Prevalence and clinical significance of sonographic evidence of mesenteric fat alterations in Crohnʼs disease

Maconi, Giovanni; Greco, Salvatore; Duca, Piergiorgio; Ardizzone, Sandro; Massari, A.; Cassinotti, A.; Radice, E.; Porro, G. Bianchi

doi:10.1002/ibd.20515

Cited by 72 publications

(52 citation statements)

References 24 publications

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“…Of the ten patients whose intestinal walls appeared hypoechoic, only 2 (20%) presented clinical signs of active disease. None of the patients had free fluid in the peritoneal cavity; lymphadenopathy was observed in three patients with active disease and internal fistulas, as previously described in the literature [32]. Power Doppler studies revealed vascular signals in 23 patients, but rich wall vascularization could be found in only four.…”

Section: Resultssupporting

confidence: 62%

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

Giangregorio

Bertone

Fanigliulo

et al. 2009

Journal of Ultrasound

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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...

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Section: Resultssupporting

confidence: 62%

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

Giangregorio

Bertone

Fanigliulo

et al. 2009

Journal of Ultrasound

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“…Although this feature have been thought to be related to increased disease activity, we must emphasize that there are a few studies that show a significant correlation and further are needed. In quiescent CD, mesentery hypertrophy does not seem to be a risk factor of relapse [45].…”

Section: Ultrasonographic Features Of the Intestinal Wall In Crohn's mentioning

confidence: 90%

“…Maconi et al [45] showed that enlarged mesenteric lymph nodes are found more frequently in young patients (p \ 0.0001) and with a shorter disease duration; in particular age, disease's duration and the presence of internal fistulas or intra-abdominal abscesses have been demonstrated to be the best independent predictive factors linked to the presence of enlarged mesenteric lymph nodes. Although this feature have been thought to be related to increased disease activity, we must emphasize that there are a few studies that show a significant correlation and further are needed.…”

Section: Ultrasonographic Features Of the Intestinal Wall In Crohn's mentioning

confidence: 99%

Ultrasonographic findings in Crohn’s disease

2014

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In recent years transabdominal bowel sonography has become a first-line modality both in the diagnosis and in the follow-up of inflammatory bowel diseases, especially Crohn's disease, reaching values of sensitivity ranging from 84 to 93 %. In particular, its role is very useful in the early diagnosis of complications such as stenosis, phlegmons, abscesses and fistulae. According to the available literature the ability of US to provide information about disease activity is still under debate and further studies are necessary. In this regard, of fundamental importance is the use of additional techniques such as color-and power-Doppler and contrast-enhanced ultrasound. The purpose of this paper is to report the main sonographic intestinal and extraintestinal findings detectable in Crohn's disease.Keywords Transabdominal bowel sonography Á Crohn's disease Á Color and power Doppler Á CEUS Á Disease activity Riassunto Nel corso degli ultimi anni l'ecografia delle anse intestinali è andata affermandosi come metodica di prima linea nella diagnosi e nel follow-up delle malattie infiammatorie croniche intestinali, soprattutto nella malattia di Crohn, con valori di accuratezza diagnostica dell'84-93 %. In particolare il suo ruolo risulta preminente nella precoce diagnosi delle complicanze, quali stenosi, flemmoni, ascessi e fistole. In accordo con la letteratura disponibile più discussa rimane la capacità di fornire informazioni circa l'attività di malattia ed ulteriori studi appaiono necessari. A tal proposito è fondamentale l'utilizzo di metodiche quali color e power Doppler e l'ecografia con mezzo di contrasto (CEUS). Scopo del presente lavoro è quello di riportare i principali quadri ecografici intestinali ed extra-intestinali evidenziabili nella malattia di Crohn.

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“…Usually, these findings totally or partially disappear during remission [31,39,40]. However, in remission or quiescent CD, mesenteric fat hypertrophy is not a risk factor for relapse [41]. Increased intramural vascularization is another US parameter for IBD, and it can be evaluated by Doppler ultrasound [42].…”

Section: Ultrasoundmentioning

confidence: 99%

“…Intraperitoneal fluid can be present as a consequence of transmural inflammation [37,38]. The finding of enlarged lymph nodes does not correlate with the course of CD, but their presence is strongly associated with the duration of the disease and the existence of internal fistulas [44].…”

Section: Ultrasoundmentioning

confidence: 99%

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

Marin

Tribus

Fierbinţeanu-Braticevici

2018

Med Ultrason

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Inflammatory bowel diseases have an important impact upon the economic and social status due to their increasing incidence and prevalence, often affecting young people. At the moment, the therapeutic goal goes beyond the improvement of symptoms and laboratory parameters, being represented by endoscopic mucosal healing, changing the disease’s natural history. Even though endoscopy is the gold standard for the assessment of mucosal healing, it is an invasive maneuver and it lacks good repeatability. These patients require frequent evaluation; therefore, interest for noninvasive techniques has risen.As a consequence, the importance of intestinal ultrasound has increased lately and recent studies support its use to assess the degree of inflammation, to differentiate between remission and relapse, to monitor therapy response and guide treatment, to evaluate prognosis, and to diagnose complications. Another promising noninvasive imagistic technique is elastography which has gained interest because of its capacity to discriminate between inflammatory and fibrotic tissue, taking into account the different therapeutic options for the fibrotic strictures compared to inflammatory processes. This review summarizes the actual recommendations regarding the use of intestinal ultrasound and elastographic techniques for the diagnosis and monitoring of inflammatory bowel diseases.

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Prevalence and clinical significance of sonographic evidence of mesenteric fat alterations in Crohnʼs disease

Abstract: Mesenteric adipose tissue alteration is correlated with biochemical and clinical activity of CD and with internal fistulas and increased bowel wall thickness. In quiescent CD, mesenteric hypertrophy does not appear to be a risk factor of relapse.

Cited by 72 publications

References 24 publications

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

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

Ultrasonographic findings in Crohn’s disease

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

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