Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn’s Disease: Systematic Review and Meta-Analysis

Abstract

Purpose To perform a systematic review with meta-analysis to assess whether ultrasound elastography can have a diagnostic role in detecting fibrotic bowel strictures in patients with Crohn’s disease. Materials and Methods MEDLINE via the PubMed, Ovid Embase, Scopus and Cochrane Library databases, and abstracts of international conference proceedings were searched up to March 31, 2018. Studies were included if they assessed the performance of abdominal ultrasound elastography in detecting fibrotic bowel strictures in patients with Crohn’s disease using histology or the need for surgery after medical treatment as a reference standard. The quality of the studies was assessed using Quality Assessment of Diagnostic Accuracy Studies. Results 6 studies including a total of 217 patients with Crohn’s disease and 231 bowel segments, of which 76 were bowel segments with fibrotic stricture, were selected. Three studies used strain ratio and three studies used strain value as parameters of bowel stiffness. Both the pooled standardized mean strain ratio and the pooled standardized mean strain value were higher in bowel segments with fibrotic strictures than in those without fibrotic strictures with a standardized mean difference of 0.85 (95 % confidence level [CI]: 0 to 1.71; p = 0.05) and 1.0 (95 % CI: –0.11 to 2.10; p = 0.08), respectively. There was a high heterogeneity between studies. All studies were at “high risk” or “unclear risk” of bias. Conclusion Ultrasound elastography could be able to detect fibrotic bowel strictures in patients with Crohn’s disease. Well-designed high quality diagnostic studies with a large sample size are needed.

Ultrasonographic Evaluation of Intestinal Fibrosis and Inflammation in Crohn’s Disease. The State of the Art

“…Three studies used strain elastography and showed that the strain ratio was higher in strictures with fibrosis compared to strictures without fibrosis (p 0.05). Similar results were found by the other three studies that used SWE, where the strain value was statistically higher in fibrotic stenosis (p 0.08) (Vestito et al, 2019).…”

“…Conventionally, the blue or red color means hard or soft tissue, respectively. The system gives either a qualitative and subjective assessment of the stiffness by examining the colors, and a quantitative estimation of the stiffness, by comparing the value within a region of interest in the wall with a similar one outside of the wall, usually taken from the softer tissue around (Stidham et al, 2011;Lu et al, 2019;Vestito et al, 2019). On the contrary, the SWE is a system that directly calculates the elasticity in kPascal thanks to the diffusion of the beam within the tissue in specific regions of interest, without the necessity to pressurize repeatedly the abdomen (Vestito et al, 2019).…”

Impact of intestinal ultrasound with a portable system in the management of Crohn’s disease

“…Given the substantial number of studies comparing MRE imaging with IUS imaging, our study did not aim to compare different radiologic modalities in a strictly controlled population, but to determine the yield of ultrasonographic examination performed using a portable system in a real-life setting. The portable ultrasonography system used in this study lacked elastography and contrast-enhanced ultrasonography modalities, both of which can increase the diagnostic capability of ultrasonographic imaging [ 25 , 26 ]. The addition of these modalities into portable systems may enhance the system’s accuracy in the future.…”

Intraoperative Ultrasound in Colorectal Surgery

“…Another study conducted by Chen [23] looked at the distinction of intestinal fibrosis from inflammation in Crohn's disease (CD)-associated strictures, as presented by Vestito [24] in a systematic review with meta-analysis to assess whether ultrasound elastography can have a diagnostic role in detecting fibrotic bowel strictures in patients with Crohn's disease. The study included consecutive CD patients with ileal/ileocolonic strictures who had shear wave elastography (SWE) within 1 week of surgical resection.…”