Can Contrast‐Enhanced Sonography Detect Bowel Wall Fibrosis in Mixed Inflammatory and Fibrotic Crohn Disease Lesions in an Animal Model?

Dillman, Jonathan R.; Rubin, Jonathan M.; Johnson, Laura A.; Moons, David S.; Higgins, Peter

doi:10.7863/ultra.16.04064

Cited by 10 publications

(6 citation statements)

References 22 publications

(45 reference statements)

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“…A study by Ripollés et al [20] demonstrated that inflammatory lesions had greater contrast enhancement when compared to fibrotic lesions. Additionally, our patient had a low elastography value, which was consistent with previous studies that demonstrate decreased tissue stiffness associated with acute inflammation when fibrosis is not present [192223]. Together, these findings suggest acute inflammation without the presence of fibrosis.…”

Section: Discussionsupporting

confidence: 91%

“…They found that no quantitative parameter could reliably detect fibrosis [23]. Strictures often contain both inflammatory and fibrotic components, and as such, CEUS perfusion parameters are predominantly affected by the degree of inflammation [23]. Our results are consistent with this study, as CEUS effectively identified the presence of acute inflammation, but a lack of contrast enhancement was common to both the surgical fibrotic stricture and the chronic inflammation with stricture formation.…”

Section: Discussionsupporting

confidence: 87%

“…However, another study using an animal model demonstrated that quantitative perfusion parameters cannot detect the degree of fibrosis in CD when inflammation is also present. They found that no quantitative parameter could reliably detect fibrosis [23]. Strictures often contain both inflammatory and fibrotic components, and as such, CEUS perfusion parameters are predominantly affected by the degree of inflammation [23].…”

Section: Discussionmentioning

confidence: 99%

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

Thimm

Cuffari

Garcia

et al. 2019

Pediatr Gastroenterol Hepatol Nutr

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Characterizing inflammation and fibrosis in Crohn's disease (CD) is necessary to guide clinical management, but distinguishing the two remains challenging. Novel ultrasound (US) techniques: contrast-enhanced US (CEUS) and shear wave elastography (SWE) offer great potential in evaluating disease activity in pediatric patients. Three patients ages 16 to 20 with known CD underwent CEUS and SWE to characterize bowel wall inflammation and fibrosis. Magnetic resonance enterography, endoscopy, or surgical pathology findings are also described when available. The patients' disease activity included acute inflammation, chronic inflammation with stricture formation, and a fibrotic surgical anastomosis without inflammation. CEUS was useful in determining the degree of inflammation, and SWE identified bowel wall fibrosis. Used together these techniques allow for better characterization of the degree of fibrosis and inflammation in bowel strictures. With further validation CEUS and SWE may allow for improved characterization of bowel strictures and disease flares in pediatric patients suffering from CD.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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

Thimm

Cuffari

Garcia

et al. 2019

Pediatr Gastroenterol Hepatol Nutr

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“…23 Similar observations were noted also in an animal model of CD. 24 This could be attributed to coexistence of mural fibrosis and active inflammation in varying amounts. Nevertheless, the results of a case series of three patients (two adolescents and one young adult) who underwent CEUS, shear wave elastography and MR enterography support the potential of CEUS to correctly discriminate between inflammatory and fibrotic strictures in CD.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Quantitative Contrast‐Enhanced Ultrasound in Comparison to Endoscopy in Children With Crohn's Disease

Ponorac

Dahmane

Urlep

et al. 2022

J of Ultrasound Medicine

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Objective Quantitative contrast‐enhanced US (CEUS) provides objective evaluation of bowel wall perfusion and has been reported as a useful method for evaluating Crohn's disease (CD) activity in children. We tested its' diagnostic accuracy in comparison to endoscopy and evaluated its' usefulness in comparison to Pediatric Crohn's Disease Activity Index (PCDAI) and fecal Calprotectin (FC). Materials and methods Children with CD and thickened bowel wall on abdominal US were prospectively enrolled. Disease activity was evaluated with quantitative CEUS, PCDAI and FC and compared to a simple endoscopic score for Crohn's disease (SES‐CD). Spearman's correlation and Cohen's kappa statistic between the SES‐CD and other disease activity measures were performed and diagnostic accuracies calculated. Results 36 children 3.5–18 years old (mean age 14 years) were included. The quantitative CEUS had 78.57% sensitivity (95%CI 0.59–0.92), 100% specificity (95%CI 0.63–1.0) and 83.33% diagnostic accuracy (95% CI 0.67–0.94). The concordance remission agreement with endoscopy was substantial for quantitative CEUS and PCDAI (quantitative CEUS: κ = 0.62; 95% CI 0.363–0.877; PCDAI: κ = 0.615; 95% CI 0.311–0.920), but only fair for FC (κ = 0.389; 95% CI 0.006–0.783). Correlation between all measures and endoscopy was moderate and statistically significant (quantitative CEUS: rs = 0.535, PCDAI: rs = 0.543, FC: rs = 0.497). Conclusions Quantitative CEUS has a potential of becoming a complementary method for evaluation of CD activity in children due to its' high specificity in comparison to endoscopy. Lower sensitivity makes it deficient as a single measure and further management should be guided by PCDAI and FC results as well.

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“…In a recently conducted animal study, imaging parameters derived from time-intensity curve analysis were compared to histopathological scores of tissue samples obtained from thickened bowel wall segments with experimentally induced inflammation mixed with variable degrees of fibrosis. In this study, quantitative CEUS perfusion parameters failed to differentiate bowel wall fibrosis if significant inflammation coexisted [ 57 ].…”

Section: Contrast-enhanced Ultrasound For Adults With Inflammatory Bowel Diseasementioning

confidence: 99%

Contrast-enhanced ultrasound of the pediatric bowel

et al. 2021

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Contrast-enhanced ultrasound (CEUS) has emerged as a valuable modality for bowel imaging in adults and children. CEUS enables visualization of the perfusion of the bowel wall and of the associated mesentery in healthy and disease states. In addition, CEUS images can be used to make quantitative measurements of contrast kinetics, allowing for objective assessment of bowel wall enhancement. Bowel CEUS is commonly applied to evaluate inflammatory bowel disease and to monitor treatment response. It has also been applied to evaluate necrotizing enterocolitis, intussusception, appendicitis and epiploic appendagitis, although experience with these applications is more limited. In this review article, we present the current experience using CEUS to evaluate the pediatric bowel with emphasis on inflammatory bowel disease, extrapolating the established experience from adult studies. We also discuss emerging applications of CEUS as an adjunct or problem-solving tool for evaluating bowel perfusion. Electronic supplementary material The online version of this article (10.1007/s00247-020-04868-x) contains supplementary material, which is available to authorized users.

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Can Contrast‐Enhanced Sonography Detect Bowel Wall Fibrosis in Mixed Inflammatory and Fibrotic Crohn Disease Lesions in an Animal Model?

Abstract: Contrast-enhanced sonographic quantitative perfusion parameters failed to effectively detect bowel wall fibrosis in the setting of superimposed inflammation in a Crohn disease animal model.

Cited by 10 publications

References 22 publications

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

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

Diagnostic Value of Quantitative Contrast‐Enhanced Ultrasound in Comparison to Endoscopy in Children With Crohn's Disease

Contrast-enhanced ultrasound of the pediatric bowel

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