Quantitative measurements of bowel enhancement obtained by using contrast material–enhanced US correlate with severity grade determined at endoscopy.

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

© RSNA, 2009

References

  • 1 Stange EF , Travis SP , Vermeire S , et al.. European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis. Gut 2006;55(suppl 1):i1–i15. Crossref, MedlineGoogle Scholar
  • 2 Sandborn WJ , Feagan BG , Hanauer SB , et al.. A review of activity indices and efficacy endpoints for clinical trials of medical therapy in adults with Crohn's disease. Gastroenterology 2002;122:512–530. Crossref, MedlineGoogle Scholar
  • 3 Lichtenstein GR , Abreu MT , Cohen R , Tremaine W . American Gastroenterological Association Institute technical review on corticosteroids, inmunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology 2006;130:940–987. Crossref, MedlineGoogle Scholar
  • 4 Vermeire S , Van Assche G , Rutgeerts P . Altering the natural history of Crohn's disease: evidence for and against current therapies. Aliment Pharmacol Ther 2007;25:3–12. Crossref, MedlineGoogle Scholar
  • 5 Frøslie KF , Jahnsen J , Moum BA , Vatn MH IBSEN Group . Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 2007;133:412–422. Crossref, MedlineGoogle Scholar
  • 6 Spalinger J , Patriquin H , Miron MC , et al.. Doppler US in patients with Crohn disease: vessel density in the diseased bowel reflects disease activity. Radiology 2000;217:787–791. LinkGoogle Scholar
  • 7 Esteban JM , Maldonado L , Sanchiz V , Minguez M , Benages A . Activity of Crohn's disease assessed by colour Doppler ultrasound analysis of the affected loops. Eur Radiol 2001;11:1423–1428. Crossref, MedlineGoogle Scholar
  • 8 Haber HP , Busch A , Ziebach R , Dette S , Ruck P , Stern M . Ultrasonographic findings correspond to clinical, endoscopic, and histologic findings in inflammatory bowel disease and other enterocolitides. J Ultrasound Med 2002;21:375–382. Crossref, MedlineGoogle Scholar
  • 9 Neye H , Voderholzer W , Rickes S , Weber J , Wermke W , Lochs H . Evaluation of criteria for the activity of Crohn's disease by power Doppler sonography. Dig Dis 2004;22:67–72. Crossref, MedlineGoogle Scholar
  • 10 Ruess L , Nussbaum AR , Bulas D , et al.. Inflammatory bowel disease in children and young adults: correlation of sonographic and clinical parameters during treatment. AJR Am J Roentgenol 2000;175:79–84. Crossref, MedlineGoogle Scholar
  • 11 Ripollés T , Martinez MJ , Barrachina M . Crohn's disease and color Doppler sonography: response to treatment and its relationship with long-term prognosis. J Clin Ultrasound 2008;36:267–272. Crossref, MedlineGoogle Scholar
  • 12 Wakefield AJ , Sawyerr AM , Dhillon AP , et al.. Pathogenesis of Crohn's disease: multifocal gastrointestinal infarction. Lancet 1989;2:1057–1062. Crossref, MedlineGoogle Scholar
  • 13 Thornton M , Solomon MJ . Crohn's disease: in defense of a microvascular aetiology. Int J Colorectal Dis 2002;17:287–297. Crossref, MedlineGoogle Scholar
  • 14 Di Sabatino A , Fulle I , Ciccocioppo R , et al.. Doppler enhancement after intravenous levovist injection in Crohn's disease. Inflamm Bowel Dis 2002;8:251–257. Crossref, MedlineGoogle Scholar
  • 15 Robotti D , Cammarota T , Debani P , Sarno A , Astegiano M . Activity of Crohn disease: value of color-power-Doppler and contrast-enhanced ultrasonography. Abdom Imaging 2004;29:648–652. Crossref, MedlineGoogle Scholar
  • 16 Pauls S , Gabelmann A , Schmidt SA , et al.. Evaluating bowel wall vascularity in Crohn's disease: a comparison of dynamic MRI and wideband harmonic imaging contrast-enhanced low MI ultrasound. Eur Radiol 2006;16:2410–2417. Crossref, MedlineGoogle Scholar
  • 17 Kratzer W , Schmidt SA , Mittrach C , et al.. Contrast-enhanced wideband harmonic imaging ultrasound (SonoVue): a new technique for quantifying bowel wall vascularity in Crohn's disease. Scand J Gastroenterol 2005;40:985–991. Crossref, MedlineGoogle Scholar
  • 18 Patriquin HB , Garcier JM , Lafortune M , et al.. Appendicitis in children and young adults: Doppler sonographic-pathologic correlation. AJR Am J Roentgenol 1996;166:629–633. Crossref, MedlineGoogle Scholar
  • 19 Rutgeerts P , Geboes K , Vantrappen G , Beyls J , Kerremans R , Hiele M . Predictability of the postoperative course of Crohn's disease. Gastroenterology 1990;99:956–963. Crossref, MedlineGoogle Scholar
  • 20 Daperno M , D'Haens G , Van Assche G , et al.. Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD. Gastrointest Endosc 2004;60:505–512. Crossref, MedlineGoogle Scholar
  • 21 Jaffe TA , Gaca AM , Delaney S , et al.. Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn's disease. AJR Am J Roentgenol 2007;189:1015–1022. Crossref, MedlineGoogle Scholar
  • 22 Horsthuis K , Bipat S , Bennink RJ , Stoker J . Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 2008;247:64–79. LinkGoogle Scholar
  • 23 Parente F , Greco S , Molteni M , Anderloni A , Maconi G , Porro GB . Modern imaging of Crohn's disease using bowel ultrasound. Inflamm Bowel Dis 2004;10:452–461. Crossref, MedlineGoogle Scholar
  • 24 Ripollés González T , Martínez Pérez MJ . Ultrasound, CT, and MRI in Crohn's disease [in Spanish]. Radiologia 2007;49:97–108. Crossref, MedlineGoogle Scholar
  • 25 Low RN , Sebrechts AR , Politoske DA , et al.. Crohn disease with endoscopic correlation: single-shot fast spin-echo and gadolinium-enhanced fat-suppressed spoiled gradient-echo MR imaging. Radiology 2002;222:652–660. LinkGoogle Scholar
  • 26 Bodily KD , Fletcher JG , Solem CA , et al.. Crohn disease: mural attenuation and thickness at contrast-enhanced CT enterography—correlation with endoscopic and histologic findings of inflammation. Radiology 2006;238:505–516. LinkGoogle Scholar
  • 27 Serra C , Menozzi G , Morselli AM , 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. Eur J Radiol 2007;62:114–121. Crossref, MedlineGoogle Scholar

Article History

Received December 21, 2008; revision requested February 4, 2009; final revision received March 14; accepted April 7; final version accepted May 4.
Published in print: Oct 2009