Power Doppler sonography to predict the risk of surgical recurrence of Crohn’s disease

Abstract

Purpose The aim of this work is to investigate the role of power Doppler sonography as an additional predictor of surgical recurrence in Crohn's disease. Methods A sample of 33 patients, with ileal or ileocolonic Crohn's disease, that had underwent intestinal resection, were retrospectively enrolled. All patients had bowel ultrasonography 7-16 months after resection. Power Doppler sonography of the preanastomotic ileum was evaluated as a possible prognostication tool to assess the risk of long-term need for reoperation. Results The absolute incidence of surgical recurrence in those who had a positive power Doppler was 42 %, while that of those who had a negative power Doppler was 28.6 %. Combining the power Doppler with bowel wall thickness, the surgical recurrence risk grew from 41.2 % of those with a positive power Doppler and thickness [3 mm to 55.6 % of those with a positive power Doppler and thickness [6 mm. Conclusions Power Doppler look to be another useful prediction tool for the personalization of patient's care. It could be useful to perform power Doppler in all patients with a wall thickness [5 mm: for those who have a positive power Doppler it may be indicated as a more aggressive prophylactic therapy.Riassunto Scopo L'obiettivo di questo lavoro è investigare il ruolo del power Doppler ecografico come fattore predittivo aggiuntivo della recidiva chirurgica nella malattia di Crohn. Metodo Un campione di 33 pazienti, con malattia di Crohn ileale o ileo-colica, che sono stati sottoposti a resezione intestinale, sono stati arruolati retrospettivamente. A tutti i pazienti è stata effettuata un'ecografia intestinale nei 7-16 mesi successivi alla resezione. E' stato valutato il power Doppler ecografico dell'ileo pre-anastomotico come un possibile predittore del rischio di necessità di una nuova operazione nel lungo termine. Risultati L'incidenza assoluta di recidiva chirurgica nei pazienti con power Doppler positivo è risultata essere del 42 %, mentre quella nei pazienti con power Doppler negativo è risultata essere del 28.6 %. Unendo i risultati del power Doppler con quelli dello spessore di parete, il rischio di recidiva chirurgica aumenta dal 41.2 % di quelli con power Doppler positivo e spessore di parete intestinale [3 mm al 55.6 % di quelli con power Doppler positivo e spessore di parete [6 mm. Conclusioni Il power Doppler sembra essere un ulteriore utile fattore predittivo per personalizzare la terapia del

Acoustic radiation force impulse (ARFI) shear wave elastography of the bowel wall in healthy volunteers and in ulcerative colitis

“…High-frequency ultrasound of the bowel wall is used in patients with UC to reveal signs of inflammation such as bowel wall thickening, loss of wall stratification, or increased blood flow within the thickened wall (15,16). This inflammation may change elasticity of the bowel wall and might be depicted by ARFI point shear wave elastography.…”

Role of Intestinal Ultrasound in the Management of Patients with Inflammatory Bowel Disease

“…In addition to bowel wall thickness, increased vascularization measured by Doppler signal or CEUS may be additional tools to predict POR [ 38 , 39 ]. An Italian group identified bowel wall thickness (cutoff value of bowel wall thickness > 3 mm) and power color Doppler at anastomosis assessed by IUS one year after surgery as predictors of early recurrence after ileo-colonic resection.…”

A preserved stratified pattern of the bowel wall 1 year after major surgery does not influence the surgical recurrence of Crohn’s disease

“…In two recent studies we found that bowel wall thickness at the anastomosis >3 mm, detected through bowel ultrasound performed 1 year after surgery [3], with additional contribution of power-colour Doppler [4] could be added to the list of non-invasive predictors of early recurrence after ileo-colonic resection besides those already known in literature.…”

“…The hypoechoic echopattern of bowel wall is associated with predominant acute inflammatory changes of bowel wall when compared to the stratified pattern [5], like a positive power Doppler [4].…”