Comparison of Sonographically Measured Bowel Wall Vascularity, Histology, and Disease Activity in Crohn's Disease

2009 ◽  
Vol 25 (2) ◽  
pp. 80
Author(s):  
Carolyn M. Sofka
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Wall

scholarly journals Development and Validation of a Simple Ultrasound Activity Score for Crohn’s Disease

2020 ◽  
Author(s):  
Fredrik Sævik ◽  
Ragnar Eriksen ◽  
Geir Egil Eide ◽  
Odd Helge Gilja ◽  
Kim Nylund
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Wall Thickness ◽  
Bowel Wall ◽  
Activity Index ◽  
Reference Standard ◽  
Colour Doppler ◽  
Bowel Wall Thickness ◽  
Ultrasound Score

Abstract Background and Aims To improve management of patients with Crohn’s disease, objective measurements of disease activity are needed. Ileocolonoscopy is the current reference standard but has limitations that restrict repeated use. Ultrasonography is potentially useful for activity monitoring, but no validated sonographic activity index is currently in widespread use. Thus, we aimed to construct and validate a simple ultrasound score for Crohn’s disease. Methods Forty patients were prospectively examined with ultrasound and endoscopy in the development phase. The Simple Endoscopic Score for Crohn’s Disease [SES-CD] was used as a reference standard. Seven ultrasound variables [bowel wall thickness, length, colour Doppler, stenosis, fistula, stratification and fatty wrapping] were initially included, and multiple linear regression was used to select the variables that should be included in the final score. Second, the ultrasound data from each patient were re-examined for interobserver assessment using weighted kappa and intraclass correlation. Finally, the activity index was validated in a new cohort of 124 patients. Results Length, fistula and stenosis were excluded. The combination of the remaining variables provided a multiple correlation coefficient of r = 0.78. Interobserver analysis revealed poor agreement for stratification and fatty wrapping and these were thus excluded. There was excellent interobserver agreement for the remaining score consisting of wall thickness and colour Doppler. In both patient cohorts, the ultrasound score correlated well with SES-CD [Development cohort: rho = 0.83, p < 0.001, Validation cohort: rho = 0.78, p < 0.001]. A receiver operating characteristic curve analysis revealed an area under the curve of 0.92 and 0.88 for detecting endoscopic activity and moderate endoscopic activity, respectively. Conclusions A simple ultrasound activity index for Crohn’s disease consisting of bowel wall thickness and colour Doppler was constructed and validated and correlated well with endoscopic disease activity. ClinicalTrials. gov ID: NCT03481751

scholarly journals P273 Point-of-care bowel ultrasound for detecting ileocolonic inflammation in Crohn’s disease

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S288-S288
Author(s):  
M Allocca ◽  
G Fiorino ◽  
F Furfaro ◽  
A Zilli ◽  
D Gilardi ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Wall ◽  
Point Of Care ◽  
Multivariable Analysis ◽  
Close Monitoring ◽  
Reference Standard ◽  
Bowel Ultrasound ◽  
Active Disease

Abstract Background A ‘treat-to-target’ strategy with close monitoring of intestinal inflammation is recommended in Crohn’s disease (CD). Bowel ultrasound (US) is a non-invasive, point-of-care tool to assess CD activity and severity. However, no clear US-based parameters of activity have been identified by using magnetic resonance imaging (MRI) and colonoscopy together as a reference standard. We aimed to investigate whether US parameters could be able to measure CD activity and severity, comparing with the MaRIA and the SES-CD scores. Methods Ileal and/or colonic CD consecutive patients were prospectively assessed by CS, MRE and bowel US. Bowel wall thickening (mm), bowel wall-flow at colour Doppler (BWF: 0 absent; 1 present), bowel wall pattern (BWP: 0 normal; 1 hypoechogenic; 2 hyperchogenic; 3 lost), presence of mesenteric lymph nodes (0 absent; 1 present) and mesenteric hypertrophy (0 absent; 1 present), evaluated at bowel US were compared with CS+MRE findings as a reference standard. Activity was defined by an SES-CD score>2 and/or a MaRIA score>7). Results Sixty CD patients were prospectively enrolled (37% with ileal localisation, 15% with colonic localisation and 48% with ileocolonic localisation). Thirty patients had endoscopically active CD, 34 had radiologically active disease, 37 (62%) had active disease assessed at CS or MRE (SES-CD > 2 or MaRIA score >7 in at least one segment). BWT, presence of BWF, hypoechogenic or lost BWP significantly correlated with endoscopic and radiological activity (OR 4.51, 33.75, and 2.74 respectively, all p < 0.001). The multivariable analysis identified only BWT (per 1-mm increase, OR: 6.56, 95% CI 1.25–34.44, p = 0.026) as an independent predictor for disease activity. The cut-off value of 4.4 mm BWT was identified to distinguish active vs. non-active disease (AUROC 0.905, Sensitivity 81%, Specificity 96%). A significant correlation was found between BWT and MaRIA and SES-CD score (r = 0.768, 95% CI 0.662–0.868, p < 0.0001; r = 0.602, 95% CI 0.409–0.743; p < 0.0001; respectively). Conclusion Bowel US is able to assess and measure disease activity in ileocolonic CD in real-time. BWT correlated very well with the MaRIA score and the SES-CD score. Further studies are needed to confirm these findings and to demonstrate the role of point-of-care US in CD management.

Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn’s disease

2009 ◽  
Vol 19 (6) ◽  
pp. 1379-1386 ◽  
Author(s):  
B. H. Drews ◽  
T. F. E. Barth ◽  
M. M. Hänle ◽  
A. S. Akinli ◽  
R. A. Mason ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Wall

Bowel wall thickness measured by ultrasound as a marker of Crohn's disease activity in children

The Lancet ◽  
2000 ◽  
Vol 355 (9211) ◽  
pp. 1239-1240 ◽  
Author(s):  
Hans P Haber ◽  
Andreas Busch ◽  
Rita Ziebach ◽  
Martin Stern
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Wall Thickness ◽  
Bowel Wall ◽  
Bowel Wall Thickness ◽  
Crohn’S Disease Activity

Dynamic Contrast-Enhanced MRI of the Bowel Wall for Assessment of Disease Activity in Crohn's Disease

2006 ◽  
Vol 186 (5) ◽  
pp. 1384-1392 ◽  
Author(s):  
Jasper Florie ◽  
Martin N. J. M. Wasser ◽  
Kasia Arts-Cieslik ◽  
Erik M. Akkerman ◽  
Peter D. Siersema ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Bowel Wall ◽  
Dynamic Contrast Enhanced Mri ◽  
Dynamic Contrast Enhanced ◽  
Enhanced Mri ◽  
Contrast Enhanced ◽  
Assessment Of Disease Activity ◽  
Contrast Enhanced Mri

scholarly journals Factors affecting splanchnic haemodynamics in Crohn’s disease: a prospective controlled study using Doppler ultrasound

Gut ◽  
1998 ◽  
Vol 43 (5) ◽  
pp. 645-650 ◽  
Author(s):  
G Maconi ◽  
F Parente ◽  
S Bollani ◽  
V Imbesi ◽  
S Ardizzone ◽  
...  
Keyword(s):  
Blood Flow ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Doppler Ultrasound ◽  
Wall Thickness ◽  
Bowel Wall ◽  
Resistance Index ◽  
Anatomical Location ◽  
Biochemical Activity

Background—Current knowledge on splanchnic haemodynamics in Crohn’s disease is limited.Aims—To investigate which features of Crohn’s disease affect splanchnic haemodynamics, and to establish whether portal vein (PV) and superior mesenteric artery (SMA) blood supply reflects clinical or biochemical activity of Crohn’s disease.Methods—Seventy nine patients with Crohn’s disease and 40 controls were evaluated by Doppler ultrasound (US). The mean velocity of PV and SMA flow, the volume of blood flow of the PV and SMA, and the resistance index of SMA were studied. A series of clinical, biochemical, and US variables including Crohn’s disease activity index, serum C reactive protein concentrations, disease duration and its anatomical location, smoking habits, abdominal complications, and current medical therapy, as well as the maximum bowel wall thickness as measured by US, were determined. The relation between PV and SMA blood flow and these variables was assessed by univariate and multivariate analysis.Results—Patients with Crohn’s disease had significantly higher PV and SMA flow and a lower SMA resistance index than controls. Stepwise multiple regression analysis identified bowel wall thickness and location of the disease as the main predictive variables of both PV and SMA blood flow variation, accounting for 36% and 45% of their variability, respectively. No relation was found between splanchnic haemodynamics and disease activity.Conclusion—A hyperdynamic mesenteric circulation does exist in Crohn’s disease; however splanchnic blood flow does not reflect the clinical or biochemical activity of the disease, but seems to be linked more to other Crohn’s disease characteristics, such as maximum bowel thickness and anatomical location.

scholarly journals Dynamic contrast-enhanced ultrasound of the bowel wall with quantitative assessment of Crohn’s disease activity in childhood

2016 ◽  
Vol 50 (4) ◽  
pp. 347-354 ◽  
Author(s):  
Damjana Kljucevsek ◽  
Dubravka Vidmar ◽  
Darja Urlep ◽  
Rok Dezman
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Kinetic Parameters ◽  
Crohn Disease ◽  
Quantitative Assessment ◽  
Bowel Wall ◽  
Contrast Enhanced Ultrasound ◽  
Dynamic Contrast Enhanced ◽  
Contrast Enhanced

Abstract Background Contrast-enhanced ultrasound (CEUS) has become an established non-invasive, patient-friendly imaging technique which improves the characterization of lesions. In addition, dynamic contrast-enhanced ultrasound (DCE-US) provides valuable information concerning perfusion of examined organs. This review addresses current applications of CEUS in children, focused on DCE-US of the bowel wall in patients with Crohn disease, which enables realtime assessment of the bowel wall vascularity with semi-quantitative and quantitative assessment of disease activity and response to medical treatment. Conclusions Crohn’s disease is a chronic inflammatory relapsing disease. Frequent imaging re-evaluation is necessary. Therefore, imaging should be as little invasive as possible, children friendly with high diagnostic accuracy. US with wide varieties of techniques, including CEUS/DCE-US, can provide an important contribution for diagnosing and monitoring a disease activity. Even if the use of US contrast agent is off-label in children, it is welcome and widely accepted for intravesical use, and a little less for intravenous use, manly in evaluation of parenchymal lesions. To our knowledge this is the first time that the use of DCE-US in the evaluation of activity of small bowel Crohn disease with quantitative assessment of kinetic parameters is being described in children. Even if the results of the value and accuracy of different quantitative kinetic parameters in published studies in adult population often contradict one another there is a great potential of DCE-US to become a part of the entire sonographic evaluation not only in adults, but also in children. Further control studies should be performed.

scholarly journals P152 Bowel ultrasound as an early monitoring tool to assess disease activity in Crohn’s disease patients after induction therapy with infliximab

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S232-S232
Author(s):  
B Morão ◽  
C Nascimento ◽  
C Frias Gomes ◽  
T Gonçalves ◽  
F Castro ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Disease Activity ◽  
Induction Therapy ◽  
Bowel Wall ◽  
Intestinal Inflammation ◽  
Clinical Laboratory ◽  
Response To Therapy ◽  
Laboratory Parameters ◽  
Bowel Ultrasound

Abstract Background Bowel wall thickness (BWT) is an accurate sonographic parameter to assess disease activity in Crohn’s disease (CD). International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) was developed to allow a reproducible assessment of intestinal inflammation in CD using bowel ultrasound (IUS). Aim to assess BWT and IBUS-SAS variation after induction therapy with infliximab (IFX) and their correlation with clinical and laboratory parameters. Methods Prospective multicentre study including patients with active CD starting IFX. Harvey-Bradshaw index (HBI), C-reactive protein (CRP), faecal calprotectin (FC) and IUS were performed at week 0 (W0) and 14 (W14). IUS response and remission were defined as a reduction in BWT ≥25% and its normalization(≤3mm) in the most affected segment, respectively. IBUS-SAS was calculated using BWT, Doppler signal, bowel wall stratification (BWS) and inflammatory fat. Results We included 37 patients (62% males; median age 30 years, range 16–73). According to Montreal classification, most patients were A2 (70%), had ileocolonic disease (L3 57%) and an inflammatory phenotype (B1 60%); 41% had perianal disease. Most were anti-TNF therapy naive(84%), and combination therapy was used in 62%. Terminal ileum was the most affected segment identified by IUS (60%). Table 1 shows clinical, laboratory and sonographic parameters [median (IQR)]. At W14, 81% were in clinical remission, 43% in laboratorial remission (normal CRP and FC), 24% had IUS response and 11% had IUS remission. There was a significant reduction in HBI, CRP, FC and sonographic parameters (except for BWS) between W0 and W14. We found a fair to good correlation between BWT and HBI(r=0.363, p=0.03), CRP(r=0.391, p=0.02) and FC(r=0.373, p=0.03) at W14. IBUS-SAS had also a fair to good correlation with CRP(r=0.340, p=0.04) and FC(r=0.527, p=0.001) at W14. The area under the curve of IBUS-SAS for predicting clinical and laboratorial remission was 0.60; best-cut off 64.65 (sens. 57%; specif. 63%). Conclusion There was a significant reduction in sonographic parameters after 14 weeks of IFX and one quarter of our patients had an IUS response, suggesting that reduction in BWT could be an early marker of response to therapy. We found a good correlation between IUS and clinical and laboratory parameters at W14. IUS evaluation after induction therapy can be a helpful tool to monitor disease activity and guide CD patient management in our daily practice.

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