Real-time elastography in Crohn’s disease: feasibility in daily clinical practice

Giannetti, Andrea; Matergi, M; Biscontri, Marco; Tedone, Francesco; Falconi, L; Franci, Luca

doi:10.1007/s40477-017-0243-8

Cited by 17 publications

(10 citation statements)

References 11 publications

(17 reference statements)

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“…After duplicates were removed, 31 studies (26 full text articles [8, 11 -14, 16, 20 -39] and 5 abstracts [40 -44] were assessed for eligibility. Of the 31 records selected, 2 [20,29] were excluded because they used other semi-quantitative or color scales as a parameter of bowel stiffness, 1 reported the results in kPa [44], 11 [8,11,12,16,23,24,27,28,31,33,34] were review articles, 3 [21,22,32] were excluded as they used magnetic resonance as a reference standard, and 8 [13, 30, 35 -38, 40, 43] for other reasons (▶ Fig. 1).…”

Section: Resultsmentioning

confidence: 99%

Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn’s Disease: Systematic Review and Meta-Analysis

et al. 2019

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Purpose To perform a systematic review with meta-analysis to assess whether ultrasound elastography can have a diagnostic role in detecting fibrotic bowel strictures in patients with Crohn’s disease. Materials and Methods MEDLINE via the PubMed, Ovid Embase, Scopus and Cochrane Library databases, and abstracts of international conference proceedings were searched up to March 31, 2018. Studies were included if they assessed the performance of abdominal ultrasound elastography in detecting fibrotic bowel strictures in patients with Crohn’s disease using histology or the need for surgery after medical treatment as a reference standard. The quality of the studies was assessed using Quality Assessment of Diagnostic Accuracy Studies. Results 6 studies including a total of 217 patients with Crohn’s disease and 231 bowel segments, of which 76 were bowel segments with fibrotic stricture, were selected. Three studies used strain ratio and three studies used strain value as parameters of bowel stiffness. Both the pooled standardized mean strain ratio and the pooled standardized mean strain value were higher in bowel segments with fibrotic strictures than in those without fibrotic strictures with a standardized mean difference of 0.85 (95 % confidence level [CI]: 0 to 1.71; p = 0.05) and 1.0 (95 % CI: –0.11 to 2.10; p = 0.08), respectively. There was a high heterogeneity between studies. All studies were at “high risk” or “unclear risk” of bias. Conclusion Ultrasound elastography could be able to detect fibrotic bowel strictures in patients with Crohn’s disease. Well-designed high quality diagnostic studies with a large sample size are needed.

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Section: Resultsmentioning

confidence: 99%

Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn’s Disease: Systematic Review and Meta-Analysis

et al. 2019

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“…For SE examinations, it was necessary to use slight pressure and hold the probe still for 5 seconds, with a quality indication above 60 to ensure high‐quality elastic images. If the region of interest (ROI) was large and included the bowel lumen and sufficient amounts of adjacent bowel wall, we then traced the outline of the intestinal wall and lumen with yellow lines.…”

Section: Methodsmentioning

confidence: 99%

Usefulness of Strain Elastography, ARFI Imaging, and Point Shear Wave Elastography for the Assessment of Crohn Disease Strictures

Ding

Fang

Wan

et al. 2019

J of Ultrasound Medicine

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Objectives The aim of this study was to evaluate the diagnostic performance of strain elastography, acoustic radiation force impulse (ARFI) imaging and point shear wave elastography (p‐SWE) for assessment of the predominant types of intestinal stenosis in Crohn disease. Methods Twenty‐five patients were enrolled in this study, among whom 25 suspicious stenoses in 25 intestinal segments were studied using gray scale ultrasonography. All 3 elastography methods were performed, and all patients underwent endoscopy within 24 hours with pathologic biopsy. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), Youden index, and area under the receiver operating characteristic curve (AUROC) were calculated. Pathologic findings were regarded as the gold standard. Results For SE, the optimal cutoff value was a score of 4 or greater (sensitivity, 75%; specificity, 66.7%; accuracy, 68%; PPV, 30%; NPV, 93.3%; AUROC, 0.708; however, P > .05). The results of ARFI imaging were similar: the optimal cutoff value was a score of 4 or greater (sensitivity, 50%; specificity, 81%; accuracy, 76%; PPV, 33.3%; NPV, 89.4%; AUROC, 0.669; P < .05). However, for p‐SWE, the optimal cutoff value was reached when the shear wave velocity exceeded 2.73 m/s (sensitivity, 75%; specificity, 100%; accuracy, 96%; PPV, 100%; NPV, 95.5%; AUROC, 0.833; P < .05). Conclusions p‐SWE had the best performance for evaluating and differentiating intestinal stenosis in Crohn disease, while neither SE nor ARFI imaging achieved satisfactory outcomes for evaluating inflammatory stenosis and fibrotic stenosis of Crohn disease.

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“…Moreover, comparing the SE results with histologic features, the strain values correlate with the histologic characteristics of fibrosis, such as collagen and muscular fibers deposits [101,102]. The assessment of intestinal fibrosis and the differentiation of inflammation from fibrosis have been studied using a semi quantitative visual color scale and the strain ratio (SR) which is the ratio between the mean strain in the normal intestinal tissue near the lesions and the mean strain of the affected intestinal tissue [106]. SR demonstrated a good ability to diagnose severe intestinal fibrosis, but failed to differentiate the degree of inflammation [102].…”

Section: Elastographymentioning

confidence: 99%

The importance of intestinal ultrasound and elastographic techniques in inflammatory bowel diseases

Marin

Tribus

Fierbinţeanu-Braticevici

2018

Med Ultrason

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Inflammatory bowel diseases have an important impact upon the economic and social status due to their increasing incidence and prevalence, often affecting young people. At the moment, the therapeutic goal goes beyond the improvement of symptoms and laboratory parameters, being represented by endoscopic mucosal healing, changing the disease’s natural history. Even though endoscopy is the gold standard for the assessment of mucosal healing, it is an invasive maneuver and it lacks good repeatability. These patients require frequent evaluation; therefore, interest for noninvasive techniques has risen.As a consequence, the importance of intestinal ultrasound has increased lately and recent studies support its use to assess the degree of inflammation, to differentiate between remission and relapse, to monitor therapy response and guide treatment, to evaluate prognosis, and to diagnose complications. Another promising noninvasive imagistic technique is elastography which has gained interest because of its capacity to discriminate between inflammatory and fibrotic tissue, taking into account the different therapeutic options for the fibrotic strictures compared to inflammatory processes. This review summarizes the actual recommendations regarding the use of intestinal ultrasound and elastographic techniques for the diagnosis and monitoring of inflammatory bowel diseases.

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Real-time elastography in Crohn’s disease: feasibility in daily clinical practice

Cited by 17 publications

References 11 publications

Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn’s Disease: Systematic Review and Meta-Analysis

Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn’s Disease: Systematic Review and Meta-Analysis

Usefulness of Strain Elastography, ARFI Imaging, and Point Shear Wave Elastography for the Assessment of Crohn Disease Strictures

The importance of intestinal ultrasound and elastographic techniques in inflammatory bowel diseases

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