Crohn's disease activity assessed by doppler sonography: the role of aortic flow parameters

Abstract

OBJECTIVES:Intestinal neovascularization and abnormal abdominal arterial flow rates have been reported in Crohn's disease. The aim of this study was to evaluate Doppler sonography as a method for assessing Crohn's disease activity based on changes in splanchnic hemodynamics.METHODS:Forty-eight patients with Crohn's disease, 22 healthy volunteers and 12 patients with irritable bowel syndrome were evaluated by Doppler ultrasound for flow parameters of the aorta and superior mesenteric artery. This evaluation included the cross-sectional area, maximum flow volume, peak systolic velocity, end diastolic velocity, resistance and the pulsatility index. Disease activity was classified according to the Crohn's disease activity index.RESULTS:Most measurements in the aorta and superior mesenteric artery were significantly different between Crohn's disease patients and both control groups. Only the aortic maximum flow volume (CC = 0.37, p = 0.009) and aortic peak systolic velocity (CC = 0.30, p = 0.035) showed a significant positive correlation with the Crohn's disease activity index. The determination of cut-off points for the aortic maximum flow volume and peak systolic velocity measurements increased the sensitivity (80 and 75% for flow volume and velocity, respectively), specificity (57 and 75%), accuracy (67 and 75%) and positive (57 and 68%) and negative (80 and 81%) predictive values. These cut-off values permitted the correct classification of most of the patients with Crohn's disease with respect to disease activity. None of the superior mesenteric artery measurements were able to discriminate patients in relation to disease activity.CONCLUSION:The aortic maximum flow volume and peak systolic velocity levels estimated by Doppler sonography reflected disease activity in Crohn's disease. Doppler sonography of the aorta is therefore a novel noninvasive adjunct method that may be useful in the clinical follow-up of patients with Crohn's disease.

Initial Abdominal CT and Laboratory Findings Prior to Diagnosis of Crohn’s Disease in Children

“…Some studies have raised concerns that CD patients might have increased splanchnic vascular flow seen on Doppler US or contrast-enhanced US. 20 21 Our study showed that while aorta diameter was not significantly different, portal vein diameter and the ratio between the two diameters were significantly larger in the CD group. Further studies with a larger pediatric cohort that focus on splanchnic perfusion and its effect on the abdominal organs or liver are warranted.…”

Abdominal ultrasonography with color Doppler analysis in the assessment of ileal Crohn’s disease: comparison with magnetic resonance enterography

“…Another critical point in this investigation refers to the question whether the data acquired by Doppler sonography of small size vessels, for the assessment of CD activity is actually reliable [16,41]. In fact, in accordance with this, we previously demonstrated that the results from aorta were more consistent than the ones obtained with SMA measurements, which was attributed to the diameter of the vessels analyzed [37]. On the other hand, the alternative assessment of Doppler sonography proposed in this study relied more on semi-quantitative, and less on quantitative data, such as measurements of diameters and flow values.…”

“…In a previous work from our group, we also demonstrated the usefulness of Doppler ultrasound examination for patients with CD by the detection of abnormal patterns of splanchnic hemodynamics, confirming the presence of a hyperdynamic circulation. However, analysis of the SMA parameters could not discriminate disease activity confidently among the individual patients [37]. In another investigation, following a protocol similar to the one presented in this study, investigators demonstrated the effectiveness of combining abdominal ultrasonography and color Doppler for the monitoring of CD, and proposed the method as a strong predictor of mucosal healing [38].…”

Current noninvasive modalities in Crohn’s disease monitoring

“…Besides the role of Doppler ultrasonography in the evaluation of intestinal lesion vascularity, its use in the assessment of abdominal aortic and superior mesenteric artery (SMA) flow has been proposed as an adjunctive method in the evaluation of CD activity, as hyperdynamic mesenteric circulation is a characteristic of CD [ 144 ]. Despite the conflicting results of various studies, SMA measurements were not able to distinguish disease activity among patients, in contrast to aortic measurements, where significant differences correlated with disease activity confirming hyperdynamic circulation in CD [ 138 - 144 ].…”