Evaluation of Criteria for the Activity of Crohn’s Disease by Power Doppler Sonography

Abstract

Background/Aim: In recent years, power Doppler sonography has been proposed as a method to assess disease activity in patients with Crohn’s disease. The aim of this prospective study was to evaluate diagnostic criteria for power Doppler sonography by blinded comparison with ileocolonoscopy. Methods: Twenty-two patients with confirmed Crohn’s disease were prospectively investigated with B-mode and power Doppler sonography (HDI 5000, Philips Ultrasound) as well as ileocolonoscopy. Sonography was performed within 3 days before endoscopy. All procedures were performed by experienced examiners who were blinded to the clinical data and other results. Defined ultrasound parameters (bowel wall thickness, vascularization pattern) were used to determine a sonographic score of the activity. The degree of activity was scored from 1 (none) to 4 (high) by both ultrasound and ileocolonoscopy (pattern, extent of typical lesions). For each patient all segments of the colon and the terminal ileum were evaluated by both ultrasound and endoscopy. The weighted ĸ test was used (StatXact software) for statistical analysis. Results: In total, 126 bowel segments were evaluated by both ultrasound and endoscopy. The study showed a high concordance of power Doppler sonography and ileocolonoscopy (weighted ĸ by region: sigmoid colon: 0.81; transverse colon: 0.78; ascending colon: 0.75; cecum: 0.84; terminal ileum: 0.82). Highest concordance was found in the descending colon (weighted ĸ: 0.91; 95% CI: 0.83–0.98). Conclusions: Combination of B-mode and power Doppler sonography has a high accuracy in the determination of disease activity in Crohn’s disease when compared to ileocolonoscopy. The diagnostic criteria established in this study can be useful for the evaluation of inflammatory bowel diseases by ultrasound.

Magnetic resonance imaging for evaluation of disease activity in Crohn’s disease: a systematic review

“…Data on staging disease activity in CD are lacking for these techniques; by using the same inclusion criteria as we described above, only one article on power Doppler sonography [34] would be eligible for analysis (data not shown).…”

Significance of Abdominal Ultrasound in Inflammatory Bowel Disease

“…Although a number of authors have described the utility of color Doppler imaging in gastrointestinal disorders, particularly CD, celiac disease and mesenteric artery stenosis, its exact role in diagnosis and/or monitoring disease activity remains to be investigated further. In a trial with 22 patients with confirmed CD, a high concordance between a power Doppler ultrasound score (measuring vascularization) and the degree of local inflammation assessed with an endoscopic severity score was demonstrated with values from 0.83 to 0.98 [34] . A pilot study prospectively involving 20 patients demonstrated a highly significant correlation between the mean blood vessel density assessed by power Doppler sonography and the semiquantitative score tested by Limberg showing its potential application in routine clinical practice [35] .…”

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

“…Increased intramural vascularization is another US parameter for IBD, and it can be evaluated by Doppler ultrasound [42]. It is also a marker of active inflammation and is well correlated with endoscopic findings and CDAI [35,43]. The quantification of the degree of inflammation in this case is difficult, considering that the transmural vascularization is related to many factors, including the ingestion of food.…”

“…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]. For the evaluation of microvascularization, CEUS accuracy is comparable to MRI accuracy and superior to Doppler ultrasound [76].…”