Contrast-enhanced ultrasound (CEUS) in Crohn’s disease: technique, image interpretation and clinical applications

Abstract

BackgroundRecent meta-analysis has demonstrated no significant differences in diagnostic accuracy among different imaging techniques (US, MRI and CT) in the evaluation of Crohn’s disease (CD). High-resolution bowel ultrasound has emerged as an alternative imaging technique for the diagnosis and follow-up of patients with CD, being as accurate as CT and MR for detecting intramural and extramural extension of the disease. B-Mode US can evaluate the localization and length of the affected intestinal segments and allow identification of transmural complications, stenosis and intestinal obstruction. Doppler techniques are tools that visualize and quantify bowel vascularization. Contrast-enhanced ultrasound (CEUS) is a new technique that involves IV administration of an ultrasound contrast agent with real-time examination, providing an accurate depiction of the bowel wall microvascularization and the perienteric tissues. The introduction of imaging quantification techniques enables an objective quantitative measurement of the enhancement.Method and resultsThe article reviews the technique, sonographic findings, advantages and limitations, and clinical applications of contrast-enhanced US in the evaluation of Cohn’s disease. Current CEUS applications in CD are: CD activity assessment, evaluation of inflammatory masses, distinguishing phlegmons from abscesses, characterization of stenosis by differentiating fibrosis from inflammation, monitoring the efficacy of drug treatments and improving the detection of disease recurrence.ConclusionCEUS is an emerging technique that is part of the entire sonographic evaluation, with a role in the diagnosis and follow-up of CD, thus improving therapy planning and monitoring of the efficacy of treatment.Electronic supplementary materialThe online version of this article (doi:10.1007/s13244-011-0124-1) contains supplementary material, which is available to authorized users.

Diagnostic imaging and radiation exposure in inflammatory bowel disease

“…It allows more accurate evaluation of bowel wall vascularisation. Mural hyper-enhancement following contrast in CEUS has been shown to correlate well with bowel inflammation and allows grading of CD activity [57,58] . CEUS also has the potential additional benefit of better distinguishing between inflammatory and fibro-stenotic lesions, which can be difficult with conventional ultrasound [58] .…”

“…Current studies suggest a role for CEUS in monitoring treatment response in CD, but further prospective studies are required to quantify how well CEUS correlates with endoscopic changes and SICUS [57] .…”

Oral and IV Contrast Enhanced Ultrasonography of the digestive tract – a useful completion of the B-mode examination: a literature review and an exhaustive illustration through images

“…In the early activity phase of the disease a process of angiogenesis takes place in the mucosa and submucosa [33]. Vascular proliferation leads to an increase of the blood flow in the intestine wall, an alteration that represents the basis for CEUS and other contrast imaging methods ability to demonstrate wall inflammation [34]. The CEUS signal is always visualized when there is intestinal congestion.…”

“…In patients with a long standing condition, inflammation and fibrosis may coexist in the same area. In these situations CEUS shows wall thickening, but it cannot differentiate between their pathological mechanisms [34].…”

Monitoring Disease Activity and Progression in Crohn's Disease. A Swiss Perspective on the IBD Ahead ‘Optimised Monitoring' Recommendations

“…Contrast-enhanced ultrasound (CEUS) and small intestine contrast ultrasound (SICUS) play a limited role in baseline assessment due to lack of standardisation and poor accessibility [93,94,95,96]. …”