Role of Multiparametric Intestinal Ultrasound in the Evaluation of Response to Biologic Therapy in Adults with Crohn’s Disease

Abstract

Crohn’s disease is one of the two most common types of inflammatory bowel disease. Current medical therapies are based on the use of glucocorticoids, exclusive enteral nutrition, immunosuppressors such as azathioprine and methotrexate, and biological agents such as infliximab, adalimumab, vedolizumab, or ustekinumab. International guidelines suggest regular disease assessment and surveillance through objective instruments to adjust and personalize the therapy, reducing the overall rates of hospitalization and surgery. Although endoscopy represents the gold-standard for surveillance, its frequent use is strongly bordered by associated risks and costs. Consequently, alternative non-invasive tools to objectify disease activity and rule active inflammation out are emerging. Alongside laboratory exams and computed tomography or magnetic resonance enterography, intestinal ultrasonography (IUS) shows to be a valid choice to assess transmural inflammation and to detect transmural healing, defined as bowel wall thickness normalization, no hypervascularization, normal stratification, and no creeping fat. Compared to magnetic resonance imaging (MRI) or computed tomography, CT scan, IUS is cheaper and more widespread, with very similar accuracy. Furthermore, share wave elastography, color Doppler, and contrast-enhanced ultrasonography (CEUS) succeed in amplifying the capacity to determine the disease location, disease activity, and complications. This review aimed to discuss the role of standard and novel ultrasound techniques such as CEUS, SICUS, or share wave elastography in adults with Crohn’s disease, mainly for therapeutic monitoring and follow-up.

Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The "Bed Med-Us" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients

“…In fact, it is impossible to perform a comprehensive ultrasound examination with HH-US because of the lack of spectral Doppler, tissue Doppler, and other specific technologies (shear wave, contrast-enhanced US, 3D reconstructions, etc.) offered by conventional devices with full features 31 , which transform simple conventional ultrasound into “multiparametric” ultrasound in some sectors (such as hepatology 47 , gastroenterology 48 , urology 49 , etc.)…”

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“…This applies, for example, to the noninvasive diagnosis of the progression of parenchymal liver disease, liver cirrhosis, and portal hypertension [10,11,12,13,14,15,16] and for the noninvasive evaluation of chronic kidney disease [17,18,19] and subclinical kidney transplant rejection [17,20,21,22,23,24]. There are partially contradictory data regarding the evaluation of inflammatory activity and response to biologic therapy in inflammatory bowel disease [25,26,27,28,29,30,31,32,33,34]. A relatively new field of research is the application of DCE-US for the differential diagnosis, grading of the biological behavior, and outcome assessment of malignant tumors [35,36,37,38,39,40,41].…”

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“…Neue verbesserte Doppler-Verfahren, kontrastverstärkter Ultraschall und Sonoelastografie haben die diagnostische Aussagekraft der transabdominalen Darmsonografie erweitert. Diese neuen multiparametrischen Verfahren sind Gegenstand aktueller Studien und können zum jetzigen Zeitpunkt noch nicht abschließend bewertet werden [4].…”