Acoustic radiation force impulse (ARFI) shear wave elastography of the bowel wall in healthy volunteers and in ulcerative colitis

Abstract

Background: Acoustic radiation force impulse (ARFI) elastography is a non-invasive, ultrasound-based approach of evaluation of tissue elasticity. It has not yet been systematically applied to the bowel wall. Purpose: To perform ARFI elastography of the bowel wall in healthy volunteers and patients with ulcerative colitis (UC). Material and Methods: A high-frequency ultrasound (with bowel wall thickness and vascularization score) and an ARFI elastography of the bowel wall were performed in 20 patients with UC and 13 healthy volunteers. At least 10 ARFI measurements were obtained within the terminal ileum and the ascending, transverse, descending, and sigmoid colon and correlated with results of high-frequency ultrasound. Results: The UC group had mostly moderate disease activity. All patients had signs of inflammation upon B-mode ultrasound. Eight patients showed an ulcerative (ileo)pancolitis. Overall, ARFI elastography values and wall thickness were higher in the UC group than in the group of healthy volunteers (P ¼ 0.021 and P < 0.001, respectively). ARFI velocities of the separate segments were significantly higher in the transverse (P ¼ 0.045) and sigmoid colon (P ¼ 0.032) in case of UC. Conclusion: ARFI elastography of the bowel wall of the colonic frame and the terminal ileum is feasible but shows high standard deviation. ARFI shear wave velocities appear to be slightly higher in patients with UC than in healthy volunteers, particularly in the sigmoid and transverse colon. Further studies are needed.

Using shear wave elasticity in normal terminal ileum of a healthy southwest Chinese population: a pilot study of reference elasticity ranges

“…The average value of E was 6.38±1.35 kPa in the normal intestine of healthy volunteers (with a sample size of 59 for the TI), which was higher than that in our study (3.84±1.84 kPa), and which may be related to the type of US device and the different sample size. A study conducted by Goertz et al (11) using acoustic radiation force impulse (ARFI) showed that normal SWV values of the TI were 1.6±0.35 m/s (compared with 1.08±0.25 m/s in this study). However, they investigated only 13 healthy volunteers and mainly focused on pathological states.…”

“…Several published articles have also confirmed that elastography can stably provide quantitative elasticity information in the IBD bowel wall. Goertz et al (11) found that the mean ARFI values in an ulcerative colitis group (1.97±0.64 m/s, n=20) were higher than those of a healthy control group (1.75±0.51 m/s, n=13). Ding et al (18) indicated that the optimal cut-off value was reached when the shear wave velocity exceeded 2.73 m/s in evaluating and differentiating intestinal stenosis in Crohn's disease, with a sensitivity of 75%, a specificity of 100%, and an accuracy of 96%.…”

“…Studies on the use of SWE in the small intestine are currently scarce (6) and have concentrated on intestinal diseases such as IBD rather than the normal bowel. Inflammation or fibrosis can lead to increases in bowel wall elasticity (11,14,17,31). Average elasticity values in the normal TI conducted with large cohorts have not been listed in the published guidelines and recommendations about the small intestine (32).…”

“…It was first used in GI diseases in 2013 by Dillman et al (10), who conducted a Crohn's disease animal model. Several studies have reported the value of using SWE, especially in inflammatory bowel disease (IBD) and rectal neoplasms (10)(11)(12)(13)(14)(15)(16)(17)(18)(19). For instance, it has proven effective in the differentiation of fibrotic from inflammatory strictures in Crohn's disease (14,18) and in assessing and staging rectal tumors (12,13,15).…”

Ultrasound Elastography in the Assessment of the Intestinal Changes in Inflammatory Bowel Disease—Systematic Review

“…We were able to find one study on ultrasound elastography in ulcerative colitis [ 32 ]. Goertz et al performed ARFI shear wave elastography in 20 UC patients.…”