Ultrasonography in inflammatory bowel disease – So far we are?

Maconi, Giovanni; Kucharzik, Torsten; Allocca, Mariangela

doi:10.1002/ueg2.12196

Cited by 20 publications

(11 citation statements)

References 32 publications

(59 reference statements)

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“…Detection of inflammation in the bowel wall has always remained a challenge and there have been contradictory reports. You et al 19 recently studied correlations of SBW with inflammatory markers and suggested that IUS parameters significantly correlated with the inflammatory biomarkers with a better concordance rate in patients with active small bowel disease than in those with other disease locations like large bowel however Christian et al 20 suggested that traditional imaging and serum biomarkers were not reliable parameters to differentiate inflammation from fibrosis and there was a need for a newer approach. Zittan et al 21 also suggested that fecal calprotectin levels correlated only with colonic inflammation and therefore a need for newer bowel inflammatory markers.…”

Section: Discussionmentioning

confidence: 99%

Use of shear wave imaging with intestinal ultrasonography in patients with chronic diarrhea

Kapoor,

Singh,

Kapur

et al. 2023

J of Clinical Ultrasound

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ObjectiveA retrospective study was designed to determine the role of shear wave elastography (SWE) and intestinal ultrasonography to differentiate between inflammatory and fibrotic bowel strictures by determining Young's modulus (E) and shear wave dispersion (SWD) and to compare its role with contrast‐enhanced computed tomography (CECT) in patients with chronic diarrhea and pain abdomen.MethodsSeventy‐six patients who had increased small bowel thickness (SBWT) >3 mm, and large bowel wall thickness (LBWT) >4 mm on intestinal ultrasonography (IUS) were evaluated in a two‐step manner. The first step involved classifying patients with increased SBWT >3 mm and LBWT >4 mm by use of SWE and dispersion into three groups that is group I (fibrotic), group II (inflammatory) thickening, and group III (mixed‐fibrosis and inflammatory) wall thickening. In the second step, etiological classification was done using six gray scale features of IUS that is length and degree of bowel thickening, presence of bowel stratification, Limberg grade of vascularity, status of mesenteric fat, juxta bowel status‐nodes, fluid, and fistula formation to reach to a definitive diagnosis. These findings were compared with findings on CECT. Twenty‐three patients had diagnosis confirmed by biopsy while 18 underwent surgery with histologic confirmation of operative findings. The sensitivity, specificity and AUROC for both modalities were compared.ResultsGroup I that is fibrotic group had 33 patients with fibrotic strictures of which fibrotic Crohn's disease (CD)and tuberculosis of the bowel were the dominant types followed by neoplastic and infective causes. In Group II that is inflammatory there were 32 patients with predominantly infective ileo‐colitis, and ulcerative colitis patients while 11 patients were present in group III that is (mixed fibrotic and inflammatory) type of bowel wall thickening and were patients of inflammatory CD, infective ileo‐colitis. The presence of length of bowel involvement, Limberg grade, mesenteric fat proliferation, and SBWT>9 mm were the statistically significant parameters on IUS which helped to reach to final diagnosis. The sensitivity and specificity of combined SWE with SWD and IUS were 100% and 99% while that of CECT was 78% and 96% respectively with AUROC of 100% and 64%.ConclusionSWI combined with IUS in a two‐step manner is an accurate way to evaluate patients with chronic diarrhea who have increased SBWT and is not only able to differentiate inflammatory from fibrotic bowel wall thickening but also helps to form an etiological diagnosis.

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Section: Discussionmentioning

confidence: 99%

Use of shear wave imaging with intestinal ultrasonography in patients with chronic diarrhea

Kapoor,

Singh,

Kapur

et al. 2023

J of Clinical Ultrasound

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“…Although guidance on reporting of IUS parameters is now available [ 10 ▪▪ ], and several promising indices have been developed with ever better methodologies, an optimal IUS index to reflect bowel activity is yet to be defined. Rising interest in IUS also creates a demand for a training curriculum [ 11 ]. Knowledge and skills expected from newly certified IUS practitioners has recently been established based on an international, expert consensus [ 42 ▪▪ ].…”

Section: Discussionmentioning

confidence: 99%

“…IUS allows systematic scanning of the entire abdomen: after gaining panoramic view with a lower frequency (1–5 MHz) convex probe to localize pathologic conditions, detailed examination of the bowel wall is performed with higher frequency (4–8 MHz) linear probes providing a five-layer pattern (Table 1 ) [ 2 ▪▪ , 9 ]. A recent ECCO-ESGAR topical review [ 10 ▪▪ ] providing guidance on reporting of IUS parameters [ 2 ▪▪ , 11 ] (Table 2 ) recommends reporting of thickness of the most involved small bowel and/or colonic segment (bowel wall thickness, BWT) with a 3 mm cut-off value indicating mural inflammation, as well as disruptions of bowel wall. Intestinal vascularization should be reported by a semi-quantitative grading based on color Doppler.…”

Section: Technical Aspects Of Intestinal Ultrasoundmentioning

confidence: 99%

The use of ultrasound in colonic and perianal diseases

Fábián

Bor

Szepes

2022

Current Opinion in Gastroenterology

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Purpose of reviewTo revise recent literature findings regarding the use of ultrasound in colonic and perianal diseases by focusing particularly on its feasibility in inflammatory bowel diseases (IBD), colorectal neoplastic lesions, and perineal diseases, with further highlight on interventional capabilities. Recent findingsTreat-to-target approach in IBD raised an interest in intestinal ultrasound (IUS) for monitoring bowel activity considering its noninvasive nature, low costs, and well tolerability. New IUS indices have been developed with ever better methodologies and are at various stage of validation. A standardized over-the-wire technique for colonic US using a flexible overtube enables endoscopic ultrasound (EUS)-guided tissue sampling beyond the rectum, and forward-viewing radial-array echoendoscopes can assist identification of early neoplastic lesions in proximal colon. Intraoperative ultrasound and contrast-enhanced ultrasound carry an additional diagnostic value compared to conventional preoperative imaging modalities in detecting colorectal cancer liver metastases (CRLM).

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“…Hence, non-invasive imaging techniques would be preferred for patient management and therapy decision-making. In particular, diagnostic approaches like magnetic resonance imaging (MRI), computed tomography (CT), ultrasound (US) and nuclear medicine imaging, such as positron emission tomography (PET) and single photon emission tomography (SPECT), allow a non-invasive evaluation of bowel inflammation [ 4 , 5 , 6 ]. IBD is characterized by mucosal inflammation that leads to irreversible gastrointestinal damage, mediated by pro-inflammatory cytokines such as interleukin-12 (IL-12), tumor necrosis factor-α (TNFα), α 4 β 7 integrin as well as immune system cells like T-lymphocytes, regulatory cells or natural killer cells (NK) [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Radioimmune Imaging of α4β7 Integrin and TNFα for Diagnostic and Therapeutic Applications in Inflammatory Bowel Disease

et al. 2023

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Imaging using radiolabelled monoclonal antibodies can provide, non-invasively, molecular information which allows for the planning of the best treatment and for monitoring the therapeutic response in cancer, as well as in chronic inflammatory diseases. In the present study, our main goal was to evaluate if a pre-therapy scan with radiolabelled anti-α4β7 integrin or radiolabelled anti-TNFα mAb could predict therapeutic outcome with unlabelled anti-α4β7 integrin or anti-TNFα mAb. To this aim, we developed two radiopharmaceuticals to study the expression of therapeutic targets for inflammatory bowel diseases (IBD), to be used for therapy decision making. Both anti-α4β7 integrin and anti-TNFα mAbs were successfully radiolabelled with technetium-99m with high labelling efficiency and stability. Dextran sulfate sodium (DSS)-induced colitis was used as a model for murine IBD and the bowel uptake of radiolabelled mAbs was evaluated ex vivo and in vivo by planar and SPECT/CT images. These studies allowed us to define best imaging strategy and to validate the specificity of mAb binding in vivo to their targets. Bowel uptake in four different regions was compared to immunohistochemistry (IHC) score (partial and global). Then, to evaluate the biomarker expression prior to therapy administration, in initial IBD, another group of DSS-treated mice was injected with radiolabelled mAb on day 2 of DSS administration (to quantify the presence of the target in the bowel) and then injected with a single therapeutic dose of unlabelled anti-α4β7 integrin or anti-TNFα mAb. Good correlation was demonstrated between bowel uptake of radiolabelled mAb and immunohistochemistry (IHC) score, both in vivo and ex vivo. Mice treated with unlabelled α4β7 integrin and anti-TNFα showed an inverse correlation between the bowel uptake of radiolabelled mAb and the histological score after therapy, proving that only mice with high α4β7 integrin or TNFα expression will benefit of therapy with unlabelled mAb.

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Ultrasonography in inflammatory bowel disease – So far we are?

Cited by 20 publications

References 32 publications

Use of shear wave imaging with intestinal ultrasonography in patients with chronic diarrhea

Use of shear wave imaging with intestinal ultrasonography in patients with chronic diarrhea

The use of ultrasound in colonic and perianal diseases

Radioimmune Imaging of α4β7 Integrin and TNFα for Diagnostic and Therapeutic Applications in Inflammatory Bowel Disease

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