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

Abstract

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.

Contrast-enhanced ultrasound of the pediatric bowel

“…Although this case series was small, the findings support the potential of CEUS to accurately detect active inflammation and to correctly discriminate between inflammatory and fibrotic strictures in the pediatric population (Fig. 6 ) [ 11 ].

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“…In children, the studies conducted with Lumason for evaluating children with Crohn disease used the 0.03 mL/kg weight-based dose, the same as the approved dose for pediatric liver and cardiac CEUS applications [ 9 , 11 ]. A previous study with the use of SonoVue in children with Crohn disease calculated the UCA dose according to the formula: dose (mL) = child age (years) / 10, with a minimum 0.1 mL per single injection [ 12 ].…”

“…Although no pediatric peak enhancement cut-off values exist, quantitative analysis can be guided by adult findings using peak enhancement cut-off values for mild, moderate and severe inflammation (Fig. 2 ) [ 11 , 12 ].

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“…One, a review article published in 2016, presented experience from using quantitative CEUS analysis in pediatric patients with Crohn disease and highlighted its potential to become an integral part of the sonographic evaluation of IBD in children as well as adults [ 12 ]. The other, published in 2019, presented a case series of two adolescents and one young adult (age range: 16–20 years) with Crohn disease, all of whom underwent CEUS, shear-wave elastography and MR enterography [ 11 ]. The first patient in the study had active inflammation of the terminal ileum, and CEUS accurately identified avid enhancement with more prompt wash-in, higher peak intensity, and a higher area under the curve compared to an adjacent, normal jejunal bowel loop.…”

The clinical value of multimodal ultrasound for the evaluation of disease activity and complications in inflammatory bowel disease

“…Elastic ultrasound can determine the presence of intestinal wall fibrosis by evaluating the stiffness of the intestinal wall. The combination of the two can better distinguish the degree of fibrosis and inflammation of intestinal stenosis in patients with CD (28). However, another study showed that the value of the CEUS parameter PE was moderately negatively correlated with that of fibrosis suggested by histopathology, and PE has no correlation with inflammation.…”