Contrast-enhanced ultrasonographic evaluation of inflammatory activity in Crohn's disease

Vincenzo Migaleddu, Antonio M Scanu, Emilio Quaia, Paolo Cossu Rocca, Maria Pina Dore, Domenico Scanu, Lorenza Azzali, Giuseppe Virgilio

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND & AIMS: We sought to test the diagnostic accuracy of ultrasound (US), color Doppler US (CD-US), and contrast-enhanced US (CE-US) in the evaluation of inflammatory activity in patients with Crohn's disease (CD), and to correlate the findings of these sonographic studies with inflammatory activity, as scored by the CD activity index (CDAI).

METHODS: Patients with CD were enrolled in the study. Radiologists performing the scans were blinded to clinical status. Baseline US, CD-US, and CE-US examinations were conducted with high-frequency probes (8-14 and 5-7 MHz) before and after injection of sulfur hexafluoride-filled microbubbles. The diagnostic accuracy of baseline US, CD-US, and CE-US were calculated by using the endoscopic and histologic findings as reference standards and correlated with the CDAIs by using the Pearson linear correlation coefficient.

RESULTS: Forty-seven patients (20 men; 27 women; mean age +/- SD, 38 +/- 14 years) with a CDAI > 150 (n = 30) or < 150 (n = 17), were recruited. CE-US showed the highest performance, with 93.5% sensitivity, 93.7% specificity, and 93.6% overall accuracy. CE-US revealed 3 bowel wall perfusion patterns after microbubble injection: submucosal enhancement and inward and outward transparietal enhancement. The linear correlation coefficient for CE-US versus CDAI was 0.74 (P < .0001); for baseline US (assessing thickness, length, and multilayer appearance of the diseased bowel) versus the CDAI, the coefficients were 0.68 (P < .0001), 0.47 (P = .0009), and 0.60 (P < .0001), respectively; and for CD-US versus CDAI the coefficient was 0.73 (P < .0001).

CONCLUSIONS: CE-US has a high sensitivity and specificity in detecting inflammatory activity and a strong correlation with the CDAI.

Original languageEnglish
Pages (from-to)43-52
Number of pages10
JournalGastroenterology
Volume137
Issue number1
DOIs
Publication statusPublished - Jul 2009

Keywords

  • Adolescent
  • Adult
  • Aged
  • Contrast Media
  • Crohn Disease
  • Female
  • Humans
  • Male
  • Microbubbles
  • Middle Aged
  • Predictive Value of Tests
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Sulfur Hexafluoride
  • Ultrasonography, Doppler, Color
  • Young Adult

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