Predictive value of time–intensity curves obtained with contrast-enhanced ultrasonography (CEUS) in the follow-up of 30 patients with Crohn's disease

Abstract

Objectives: CEUS can provide accurate quantitative estimates of intestinal wall microvascularization in Crohn's disease. We hypothesized that inflammation of the intestinal wall is correlated not with the amount of wall vascularization (study of vascularization patterns, SVP) but with the degree of wall flow during a period of time (timeeintensity study, TIS). Our objective was to discover whether CEUS SPV and/or CEUS-TIS reflect(s) vascular inflammation of the intestinal wall and display(s) correlation with clinical activity of the disease at the time of the examination (T0) or at the 3-and 6-month follow-up (T3, T6). Materials and methods: 30 patients with Crohn's disease (12 men, 18 women, mean age: 41.96 years; treatment: 5-ASA (n Z 8), steroids (n Z 13), anti-TNF (n Z 7), azathioprine (n Z 2) were studied with CEUS SPV and CEUS-TIS and followed for at least 6 months. The sonographic examinations were performed with SonoVue (BR1, Bracco) and a dedicated scanner (TECHNOS MPX, Esaote) equipped with software for calculation of timeeintensity curves. Four vascular patterns (1: vascularization of the entire wall; 2: vascularization of >50% of the wall; 3: flow exclusively within the submucosal layer; 4: no signal). The semiquantitative analysis consisted in measurement of the area under the curve (AUC) (cut-off between active and inactive disease, 15), mean intesnity (IMA) (cut-off Z 10). Each examination (180 s) was digitally recorded and analyzed. Results: T0: cDAI <150 in 22 pts; cDAI > 150 in 8; T3: 22 pts. with cDAI<150, 8 with cDAI >150. At T0 CEUS SPV and CEUS-TIS both displayed low specificity, diagnostic accuracy, and negative predictive values (p Z ns). At T0, CEUS SPV produced 8 true positives (TP), 15 true negatives (TN), 8 false positives (FP), 0 false negative (FN) (sensitivity: 100%; specificity: 68.2%; diagnostic accuracy: 69.5%; Positive predictive value (PPV): 100%; negative predictive value (NPV: 53.3%), and CEUS-TIS produced 6 TP, 18 TN, 4 FP, 2 FN (sensitivity 75%; specificity: 81.8%; diagnostic accuracy: 75%; PPV: 60%; NPV: 90% NPV: 80%), and CEUS SIT produced the following results: 10 TP, 19 TN, 0 FP, 1 FN (sensitivity: 90,9%; specificity: 100%; diagnostic accuracy: 96,5%; PPV: 100%; NPV: 95%). At T3 CEUS-SVP displayed low sensitivity and low diagnostic accuracy, whereas SIT was able to predict clinical activity during follow-up in all but one case (which showed reactivation after 6 months) (p Z 0.001) Conclusion: CEUS-TIS alone was found to reflect vascular inflammation of the intestinal wall in Crohn's disease and predicted clinical activity during follow-up.a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c oSommario Obiettivi: La CEUS è in grado di quantificare accuratamente la microvascolarizzazione della parete intestinale nel Crohn. Ipotesi: L'infiammazione della parete intestinale non è correlata con la quantità di parete vascolarizzata (studi di pattern di vascolarizzazione -SPV), ma con il grado di flusso di parete durante un periodo di tempo (studi di intensità...

Contrast-Enhanced Ultrasound in the Diagnosis of Patients Suspected of Having Active Crohn's Disease: Meta-analysis

“…Thirteen articles were further excluded because they lacked calculable data. Ultimately, eight original articles met the inclusion criteria and were included in our final meta-analysis (Castiglione et al 2008;Giangregorio et al 2009;Migaleddu et al 2009;Paredes et al 2013;Parente et al 2004;Rapaccini et al 2004;Ripoll es et al 2009Ripoll es et al , 2013. The flow diagram for the literature search is illustrated in Figure 1.…”

“…To confirm the final diagnosis of active CD, two studies used only endoscopy as the reference standard (Castiglione et al 2008;Ripoll es et al 2009), and another two studies used not only endoscopy, but also barium enteroclysis (Parente et al 2004) and biopsy (Migaleddu et al 2009). The Crohn's Disease Activity Index (CDAI) was used as the gold standard in one study (Giangregorio et al 2009). Finally, one study used the combined clinical findings, laboratory data and either barium enema or endoscopic findings as the reference (Rapaccini et al 2004).…”

201 Intraoperative Cerebral Glioma Characterization With Contrast Enhanced Ultrasound

“…Tissue perfusion may be quantified also by further evaluating the replenishment kinetics of the volume of microbubbles after their destruction in the imaged slice (using high mechanical index US), obtaining quantitative parameters related to local tissue perfusion [15,19]. However, we believe that the first step, as already performed for other organs and in our previous study [34], is the qualitative and semiquantitative analysis; timeintensity curves providing quantitative data require very large cohorts of patients in order to achieve a statistical relevance, so we feel that a quantitative analysis would be of little value in this study [28,29,32,33].…”

“…Harrer et al used bedside transcranial CEUS prior to surgery and had been capable of discriminating brain lesions from the brain parenchyma and of partially describing them. Vicenzini et al performed time intensity/curves using dedicated software: indeed time-intensity curves should be performed on a large sample size in order to provide statistically relevant results [28]. However tumor visualization was somehow poor due to transcranial US performed through a temporal window: 7 despite being a well-established technique it suffers from limitations to tumor visualization due to the presence of the cranial vault in terms of both spatial resolution and tumor location.…”

The features of intestinal tuberculosis by contrast-enhanced ultrasound

“…It has been reported that CEUS can be used to identify the recurrence of intestinal Crohn's disease [5], whose patterns of bowel wall enhancement were correlated with the extent of inflammatory response. Increased perfusion was considered to be an indicator of active inflammation in the intestinal wall [27]. In acute bowel inflammation, increased echogenicity of the third bowel wall layer (submucosa), due to intense vascularization, was observed.…”