Dynamic Color Doppler Sonography of Intestinal Wall in Patients with Crohn Disease Compared with Healthy Subjects

Objective: Chronic inflammatory bowel diseases are characterized by inflammatory hyperperfusion of the intestinal wall in affected bowel segments. We applied a novel method to quantify color Doppler signals dynamically along a complete heart cycle inside the bowel wall. The aim was to describe bowel wall perfusion in Crohn disease patients in comparison with healthy probands and to compare a conventional activity index (Pediatric Crohn Disease Activity Index) with perfusion measurements as an indicator of inflammatory activity. Method: Color Doppler sonographic videos of bowel wall perfusion from 34 healthy children (aged 5 to 18 years) and from 14 patients with Crohn disease (aged 8.2 to 15.9 years) were recorded under defined conditions. Perfusion signals (color hue, color area) were automatically measured inside the bowel wall. Specific tissue perfusion was calculated as mean flow velocity of a region of interest during one full heart cycle. Bowel wall perfusion was compared using the Pediatric Crohn Disease Activity Index in 12 patients. Results: Specific bowel wall perfusion was significantly elevated in bowel segments of Crohn disease patients compared with healthy subjects (P < 0.001). Specific flow in small bowel was 0.025 cm/s in healthy probands and 0.095 cm/s in patients with Crohn disease, whereas large bowel wall perfusion of 0.012 cm/s in healthy probands clearly differed from 0.082 cm/s in patients with Crohn disease. No differences of perfusion between moderate and high Pediatric Crohn Disease Activity Index levels could be demonstrated despite a weak significant overall correlation. Conclusion: The new method of dynamic, automatic noninvasive perfusion quantification is useful to describe local inflammatory activity in bowel segments affected by Crohn disease and adds new information to activity evaluation by Pediatric Crohn Disease Activity Index. Specific wall perfusion in intestines of Crohn patients is significantly elevated and reaches up to sevenfold intensity compared with healthy subjects.

[1]  E. Irvine.  Usual therapy improves perianal Crohn's disease as measured by a new disease activity index. McMaster IBD Study Group. , 1995, Journal of clinical gastroenterology.

[2]  J. Varghese,et al.  Assessment of Crohn's disease activity by Doppler sonography of the superior mesenteric artery, clinical evaluation and the Crohn's disease activity index: a prospective study. , 2001, Clinical radiology.

[3]  F Kern,et al.  Development of a Crohn's disease activity index. National Cooperative Crohn's Disease Study. , 1976, Gastroenterology.

[4]  S. Rickes,et al.  Non-invasive evaluation of activity in inflammatory bowel disease by power Doppler sonography. , 2002, Zeitschrift fur Gastroenterologie.

[5]  M. Dubinsky,et al.  Doppler US in patients with crohn disease: vessel density in the diseased bowel reflects disease activity. , 2000, Radiology.

[6]  M. Daperno,et al.  Review article: Crohn's disease: monitoring disease activity. , 2003, Alimentary pharmacology & therapeutics.

[7]  M. Guslandi,et al.  Measurement of rectal blood flow by laser Doppler flowmetry in inflammatory bowel disease. , 1998, Hepato-gastroenterology.

[8]  G. Corrao,et al.  "Crohn's disease activity index" is inaccurate to detect the post-operative recurrence in Crohn's disease. A GISC study. Gruppo Italiano per lo Studio del Colon e del Retto. , 1999, Italian journal of gastroenterology and hepatology.

[9]  A. Gabelmann,et al.  [Quantifying the inflammatory activity in Crohn's disease using CE dynamic MRI]. , 2003, RoFo : Fortschritte auf dem Gebiete der Rontgenstrahlen und der Nuklearmedizin.

[10]  D. Choi,et al.  Bowel wall thickening in patients with Crohn's disease: CT patterns and correlation with inflammatory activity. , 2003, Clinical radiology.

[11]  M. Mínguez,et al.  Activity of Crohn's disease assessed by colour Doppler ultrasound analysis of the affected loops , 2001, European Radiology.

[12]  H. K. Harms,et al.  A paediatric Crohn's disease activity index (PCDAI). Is it useful? , 1994, Acta paediatrica (Oslo, Norway : 1992). Supplement.

[13]  N. Kalantzis,et al.  Doppler US of superior mesenteric artery in the assessment of ulcerative colitis. A prospective study. , 2002, Hepato-gastroenterology.

[14]  E. Stange,et al.  Mesenteric blood flow is related to disease activity and risk of relapse in Crohn's disease: a prospective follow-up study , 1999, American Journal of Gastroenterology.

[15]  R. Leong,et al.  Quality of life in Chinese patients with inflammatory bowel disease: validation of the Chinese translation of the Inflammatory Bowel Disease Questionnaire , 2003, Alimentary pharmacology & therapeutics.

[16]  E. Mascha,et al.  Prospective assessment of Cleveland Global Quality of Life (CGQL) as a novel marker of quality of life and disease activity in Crohn'S disease , 2003, American Journal of Gastroenterology.

[17]  M. Neurath,et al.  Noninvasive assessment of Crohn's disease activity: a comparison of 18F-fluorodeoxyglucose positron emission tomography, hydromagnetic resonance imaging, and granulocyte scintigraphy with labeled antibodies , 2002, American Journal of Gastroenterology.

[18]  Irvine Ej.  Usual therapy improves perianal Crohn's disease as measured by a new disease activity index. McMaster IBD Study Group. , 1995 .

[19]  A. Griffiths,et al.  A Critical Assessment of Items on the Pediatric Crohn's Disease Activity Index , 2003, Journal of pediatric gastroenterology and nutrition.

[20]  Thomas Scholbach,et al.  A New Method of Color Doppler Perfusion Measurement via Dynamic Sonographic Signal Quantification in Renal Parenchyma , 2004, Nephron Physiology.

[21]  Laura Curiel,et al.  Can color doppler predict the uniformity of HIFU‐induced prostate tissue destruction? , 2004, The Prostate.

[22]  I. Vlachonikolis,et al.  Improved validation of the Inflammatory Bowel Disease Questionnaire and development of a short form in Greek patients , 2003, American Journal of Gastroenterology.

[23]  A. Griffiths,et al.  Pediatric Crohn Disease Activity Index: Responsive to Short-term Change , 2003, Journal of pediatric gastroenterology and nutrition.

[24]  D. D. de Jong,et al.  Assessment of disease activity in inflammatory bowel disease; relevance for clinical trials. , 2003, The Netherlands journal of medicine.

[25]  J T Boyle,et al.  Development and validation of a pediatric Crohn's disease activity index. , 1991, Journal of pediatric gastroenterology and nutrition.

[26]  M. Corey,et al.  Assessing activity of pediatric Crohn's disease: which index to use? , 1999, Gastroenterology.