Crohn Disease : Correlation of Findings at Contrast-enhanced US with Severity at Endoscopy 1

PURPOSE To evaluate the effectiveness of visualization of vascularization at contrast material-enhanced ultrasonography (US) for assessment of the activity of Crohn disease, with severity grade determined at endoscopy as the reference standard. MATERIALS AND METHODS Ethics committee approval and written informed consent were obtained. Sixty-one patients (age range, 21-67 years; median age, 36 years) who had Crohn disease underwent both colonoscopy and US, including color Doppler and contrast-enhanced US, prospectively. To assess the vascularization of the involved bowel loop in a region expected to be seen at colonoscopy, the contrast agent uptake was measured by using quantitative analysis of the enhancement in regions of interest. Measurement of contrast enhancement was assessed as the increase in wall brightness with respect to the baseline brightness. Results were compared with the severity grade determined at endoscopy by using the area under the receiver operating characteristic curve and logistic regression analysis. RESULTS Colonoscopy showed inflammatory lesions in 53 patients (mild disease, seven; moderate disease, 12; and severe disease, 34). Bowel wall thickness and grade at color Doppler US (P = .019 and .002, respectively) correlated with severity grade at endoscopy. Mural contrast enhancement in patients with active disease at endoscopy was markedly increased in comparison with enhancement in patients with inactive disease (P < .001). Multivariate logistic regression analysis revealed that an increase in wall brightness was a significant and independent variable predictive of severity grade at endoscopy. A threshold brightness value of percentage of increase of 46% had a sensitivity and specificity of 96% and 73%, respectively, in the prediction of moderate or severe grade for inflammation at endoscopy. CONCLUSION Quantitative measurements of bowel enhancement obtained by using contrast-enhanced US correlate with severity grade determined at endoscopy. Contrast-enhanced US could be a useful technique to monitor the activity of Crohn disease. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2531082269/-/DC1.

[1]  Laurent Beaugerie,et al.  The second European evidence-based Consensus on the diagnosis and management of Crohn's disease: Definitions and diagnosis. , 2006, Journal of Crohn's & colitis.

[2]  T. Ripollés,et al.  Crohn's disease and color Doppler sonography: Response to treatment and its relationship with long‐term prognosis , 2008, Journal of clinical ultrasound : JCU.

[3]  Roelof J Bennink,et al.  Magnetic resonance imaging in Crohn's disease , 2008 .

[4]  A. Levy.  Radiation Doses from Small-Bowel Follow-Through and Abdominopelvic MDCT in Crohn's Disease , 2008 .

[5]  Jaap Stoker,et al.  Inflammatory Bowel Disease Diagnosed with US, MR, Scintigraphy, and CT: Meta- , 2008 .

[6]  M. Vatn,et al.  Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. , 2007, Gastroenterology.

[7]  P. Gionchetti,et al.  Ultrasound assessment of vascularization of the thickened terminal ileum wall in Crohn's disease patients using a low-mechanical index real-time scanning technique with a second generation ultrasound contrast agent. , 2007, European journal of radiology.

[8]  T. R. González,et al.  Técnicas seccionales de imagen en la enfermedad de Crohn: ecografía, tomografía computarizada y resonancia magnética , 2007 .

[9]  F. Poordad,et al.  Review article: the burden of hepatic encephalopathy , 2007, Alimentary pharmacology & therapeutics.

[10]  P. Rutgeerts,et al.  Review article: altering the natural history of Crohn's disease – evidence for and against current therapies , 2006, Alimentary pharmacology & therapeutics.

[11]  M. Martínez Pérez,et al.  [Ultrasound, CT, and MRI in Crohn's disease]. , 2007, Radiologia.

[12]  A. Gabelmann,et al.  Evaluating bowel wall vascularity in Crohn’s disease: a comparison of dynamic MRI and wideband harmonic imaging contrast-enhanced low MI ultrasound , 2006, European Radiology.

[13]  W. Tremaine,et al.  American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. , 2006, Gastroenterology.

[14]  W. Tremaine,et al.  American Gastroenterological Association Institute medical position statement on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. , 2006, Gastroenterology.

[15]  B F Warren,et al.  European evidence based consensus on the diagnosis and management of Crohn’s disease: definitions and diagnosis , 2006, Gut.

[16]  Joel G Fletcher,et al.  Crohn Disease: mural attenuation and thickness at contrast-enhanced CT Enterography--correlation with endoscopic and histologic findings of inflammation. , 2006, Radiology.

[17]  W. Kratzer,et al.  Contrast-enhanced wideband harmonic imaging ultrasound (SonoVue®): A new technique for quantifying bowel wall vascularity in Crohn's disease , 2005, Scandinavian journal of gastroenterology.

[18]  P. Rutgeerts,et al.  Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD. , 2004, Gastrointestinal endoscopy.

[19]  S. Rickes,et al.  Evaluation of Criteria for the Activity of Crohn’s Disease by Power Doppler Sonography , 2004, Digestive Diseases.

[20]  G. Porro,et al.  Modern Imaging of Crohn's Disease Using Bowel Ultrasound , 2004, Inflammatory bowel diseases.

[21]  M. Astegiano,et al.  Activity of Crohn disease: value of Color-Power-Doppler and contrast-enhanced ultrasonography , 2004, Abdominal Imaging.

[22]  M. Solomon,et al.  Crohn's disease: in defense of a microvascular aetiology , 2002, International Journal of Colorectal Disease.

[23]  S. Dette,et al.  Ultrasonographic Findings Correspond to Clinical, Endoscopic, and Histologic Findings in Inflammatory Bowel Disease and Other Enterocolitides , 2002, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[24]  Richard J. Snyder,et al.  Crohn disease with endoscopic correlation: single-shot fast spin-echo and gadolinium-enhanced fat-suppressed spoiled gradient-echo MR imaging. , 2002, Radiology.

[25]  P. Rutgeerts,et al.  A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn's disease. , 2002, Gastroenterology.

[26]  G. Corazza,et al.  Doppler Enhancement After Intravenous Levovist Injection in Crohn's Disease , 2001, Inflammatory bowel diseases.

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

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

[29]  D. Bulas,et al.  Inflammatory bowel disease in children and young adults: correlation of sonographic and clinical parameters during treatment. , 2000, AJR. American journal of roentgenology.

[30]  Appendicitis in Children and Young Adults: Doppler Sonographic-Pathologic Correlation , 1996 .

[31]  P. Rutgeerts,et al.  Predictability of the postoperative course of Crohn's disease. , 1990, Gastroenterology.

[32]  R. Pounder,et al.  PATHOGENESIS OF CROHN'S DISEASE: MULTIFOCAL GASTROINTESTINAL INFARCTION , 1989, The Lancet.