Non-invasive Evaluation of Activity in Inflammatory Bowel Disease by Power Doppler Sonography[*]

 

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Abstract

Background: To study the vascularization in the diseased bowel wall by power Doppler sonography in patients with inflammatory bowel disease.

Patients and methods: The diseased bowel wall was investigated in 99 patients with inflammatory bowel disease (60 patients with Crohn’s disease and 39 patients with ulcerative colitis) either with active disease or in remission by B-mode and power Doppler sonography. Disease activity was determined by clinical indices. Twenty healthy age and sex matched individuals served as controls.

Results: Bowel wall was thickened in active Crohn’s disease (mean 7 mm, range 4-14) and ulcerative colitis (mean 5 mm, range 2-15) as compared to healthy controls (mean 2 mm, range 1-3), p < 0.001. In contrast to healthy controls blood vessels were detected in the bowel wall in 100 % of patients with active Crohn’s disease and 91 % with active ulcerative colitis. Vascularization was significant decreased in patients with quiescent versus active disease in ulcerative colitis (p < 0.05), while in Crohn’s disease there was no significance between active and remission phase.

Conclusions: Thickened and hypervascularized bowel wall are characteristic findings in inflammatory bowel disease. A combination of B-mode and power Doppler sonography offers an additional noninvasive procedure for the determination of activity in patients with inflammatory bowel disease.

Zusammenfassung

Studienziel: Mit der Power-Doppler-Sonographie sollte prospektiv die Vaskularisation in erkrankten Darmabschnitten von Patienten mit chronisch-entzündlichen Darmerkrankungen untersucht werden.

Patienten und Methoden: Erkrankte Darmsegmente von 99 Patienten mit chronisch-entzündlicher Darmerkrankung (60 Patienten mit Morbus Crohn und 39 Patienten mit Colitis ulcerosa) im aktiven Stadium oder in Remission wurden mit der B-Bild-Sonographie und der Power-Doppler-Sonographie untersucht. Die Krankheitsaktivität wurde anhand klinischer Parameter bestimmt. 20 gesunde Personen dienten als Kontrollgruppe.

Ergebnisse: Die Darmwand war verdickt in Patienten mit aktivem Morbus Crohn (Durchschnitt 7 mm, Range 4-14) und aktiver Colitis ulcerosa (Durchschnitt 5 mm, Range 2-15) verglichen mit der Kontrollgruppe (Durchschnitt 2 mm, Range 1-3), p < 0,001. Blutgefäße wurden detektiert in 100 % der Patienten mit aktivem Morbus Crohn und 91 % der Patienten mit aktiver Colitis ulcerosa. Die Vaskularisation war signifikant erniedrigt in Darmabschnitten von Patienten mit inaktiver Colitis ulcerosa gegenüber Patienten mit aktiver Krankheit (p < 0,05). Bei Patienten mit Morbus Crohn war kein Unterschied zwischen inaktiver und aktiver Phase zu beobachten.

Folgerungen: Verdickte und vermehrt durchblutete Darmwände sind charakteristisch für chronisch-entzündliche Darmerkrankungen. Eine Kombination von konventionellem Ultraschall und echosignalverstärkter Power-Doppler-Sonographie ist ein zusätzliches nichtinvasives Verfahren zur Bestimmung der Aktivität bei Patienten mit chronisch-entzündlichen Darmerkrankungen.

1 Paper has been represented at the 1998 Annual Meeting during Digestive Disease Week in New Orleans, LA, May 17-20.

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1 Paper has been represented at the 1998 Annual Meeting during Digestive Disease Week in New Orleans, LA, May 17-20.

Address for correspondence

Prof. Dr. W. Wermke

Dept. of Gastroenterology, Hepatology and Endocrinology
University Hospital Charité (Campus Mitte)

Schumannstraße 20/21

10117 Berlin

Email: steffen.rickes@charite.de