Assessment of Inflammatory and Fibrotic Stenoses in Patients with Crohn’s Disease Using Contrast-Enhanced Ultrasound and Computerized Algorithm: A Pilot Study

Schirin-Sokhan, Ramin; Winograd, Ron; Tischendorf, Stefanie; Wasmuth, Hermann E.; Streetz, Konrad L.; Tacke, Frank; Tischendorf, Jens J. W.

doi:10.1159/000321389

Cited by 30 publications

(22 citation statements)

References 31 publications

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“…However, existing data are controversial as others did not report any additional benefit in quantitative assessment of stenotic bowel wall segments by using CEUS [56]. As stenosis is always a mixture of inflammatory and fibrotic components, it remains questionable whether useful differentiation can be done with any diagnostic modality.…”

Section: Contrast-enhanced Ultrasonographymentioning

confidence: 99%

Bowel Ultrasonography in Inflammatory Bowel Disease

Kucharzik¹

2015

Dig Dis

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Background: The diagnosis of inflammatory bowel disease (IBD) is based on a combination of endoscopic, clinical and biochemical investigations as well as cross-sectional imaging. The applications of cross-sectional imaging in IBD are manifold. Ultrasonography has emerged as an important imaging modality in the diagnosis of Crohn's disease (CD) as well as for monitoring disease progression and in the therapeutic response to CD and ulcerative colitis (UC). Key Messages: Ultrasonography is non-invasive, radiation free, cheap, easy to use and well tolerated and accepted by patients. Bowel ultrasonography can be used for the primary diagnosis of CD as it has a similar sensitivity and specificity like that of MRI and CT, particularly in the case of CD. Ultrasonography can also be used to monitor treatment response to therapy and to detect disease recurrence of CD as well as UC. In CD, ultrasonography can also be used to detect complications such as strictures as well as extramural complications, including abscesses and fistulas. Contrast-enhanced ultrasonography is a useful tool that might be helpful to detect certain indications in CD, in particular the differentiation between abscesses and inflammation. Conclusion: A variety of advantages of bowel ultrasonography over other imaging modalities suggest the more frequent use of this method to manage IBD patients in daily practice. Bowel ultrasonography should be a standard tool in IBD centers.

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Section: Contrast-enhanced Ultrasonographymentioning

confidence: 99%

Bowel Ultrasonography in Inflammatory Bowel Disease

Kucharzik¹

2015

Dig Dis

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“…It has been assumed that CEUS would be useful in the study of bowel obstruction in patients with Crohn's disease in the belief that strictures are caused mainly by inflammation or fibrosis, and that CEUS can evidence inflammation thanks to more intense enhancement of the affected bowel wall [7][8][9][10]. However, studies in the literature are not concordant.…”

Section: Discussionmentioning

confidence: 99%

“…However, studies in the literature are not concordant. Schirin-Sokhan et al found no correlation between the nature of the stricture and some of the quantitative indices of CEUS [7]. According to Quaia et al, CEUS with elaboration of time/intensity curves and calculation of AUC permits adequate differentiation between Fig.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of CEUS and strain elastography in one case of ileum Crohn stricture and literature review

et al. 2016

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Contrast-enhanced ultrasonography (CEUS) and strain elastography (SE) are diagnostic imaging methods, which are still not routinely used in the clinical management of inflammatory bowel diseases. However, there are studies in the literature reporting on the use of both CEUS and SE in patients with bowel obstruction due to Crohn's disease, documenting the usefulness of these two methods in the differentiation between inflammation and fibrosis affecting the bowel wall. The aim of this case report is to evaluate the usefulness of CEUS and SE performed in a patient with Crohn's disease, who was admitted to hospital with bowel obstruction due to terminal ileal stricture and submitted to ileocecal resection. CEUS and SE identified and to some extent also characterized the inflammatory and fibrotic processes affecting the bowel wall. Macroscopic and microscopic examinations of the surgical specimen confirmed the presence of inflammatory phenomena (exudates, ulcers, and fistulas) and fibrosis as suggested by ultrasound (US) imaging methods.Sommario L' ecografia con mezzo di contrasto (CEUS) e la elastografia strain (SE) sono metodiche recenti, ancora poco utilizzate nel management clinico delle malattie infiammatorie croniche intestinali. Riguardo alle stenosi intestinali nel morbo di Crohn, in Letteratura sono pubblicati studi sia con la CEUS che con la SE che hanno documentato l'utilità delle due metodiche nel differenziare la natura flogistica o fibrotica del tratto patologico. Scopo di questo report è di valutare l'utilità delle due metodiche in un paziente affetto da morbo di Crohn, ricoverato per occlusione intestinale da stenosi dell'ultima ansa ileale ed operato di resezione dell'ileo terminale e del ceco. La CEUS e la Elastografia Strain hanno permesso la documentazione ed in un certo grado anche una misura dei processi flogistici e fibrotici a carico della parete intestinale affetta. L'esame macroscopico e microscopico del tratto resecato ha consentito di confermare la presenza dei fenomeni flogistici e fibrotici come ipotizzato con le due metodiche ecografiche.

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“…The dynamic assessment of parietal enhancement can be studied with high temporal resolution and has been shown to correlate with the inflammatory activity of bowel wall in some studies [39], although not in others [40]. In a recent study, [41] the CEUS, used for the evaluation of inflammation in 25 CD patients, using the histology of surgical specimens as standard of reference, showed a good and significant negative correlation between the degree of color doppler enhancement and the pathological score of fibrostenosis.…”

Section: Fibrostenosis and Ais Correlationmentioning

confidence: 99%

Diagnostic Performances of Diffusion-Weighted Magnetic Resonance Imaging in the Evaluation of Fibrosis and Post-Operative Endoscopic Recurrence in Crohn’s Disease

Samperi¹

2016

GHOA

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Background: Diffusion-weighted represents a new application of magnetic resonance imaging (DW-MRI) to assess inflammatory activity in Crohn's disease. ADC is a quantitative parameter of this phenomenon. We aimed to verify the correlation between DWI findings both with pathological evaluation of fibrosis in surgical specimen both with endoscopic recurrence.Methods: 31 pts undergoing ileocolonic resection for CD were submitted to DW-MRI. Conventional MRI findings of terminal or neo-terminal ileum were recorded together with a semiquantitative evaluation of DWI signal intensity and with ADC calculation. For the first aim, Acute Inflammatory (AIS) and Fibrostenosis score was correlated to ADC values of matched ileo-cecal segment. ROC curves analysis was used to find out an ADC cut-off value able to distinguish "low and high grade" severity of post-operative recurrence. Results:Comparison of DWI findings with surgical specimens pathologic evaluation showed a very good correlation, inverse and statistically significant, between ADC and AIS total (r=-0.90, p=0.013). The mean ADC value of the 5 pts with fibrosis was not statistically different from the 5 pts without. The comparison between ADC and Rutgeerts'score showed a good correlation, inverse and statistically significant (rho= -0.73, P=0.002). ROC curves analysis highlighted that a value of ADC ≤ 1.82 x10 -3 mm 2 /s could predict a severe recurrence (Rs >i2) with a sensitivity of 88.9% and a specificity of 83.3%. Conclusion:This study showed the ability of DWI sequences to provide quantitative measures of inflammation, allowing a more objective assessment of CD. Further studies should clarify whether ADC evaluation could predict the presence of fibrosis in surgical specimens.

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Assessment of Inflammatory and Fibrotic Stenoses in Patients with Crohn’s Disease Using Contrast-Enhanced Ultrasound and Computerized Algorithm: A Pilot Study

Cited by 30 publications

References 31 publications

Bowel Ultrasonography in Inflammatory Bowel Disease

Bowel Ultrasonography in Inflammatory Bowel Disease

Feasibility of CEUS and strain elastography in one case of ileum Crohn stricture and literature review

Diagnostic Performances of Diffusion-Weighted Magnetic Resonance Imaging in the Evaluation of Fibrosis and Post-Operative Endoscopic Recurrence in Crohn’s Disease

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