Ultrasonographic Changes at 12 Weeks of Anti-TNF Drugs Predict 1-year Sonographic Response and Clinical Outcome in Crohnʼs Disease

Ripollés, Tomás; Paredes, José María Rubio; Martínez-Pérez, María Jesús; Rimola, Jordi; Jauregui-Amezaga, A; Bouzas, Rosa; Martín, Gregorio; Moreno-Osset, E

doi:10.1097/mib.0000000000000882

Cited by 82 publications

(116 citation statements)

References 38 publications

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“…Using CEUS to assess response to therapy after initiation of corticosteroids or biological therapy in a small group of patients with Crohn’s disease, increased bowel perfusion at 1 month was associated with treatment failure within 12 months 8889. In this study, patients with a sonographic response at 1 year were less likely to require intensification or change of therapy or surgery within the subsequent 1 year than those without a sonographic response (11% vs 65%, respectively, P=0.0001) 89…”

Section: How To Position Gius In Ibd Clinical Practice?mentioning

confidence: 65%

Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application

Bryant¹,

Friedman²,

Wright

et al. 2018

Gut

122

158

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Evolution of treatment targets in IBD has increased the need for objective monitoring of disease activity to guide therapeutic strategy. Although mucosal healing is the current target of therapy in IBD, endoscopy is invasive, expensive and unappealing to patients. GI ultrasound (GIUS) represents a non-invasive modality to assess disease activity in IBD. It is accurate, cost-effective and reproducible. GIUS can be performed at the point of care without specific patient preparation so as to facilitate clinical decision-making. As compared with ileocolonoscopy and other imaging modalities (CT and MRI), GIUS is accurate in diagnosing IBD, detecting complications of disease including fistulae, strictures and abscesses, monitoring disease activity and detecting postoperative disease recurrence. International groups increasingly recognise GIUS as a valuable tool with paradigm-changing application in the management of IBD; however, uptake outside parts of continental Europe has been slow and GIUS is underused in many countries. The aim of this review is to present a pragmatic guide to the positioning of GIUS in IBD clinical practice, providing evidence for use, algorithms for integration into practice, training pathways and a strategic implementation framework.

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Section: How To Position Gius In Ibd Clinical Practice?mentioning

confidence: 65%

Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application

Bryant¹,

Friedman²,

Wright

et al. 2018

Gut

122

158

View full text Add to dashboard Cite

show abstract

“…To our knowledge, there are no other studies utilizing baseline CEUS as a tool to predict likelihood of response to medical therapy. Other studies investigated the role of posttreatment CEUS kinetic parameters in predicting the outcomes after commencing treatment and reported that follow‐up CEUS could identify nonresponders to medical treatment earlier . Larger studies are required to determine if baseline CEUS quantitative values can independently predict response to treatment and better triage the patients to those who would benefit from escalation or the addition of new treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies investigated the role of posttreatment CEUS kinetic parameters in predicting the outcomes after commencing treatment and reported that follow-up CEUS could identify nonresponders to medical treatment earlier. 13,14,16,28 Larger studies are required to determine if baseline CEUS quantitative values can independently predict response to treatment and better triage the patients to those who would benefit from escalation or the addition of new treatment. There is a trend toward using multiparametric data to better predict the disease outcome or response to treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The use of second-generation US contrast agents combined with low-mechanical-index real-time harmonic US has improved the accuracy of US in evaluating bowel wall vascularization in patients with CD. [8][9][10][11][12][13][14][15][16] Contrast-enhanced US (CEUS) has been used in patients with CD to correlate regional blood volume using a bolus injection method with normal bowel, 8 with color and power Doppler, 9 with endoscopy, 10 and with CDAI. 11 Also, there are a few reports of utilization of bolus CEUS to predict treatment response.…”

Section: Introductionmentioning

confidence: 99%

“…11 Also, there are a few reports of utilization of bolus CEUS to predict treatment response. [12][13][14][15][16] To our knowledge, there is no published study using the infusion technique. The purpose of this prospective study was to investigate whether pretreatment CEUS quantitative parameters of bowel wall blood flow, using both bolus and infusion techniques, correlate with other currently used clinical, laboratory, or endoscopic criteria of activity and could predict the clinical outcome in a cohort of CD patients treated medically.…”

Section: Introductionmentioning

confidence: 99%

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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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Ultrasonography in inflammatory bowel disease – So far we are?

2022

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Intestinal ultrasound (IUS) is a non‐invasive and accurate tool to assess inflammatory bowel disease. The ECCO‐ESGAR guideline recommends the use of IUS for the assessment of disease activity and complications in Crohn's disease (CD). In addition, an increasing body of evidence suggests the use of IUS as alternative to colonoscopy in monitoring CD and in assessing disease activity of ulcerative colitis. Early responsiveness of IUS findings by the first weeks of treatment and the advantage to perform the procedure in real time may dramatically change frequency of the assessment of treatment response in the future and speed up the clinical decision‐making process. Development of validated and reproducible sonographic scores to measure disease activity and therapeutic response and spread of knowledge of IUS remain relevant issues for the future in which current researchers and the International Bowel Ultrasound (IBUS) Group are actively engaged.

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Ultrasonographic Changes at 12 Weeks of Anti-TNF Drugs Predict 1-year Sonographic Response and Clinical Outcome in Crohnʼs Disease

Abstract: Sonographic response after 12 weeks of therapy is more pronounced and predicts 1-year sonographic response. Sonographic response at 1-year examination correlates with 1-year clinical response and is a predictor of further treatment's efficacy, 1-year or longer period of follow-up.

Cited by 82 publications

References 38 publications

Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application

Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application

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

Ultrasonography in inflammatory bowel disease – So far we are?

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