Differentiation of Inflammatory from Fibrotic Ileal Strictures among Patients with Crohn's Disease through Analysis of Time–Intensity Curves Obtained after Microbubble Contrast Agent Injection

Quaia, Emilio; Gennari, Antonio Giulio; Beek, Edwin Jacques Rudolph van

doi:10.1016/j.ultrasmedbio.2017.01.024

Cited by 22 publications

(19 citation statements)

References 27 publications

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“…However, the ability to differentiate fibrotic from inflammatory strictures with CEUS remains controversial. Quaia et al [24] demonstrated that area under the curve and peak enhancement could be used to differentiate predominantly fibrotic from predominantly inflammatory strictures. However, another study using an animal model demonstrated that quantitative perfusion parameters cannot detect the degree of fibrosis in CD when inflammation is also present.…”

Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Ultrasound and Shear Wave Elastography Evaluation of Crohn's Disease Activity in Three Adolescent Patients

Thimm

Cuffari

Garcia

et al. 2019

Pediatr Gastroenterol Hepatol Nutr

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Characterizing inflammation and fibrosis in Crohn's disease (CD) is necessary to guide clinical management, but distinguishing the two remains challenging. Novel ultrasound (US) techniques: contrast-enhanced US (CEUS) and shear wave elastography (SWE) offer great potential in evaluating disease activity in pediatric patients. Three patients ages 16 to 20 with known CD underwent CEUS and SWE to characterize bowel wall inflammation and fibrosis. Magnetic resonance enterography, endoscopy, or surgical pathology findings are also described when available. The patients' disease activity included acute inflammation, chronic inflammation with stricture formation, and a fibrotic surgical anastomosis without inflammation. CEUS was useful in determining the degree of inflammation, and SWE identified bowel wall fibrosis. Used together these techniques allow for better characterization of the degree of fibrosis and inflammation in bowel strictures. With further validation CEUS and SWE may allow for improved characterization of bowel strictures and disease flares in pediatric patients suffering from CD.

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Section: Discussionmentioning

confidence: 99%

Contrast-Enhanced Ultrasound and Shear Wave Elastography Evaluation of Crohn's Disease Activity in Three Adolescent Patients

Thimm

Cuffari

Garcia

et al. 2019

Pediatr Gastroenterol Hepatol Nutr

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“…Differentiation of these two broad categories is recognized as a major role for imaging techniques as management differs. Several investigators have addressed the role of CEUS [ 40 – 42 ] and also elastography to characterize these strictures with ultrasound [ 42 , 43 ]. Our own study shows that, in patients with chronic stenotic disease, smooth muscle hyperplasia/hypertrophy may contribute more to stricture than fibrosis [ 44 ] similar that to prior study by Baumgart [ 45 ].…”

Section: Indications For Ceus Of the Bowelmentioning

confidence: 99%

“…[ 30 ]. Quaiai et al show differentiation of inflammatory vs fibrotic strictures in which determination of active inflammation would favor the role of medical therapy [ 40 ].…”

Section: Indications For Ceus Of the Bowelmentioning

confidence: 99%

Role of contrast-enhanced ultrasound in evaluation of the bowel

2017

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Contrast-enhanced ultrasound (CEUS) of the gastrointestinal tract provides vascular information helpful for characterizing masses and other pathologies in and around the bowel, similar to contrast applications in other solid organs. However, the use of microbubble contrast agents for the bowel provides additional unique contributions as it gives both subjective and objective information about mural and mesenteric blood flow, invaluable for the determination of disease activity in those many patients affected by inflammatory bowel disease (IBD). IBD is a lifelong chronic disease and has its peak age of onset in adolescence or young adult life. Today, we have moved away from treating patient’s symptoms and strive instead to alter the course of disease by obtaining mucosal healing. Expensive and aggressive biologic therapies and lack of agreement of patient’s symptoms with their disease activity and complications necessitate frequent imaging surveillance, which must be safe, readily available, inexpensive, and effective. Ultrasound with the benefit of contrast enhancement meets these requirements and is shown in meta-analysis to be equivalent to CT and MRI scans for these indications.Electronic supplementary materialThe online version of this article (10.1007/s00261-017-1399-6) contains supplementary material, which is available to authorized users.

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“…8,15,23,24 Recent CEUS studies showed higher values of enhancement intensity and volume kinetic parameters in patients with inflammatory strictures compared to patients with fibrotic strictures. [25][26][27] We also compared the baseline CEUS parameters as a predictor of response to treatment in a small cohort. The values measured with both techniques showed higher PI and AUC parameters in the responders.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies found correlations between Doppler measurements and CEUS parameters but not with clinical, laboratory, or endoscopic indices, while others showed correlations between CEUS kinetic parameters, HBI score, CRP levels, and/or endoscopic activity . Recent CEUS studies showed higher values of enhancement intensity and volume kinetic parameters in patients with inflammatory strictures compared to patients with fibrotic strictures …”

Section: Discussionmentioning

confidence: 99%

Associations between quantitative evaluation of bowel wall microvascular flow by contrast‐enhanced ultrasound and indices of disease activity in Crohn's disease patients using both bolus and infusion techniques

Zezos

Zittan

Islam

et al. 2019

J of Clinical Ultrasound

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Purpose The aim is to investigate whether baseline contrast‐enhanced ultrasound (CEUS) correlates with indices of activity in Crohn's disease (CD) and can predict response to medical treatment. Methods In this prospective study, symptomatic CD patients underwent baseline CEUS performed with Definity using both bolus and infusion methods. Time‐intensity curves (TIC), peak intensity (PI), and area under curve (AUC) from a region of interest over the diseased bowel were calculated for both bolus and infusion acquisitions. We used Mann‐Whitney U test for continuous and chi‐square/two‐tailed Fisher's exact test for categorical variable comparison and Spearman's correlation coefficient to correlate clinical score and CEUS kinetic parameters. Results Twenty‐one patients (9 men, 12 women, median age 32 years) were accrued. Fifteen patients had clinically active disease defined as Harvey‐Bradshaw Index (HBI) score ≥5. Median values of baseline CEUS parameters PI (bolus: 26 vs 8.86; P = .023 and perfusion: 7.6 vs 3.2; P = .009) and AUC (bolus: 769 vs 248.8; P = .036 and perfusion: 188.9 vs 73.9; P = .012) differed significantly in patients with active vs inactive disease. Nine patients with active disease underwent escalated or new treatment. Five were nonresponders. Responders had higher median values of baseline parameters (PI, bolus: 35 vs 18.8; P = .556, and perfusion: 7.6 vs 3.9; P = 190), (AUC, bolus: 1473.9 vs 314; P = .111, and perfusion: 154.7 vs 74.4, P = .286). Conclusions CEUS kinetic parameters correlate with clinical and laboratory indices and are significantly higher in patients with active disease. The responders had higher CEUS kinetic parameters than nonresponders that did not reach statistical significance in our small cohort.

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Differentiation of Inflammatory from Fibrotic Ileal Strictures among Patients with Crohn's Disease through Analysis of Time–Intensity Curves Obtained after Microbubble Contrast Agent Injection

Cited by 22 publications

References 27 publications

Contrast-Enhanced Ultrasound and Shear Wave Elastography Evaluation of Crohn's Disease Activity in Three Adolescent Patients

Contrast-Enhanced Ultrasound and Shear Wave Elastography Evaluation of Crohn's Disease Activity in Three Adolescent Patients

Role of contrast-enhanced ultrasound in evaluation of the bowel

Associations between quantitative evaluation of bowel wall microvascular flow by contrast‐enhanced ultrasound and indices of disease activity in Crohn's disease patients using both bolus and infusion techniques

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