Bowel Perfusion Measured with Dynamic Contrast-enhanced Ultrasound Predicts Treatment Outcome in Patients with Crohnʼs Disease

Sævik, Fredrik; Nylund, Kim; Hausken, Trygve; Ødegaard, Svein; Gilja, Odd Helge

doi:10.1097/mib.0000000000000159

Cited by 68 publications

(58 citation statements)

References 39 publications

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“…To our knowledge, there are no other studies utilizing baseline CEUS as a tool to predict likelihood of response to medical therapy. Other studies investigated the role of posttreatment CEUS kinetic parameters in predicting the outcomes after commencing treatment and reported that follow‐up CEUS could identify nonresponders to medical treatment earlier . Larger studies are required to determine if baseline CEUS quantitative values can independently predict response to treatment and better triage the patients to those who would benefit from escalation or the addition of new treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The use of second-generation US contrast agents combined with low-mechanical-index real-time harmonic US has improved the accuracy of US in evaluating bowel wall vascularization in patients with CD. [8][9][10][11][12][13][14][15][16] Contrast-enhanced US (CEUS) has been used in patients with CD to correlate regional blood volume using a bolus injection method with normal bowel, 8 with color and power Doppler, 9 with endoscopy, 10 and with CDAI. 11 Also, there are a few reports of utilization of bolus CEUS to predict treatment response.…”

Section: Introductionmentioning

confidence: 99%

“…11 Also, there are a few reports of utilization of bolus CEUS to predict treatment response. [12][13][14][15][16] To our knowledge, there is no published study using the infusion technique. The purpose of this prospective study was to investigate whether pretreatment CEUS quantitative parameters of bowel wall blood flow, using both bolus and infusion techniques, correlate with other currently used clinical, laboratory, or endoscopic criteria of activity and could predict the clinical outcome in a cohort of CD patients treated medically.…”

Section: Introductionmentioning

confidence: 99%

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Associations between quantitative evaluation of bowel wall microvascular flow by contrast‐enhanced ultrasound and indices of disease activity in Crohn's disease patients using both bolus and infusion techniques

Zezos

Zittan

Islam

et al. 2019

J of Clinical Ultrasound

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Purpose The aim is to investigate whether baseline contrast‐enhanced ultrasound (CEUS) correlates with indices of activity in Crohn's disease (CD) and can predict response to medical treatment. Methods In this prospective study, symptomatic CD patients underwent baseline CEUS performed with Definity using both bolus and infusion methods. Time‐intensity curves (TIC), peak intensity (PI), and area under curve (AUC) from a region of interest over the diseased bowel were calculated for both bolus and infusion acquisitions. We used Mann‐Whitney U test for continuous and chi‐square/two‐tailed Fisher's exact test for categorical variable comparison and Spearman's correlation coefficient to correlate clinical score and CEUS kinetic parameters. Results Twenty‐one patients (9 men, 12 women, median age 32 years) were accrued. Fifteen patients had clinically active disease defined as Harvey‐Bradshaw Index (HBI) score ≥5. Median values of baseline CEUS parameters PI (bolus: 26 vs 8.86; P = .023 and perfusion: 7.6 vs 3.2; P = .009) and AUC (bolus: 769 vs 248.8; P = .036 and perfusion: 188.9 vs 73.9; P = .012) differed significantly in patients with active vs inactive disease. Nine patients with active disease underwent escalated or new treatment. Five were nonresponders. Responders had higher median values of baseline parameters (PI, bolus: 35 vs 18.8; P = .556, and perfusion: 7.6 vs 3.9; P = 190), (AUC, bolus: 1473.9 vs 314; P = .111, and perfusion: 154.7 vs 74.4, P = .286). Conclusions CEUS kinetic parameters correlate with clinical and laboratory indices and are significantly higher in patients with active disease. The responders had higher CEUS kinetic parameters than nonresponders that did not reach statistical significance in our small cohort.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Associations between quantitative evaluation of bowel wall microvascular flow by contrast‐enhanced ultrasound and indices of disease activity in Crohn's disease patients using both bolus and infusion techniques

Zezos

Zittan

Islam

et al. 2019

J of Clinical Ultrasound

View full text Add to dashboard Cite

show abstract

“…Lately, it has been highlighted that colonoscopy can be replaced with noninvasive techniques, such as Doppler ultrasound or CEUS, for the diagnosis of relapsed CD, but more studies are required [39,54,[72][73][74][75]. Doppler examination of the vascularization of thickened bowel wall is useful for the differentiation of relapse from remission and is well correlated with endoscopic findings both in adults, and children [35,43,71].…”

Section: Monitoringmentioning

confidence: 99%

The importance of intestinal ultrasound and elastographic techniques in inflammatory bowel diseases

Marin

Tribus

Fierbinţeanu-Braticevici

2018

Med Ultrason

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Inflammatory bowel diseases have an important impact upon the economic and social status due to their increasing incidence and prevalence, often affecting young people. At the moment, the therapeutic goal goes beyond the improvement of symptoms and laboratory parameters, being represented by endoscopic mucosal healing, changing the disease’s natural history. Even though endoscopy is the gold standard for the assessment of mucosal healing, it is an invasive maneuver and it lacks good repeatability. These patients require frequent evaluation; therefore, interest for noninvasive techniques has risen.As a consequence, the importance of intestinal ultrasound has increased lately and recent studies support its use to assess the degree of inflammation, to differentiate between remission and relapse, to monitor therapy response and guide treatment, to evaluate prognosis, and to diagnose complications. Another promising noninvasive imagistic technique is elastography which has gained interest because of its capacity to discriminate between inflammatory and fibrotic tissue, taking into account the different therapeutic options for the fibrotic strictures compared to inflammatory processes. This review summarizes the actual recommendations regarding the use of intestinal ultrasound and elastographic techniques for the diagnosis and monitoring of inflammatory bowel diseases.

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“…A 14 patient study of CE-US showed that delayed contrast wash-in (p ¼ 0.02) and wash-out (p ¼ 0.008) were associated with therapeutic non-response, though no full thickness histology was available. 17 A 39 subject study where patients were dichotomized as being predominantly fibrotic (requiring elective surgery for refractory stricturing disease), or inflammatory (no strictures, but required steroid or anti-TNF), found those judged to be fibrotic had a slower rate of perfusion compared to the inflammatory group (22.6 vs. 45.3 mL/min per 100 mL, p ¼ 0.003). 18 The same group found that the ratio of intestinal tissue perfusion to bowel wall thickness (cutoff of 0.56 mL/min/mm) predicted surgical vs. medically managed disease with an AUROC of 0.92 and sensitivity and specificity 82% and 94%, respectively.…”

Section: Perfusion As a Surrogate For Intestinal Fibrosismentioning

confidence: 99%

Imaging of intestinal fibrosis: current challenges and future methods

Stidham

Higgins

2016

United European Gastroenterology Journal

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Crohn's disease (CD) activity assessments are dominated by inflammatory changes without discrete measurement of the coexisting fibrotic contribution to total bowel damage. Intestinal fibrosis impacts the development of severe structural complications and the overall natural history of CD. Measuring intestinal fibrosis is challenging and existing methods of disease assessment are unable to reliably distinguish fibrosis from inflammation. Both the immediate clinical need to measure fibrosis for therapeutic decision-making and the near-future need for tools to assess pipeline anti-fibrotic medications highlight the demand for biomarkers of fibrosis in CD. Developing non-invasive technologies exploit changes in intestinal perfusion, mechanical properties, and macromolecular content to provide quantitative markers of fibrosis. In this review of existing and experimental technologies for imaging intestinal fibrosis, we discuss the expanding capabilities of quantitative MR and ultrasound imaging, encouraging developments in non-invasive elastography, and emerging novel methods including photoacoustic imaging.

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Bowel Perfusion Measured with Dynamic Contrast-enhanced Ultrasound Predicts Treatment Outcome in Patients with Crohnʼs Disease

Abstract: Article first published online 2 September 2014.

Cited by 68 publications

References 39 publications

Associations between quantitative evaluation of bowel wall microvascular flow by contrast‐enhanced ultrasound and indices of disease activity in Crohn's disease patients using both bolus and infusion techniques

Associations between quantitative evaluation of bowel wall microvascular flow by contrast‐enhanced ultrasound and indices of disease activity in Crohn's disease patients using both bolus and infusion techniques

The importance of intestinal ultrasound and elastographic techniques in inflammatory bowel diseases

Imaging of intestinal fibrosis: current challenges and future methods

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