shu-508 and Crohn-Disease

Transabdominal ultrasound is currently accepted as a clinical first-line tool in the assessment of Crohn's disease activity. During recent years, great improvements have been achieved in ultrasound examination with the introduction of high-frequency transducers, ultrasonographic microbubble contrast agents, and dedicated contrast-specific ultrasound software. Therefore, contrast-enhanced ultrasonography (CEUS) is emerging as one of the most important imaging techniques in the diagnosis and follow-up of patients with ileal Crohn's disease. It is non-invasive and non-ionizing, easily repeatable, well-tolerated by patients and has significant diagnostic accuracy. Moreover, the possibility to monitor response to therapies, describing, and quantifying contrast enhancement behavior by specific software, represents an interesting aspect of its utilization, considering the still open questions about the correct use of immunosuppressive and biological agents. The aim of our review is to provide an updated overview of the role of CEUS in the patients who have an ileal localization of Crohn's disease, defining its qualitative and quantitative features.

Topics: Contrast Media; Crohn Disease; Humans; Ileal Diseases; Image Interpretation, Computer-Assisted; Phospholipids; Polysaccharides; Sensitivity and Specificity; Sulfur Hexafluoride; Ultrasonography

Although transabdominal bowel sonography (TABS) has been proposed as a reliable tool to assess increased bowel wall thickness (BWT), the most common sonographic pattern in patients with Crohn's disease (CD), its accuracy is limited in the diagnosis of CD. We therefore tried to assess whether color Doppler enhancement with Levovist, a galactose-based intravenous sonographic contrast agent able to enhance the arterial Doppler signal, increases TABS accuracy. Thirty-one patients with ileal CD, diagnosed by endoscopy and enteroclysis, and 20 healthy volunteers were examined with conventional TABS. Color Doppler of the intramural enteric vessels was then performed before and after intravenous injection of Levovist. Twenty-two CD patients had a BWT >4 mm, and 16 of them presented with active disease. Two of the remaining nine CD patients, all with BWT <4 mm, presented with active disease. By means of color Doppler we identified six patients with inactive disease, normal BWT, and normal basal Doppler signal intensity, who showed an enhanced Doppler signal in intramural vessels after contrast agent bolus. Four of these patients, identified only by color Doppler after Levovist injection, relapsed within 6 months. In our experience, sensitivity and specificity of TABS, integrated with additional stimulated acoustic emission mode, were 96.7% and 100%, respectively. The use of Levovist in color Doppler increases the accuracy of TABS in CD diagnosis and follow-up.

Topics: Abdomen; Adolescent; Adult; Colon; Contrast Media; Crohn Disease; Endoscopy; Female; Humans; Injections, Intravenous; Male; Middle Aged; Polysaccharides; Sensitivity and Specificity; Ultrasonography, Doppler, Color

Harmonic flash echo imaging (H-FEI), an intermittent scanning method using injection of Levovist, enables the evaluation of microperfusion of the gastrointestinal wall. The aim of this study was prospectively to investigate the relationship between bowel blood flow and the likelihood of the need for surgery in 70 patients with active Crohn's disease (CD), using conventional ultrasonography (US) and H-FEI.. For H-FEI, Levovist injection was followed by scanning of the bowel segment of interest with intermittent harmonic imaging for 2 min (interval, 4 s; transmission pulse at 2.3 MHz; reception at 4.6 MHz). We calculated the mean echo-intensity for the bowel wall showing strongest opacity in the FEI series for each patient. Maximum bowel-wall thickness, wall stratification, maximum echo-intensity obtained by H-FEI, CD activity index, and C-reactive protein concentration were compared between patients treated successfully with medication after H-FEI (group M) and those who proved to need surgery (group S).. No significant differences in clinical variables were evident between groups M (n=45) and S (n=25). The subsequent need for surgery was significantly indicated by multivariate analysis, showing loss of stratification in the bowel wall (odds ratio (OR)=5.98, 95% confidence interval (CI)=1.4-25.1, p=0.015) and high echo-intensity according to H-FEI (OR=1.02, CI=1.005-1.034, p=0.007).. In active CD, patients with bowel segments showing a loss of stratification and rich perfusion by H-FEI are likely to need surgical treatment.

Topics: Adolescent; Adult; Colectomy; Colitis; Colon; Confidence Intervals; Contrast Media; Crohn Disease; Decision Making; Female; Follow-Up Studies; Humans; Injections, Intravenous; Male; Microbubbles; Middle Aged; Odds Ratio; Polysaccharides; Prospective Studies; Reproducibility of Results; Severity of Illness Index; Ultrasonography

The purpose of this study was to evaluate the potential usefulness of contrast-enhanced power Doppler ultrasound in the detection and follow-up of local complications (phlegmon and abscess) in Crohn's disease.. With this aim, 28 patients with suspected abdominal inflammatory mass were examined with power Doppler ultrasound before and after intravenous administration of the ultrasound contrast agent Levovist, with evaluation of vascularity within and/or around the inflammatory mass. Colour Doppler flow was characterized as clearly visible, minimally visible or absent. All the patients underwent a post-contrast computed tomography exam.. Power Doppler ultrasound, after administration of contrast medium, allows the detection of small inflammatory masses in Crohn's disease, particularly those under 2 cm in diameter, when compared with computed tomography.. We conclude that contrast-enhanced power Doppler ultrasound is a sensitive method for the detection of small abdominal inflammatory masses and for differential diagnosis between phlegmon and abscess.

Topics: Abscess; Adolescent; Adult; Cellulitis; Contrast Media; Crohn Disease; Female; Follow-Up Studies; Humans; Intestinal Diseases; Male; Polysaccharides; Prospective Studies; Ultrasonography, Doppler

To use power Doppler sonography to quantify the vascularization in the area of stenosed bowel segments in patients with Crohn's disease and to draw conclusions from these findings with regard to the development of these stenoses.. The study collective included 11 patients with confirmed Crohn's disease and sonographically visualized stenoses of the small bowel together with intermittent abdominal cramping as a clinical correlate. Power mode examination was repeated after application of a sonographic signal-enhancing agent. Semiquantitative evaluation based on the sonographically indicated degree of vascularization led to the presumptive diagnosis of either inflammatory or cicatricial intestinal obstruction. Sonographic diagnoses were compared with the findings of surgery and subsequent histologic examination or with patients' clinical responses to conservative therapy.. Nine of 11 patients underwent surgery within 1 year of examination. All 3 cases in which sonography had facilitated the diagnosis of cicatricial stenosis were confirmed at postoperative histologic examination; similarly, the surgical and histologic findings in the other 6 patients confirmed the sonographic diagnosis of inflammatory stenosis.. Power Doppler sonography in combination with the use of a signal-enhancing agent appears to be effective in the recognition of predominantly cicatricial stenoses in patients with Crohn's disease.

Topics: Adult; Contrast Media; Crohn Disease; Female; Humans; Intestinal Obstruction; Intestine, Small; Male; Polysaccharides; Ultrasonography, Doppler