Dynamic contrast-enhanced ultrasound of the bowel wall with quantitative assessment of Crohn’s disease activity in childhood

Abstract

BackgroundContrast-enhanced ultrasound (CEUS) has become an established non-invasive, patient-friendly imaging technique which improves the characterization of lesions. In addition, dynamic contrast-enhanced ultrasound (DCE-US) provides valuable information concerning perfusion of examined organs. This review addresses current applications of CEUS in children, focused on DCE-US of the bowel wall in patients with Crohn disease, which enables realtime assessment of the bowel wall vascularity with semi-quantitative and quantitative assessment of disease activity and response to medical treatment.ConclusionsCrohn’s disease is a chronic inflammatory relapsing disease. Frequent imaging re-evaluation is necessary. Therefore, imaging should be as little invasive as possible, children friendly with high diagnostic accuracy. US with wide varieties of techniques, including CEUS/DCE-US, can provide an important contribution for diagnosing and monitoring a disease activity. Even if the use of US contrast agent is off-label in children, it is welcome and widely accepted for intravesical use, and a little less for intravenous use, manly in evaluation of parenchymal lesions. To our knowledge this is the first time that the use of DCE-US in the evaluation of activity of small bowel Crohn disease with quantitative assessment of kinetic parameters is being described in children. Even if the results of the value and accuracy of different quantitative kinetic parameters in published studies in adult population often contradict one another there is a great potential of DCE-US to become a part of the entire sonographic evaluation not only in adults, but also in children. Further control studies should be performed.

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

“…However, few studies have used quantification parameters derived from CEUS to evaluate CD activity in the pediatric population. The first study to do so, by Kljucevsek et al [16], utilized CEUS derived quantification parameters to optimize medical therapy in a 13-year-old boy with CD. The researchers in this study demonstrated that a high intensity of enhancement and a short time-to-peak enhancement were associated with active inflammation of the small bowel, and subsequently optimized the patient's medical therapy, leading to clinical improvement and normalization of the bowel on a subsequent US examination [16].…”

Inflammatory bowel diseases

“…The gold standard in the assessment and monitoring of IBD remains upper and lower endoscopy with seriate biopsies. [17] …”

European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB): An Update on the Pediatric CEUS Registry on Behalf of the “EFSUMB Pediatric CEUS Registry Working Group”

“…Application in renal disease follows that in adults, with emphasis on the appearances of solid and cystic changes. Application in the assessment of inflammatory bowel disease was noted and may well develop into a particularly useful technique in children, thereby avoiding life-long MR and CT imaging [83].…”