinical status and the CDAI,19 according to previously defined criteria,20 were designated by clinicians within 5 days before the sonographic assessment (baseline US, CD-US, and CE-US) and not >2 days after starting corticosteroid therapy. Twenty-six small bowel follow-throughs and 21 double-contrast bowel enemas were carried out, according to the sites of the lesions. Endoscopy with biopsy was performed

Results

Over a period of 2 years (February 2004 to December 2005), 59 consecutive patients referred to our hospital for abdominal symptoms or pain and suspected Crohn's disease underwent sonographic assessment consisting of baseline US, CD-US, and CE-US. Twelve patients were excluded because of lack of a histologically proven diagnosis of Crohn's disease (n = 3), incomplete sonographic findings (n = 4), an interval of >5 days between the sonographic assessment and CDAI evaluation (n = 3), or use of

Discussion

The recent introduction of new drugs, such as targeted monoclonal antibodies, in the treatment of Crohn's disease, has led to a need for noninvasive methods to assess the efficacy of pharmacologic treatment. Evaluation of inflammatory activity in Crohn's disease, a crucial aspect of treatment planning and monitoring, is currently based on a sum of clinical data and imaging findings.27 Among the various imaging methods, ultrasonography has experienced the most impressive technological advances,

Acknowledgments

The authors thank Dr Silvio Cavuto for the revision of the statistical chapter of the study.

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  • Cited by (0)

    This article has an accompanying continuing medical education activity on page 372. Learning Objective: Upon completion of this CME exercise, successful learners will be able to demonstrate the achievement of knowledge to choose the best diagnostic approach in the different clinical features that Crohn disease and its progression present, as a non-invasive technique associated with greater patient comfort, CE-US has significant diagnostic accuracy in the assessment of Crohn's disease activity.

    Conflicts of Interest The authors disclose no conflicts.

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