Bowel elastography – a pilot study for developing an elastographic scoring system to evaluate disease activity in pediatric Crohn’s disease.

Abstract

The diagnosis and monitoring of Crohn's disease (CD) represents a diagnosis challenge in which imaging plays an important role. Aim: In the present paper we aim to demonstrate the role of sonoelastography (SE), performed in addition to hydrosonography (HS), in the evaluation of CD in children and to propose a scoring system for the appreciation of disease activity. Material and method: All the patients included into the study were diagnosed with CD and had underwent HS and SE as part of the imaging evaluation. In selected cases magnetic resonance enterography (MRE) was also performed. SE aspects were classified into three types, each corresponding to a specific bowel wall pattern: normal or remission (type A), inflammation (type B) and fibrosis (type C); this classification represents the basis of the scoring system. For the purpose of statistical analysis each evaluated bowel segment became an individual case. Results: Forty eight bowel segments were evaluated by SE: 21 type A, 20 type B and 7 type C. Statistically significant correlations were found between the intestinal wall HS changes, presence of complications, activity markers and the SE score. The HS assessment of the periintestinal area correlated only partially with SE score, while certain SE scores also proved to be predictors for the presence of complications or for increased values of the disease activity markers. Conclusions: SE, along with HS, represents a reliable investigation in the correct diagnosis and monitoring of pediatric patients with CD and the SE scoring system may be introduced as a method for the assessment of disease activity.

Contrast-Enhanced Ultrasound and Shear Wave Elastography Evaluation of Crohn's Disease Activity in Three Adolescent Patients

“…Other studies have demonstrated the value of elastography to evaluate children with CD. A study by Fufezan et al [17] created an elastography scoring system for the assessment of CD inflammation and fibrosis. This classification system demonstrated that elastography could predict increased levels of disease activity markers, like C-reactive protein and erythrocyte sedimentation rate, and could predict disease complications [17].…”

“…A study by Fufezan et al [17] created an elastography scoring system for the assessment of CD inflammation and fibrosis. This classification system demonstrated that elastography could predict increased levels of disease activity markers, like C-reactive protein and erythrocyte sedimentation rate, and could predict disease complications [17]. However, there is a paucity of research that utilizes CEUS and elastography together to assess CD activity in the pediatric population.…”

Non-invasive evaluation of intestinal disorders: The role of elastographic techniques

“…Later, Fufezan et al[48] tried to evaluate the role of strain elastography in the setting of pediatric Crohn’s disease, with the aim of widening the range of non-invasive methods to avail. In their study these authors examined 48 bowel segments of 14 pediatric CD patients, and attempted to develop a visual classification of bowel wall appearance at UEI (remission bowel, inflammatory wall and fibrotic wall) and to correlate it with clinical and US features.…”

“…The results suggested some correlation between different UEI visual patterns and US and clinical signs of disease activity or complications. However, these preliminary results were not compared to histology or stratified for types of current therapy, thus requiring validation in a large prospective study[48]. …”

Commentary: PET/MR Versus PET/CT Imaging: Impact on the Clinical Management of Small-Bowel Crohn’s Disease

“…There is evidence that ultrasound-derived stiffness measurements correlate with intestinal fibrosis assessed histologically and can differentiate fibrotic from inflamed bowel in ex vivo segments from patients with inflammatory bowel disease (7). Further small studies have shown that “real-time” UEI can accurately identify fibrotic sections of bowel (8, 9). In a study (8) of patients with established stenotic Crohn’s disease awaiting surgery, ultrasound-based measures of strain correlated highly between pre-, intra-, and post-operative values, which were similar to those values measured by direct tensiometry.…”