The Utility of Contrast Enhanced Ultrasound and Elastography in the Early Detection of Fibro-Stenotic Ileal Strictures in Children with Crohn’s Disease

Abstract

Purpose Crohn’s disease (CD) is a chronic, idiopathic bowel disorder that can progress to partial or complete bowel obstruction. At present, there are no reliable diagnostic tests that can readily distinguish between acute inflammatory, purely fibrotic and mixed inflammatory and fibrotic. Our aim is to study the utility of contrast enhanced ultrasound (CEUS) in combination with shear wave elastography (SWE) to differentiate fibrotic from inflammatory strictures in children with obstructive CD of the terminal ileum. Methods Twenty-five (19 male) children between 2016-2021 with CD of the terminal ileum were recruited into the study. Among these patients, 22 had CEUS kinetic measurements of tissue perfusion, including wash-in slope (dB/sec), peak intensity (dB), time to peak intensity (sec), area under the curve (AUC) (dB sec), and SWE. In total, 11 patients required surgery due to bowel obstruction. Histopathologic analysis was performed by a pathologist who was blinded to the CEUS and SWE test results. Results Patients that underwent surgical resection had significantly higher mean area under the curve on CEUS compared to patients responsive to medical therapy ( p =0.03). The AUC also correlated with the degree of hypertrophy and the percent fibrosis of the muscularis propria, as determined by histopathologic grading ( p <0.01). There was no difference in the mean elastography measurements between these two patient groups. Conclusion CEUS is a useful radiological technique that can help identify pediatric patients with medically refractory obstructive fibrotic strictures of the terminal ileum that should be considered for early surgical resection.

Novelties and Perspectives of Intestinal Ultrasound in the Personalised Management of Patients with Inflammatory Bowel Diseases—A Systematic Review

“…Radiological remission in this group has also been suggested to greatly reduce the risk of recurrence or complications [52,105]. Contrast administration in children has been approved by the United States Food and Drug Administration in 2016, but its use in this population remains to be determined [67].…”

“…The absence of CDS is correlated to fibrotic stenoses, while increased CDS may indicate inflammatory aetiology [65,66]. Increased mean area under the curve (AUC) on CEUS is associated with higher fibrosis scores on surgical pieces [67]. One study failed to show a significant correlation between the number of vessels counted at histology and CDS or CEUS parameters [68].…”

Ultrasound in Pediatric Inflammatory Bowel Disease—A Review of the State of the Art and Future Perspectives

“…These are primarily intended to demonstrate the altered intestinal wall structure or stratification with abnormal deposition of ECM, vascular changes, and an increase in stiffness. A first study with CEUS in pediatric IBD containing a small number of patients (n = 25) shows encouraging results [93], but these protocols are far from standardization or routine use. In the future, such techniques could become more sophisticated may be able to better capture changes in flow behavior in the tissues of smaller children [94][95][96] or even depict and quantify small microstructures [97].…”