The use of ultrasound in inflammatory bowel disease

Abstract

Imaging in inflammatory bowel disease (IBD) plays a pivotal role in the primary diagnosis, as well as during the management of patients with known IBD. The evolution of ultrasound equipment and the growing expertise of examiners have both enhanced the role of intestinal ultrasound in the assessment of the gastrointestinal tract in IBD patients. Intestinal ultrasound has been shown to have high sensitivity and specificity, as well as high positive and negative predictive value, in the detection or exclusion of intestinal inflammatory activity in IBD. The obvious advantages of intestinal ultrasound over other imaging modalities include non-invasiveness, rapid availability and low costs. This review summarizes the current developments in the use of intestinal ultrasound for the detection of IBD and its complications, and discusses its use in the management of patients with IBD. Indications for the use of intestinal ultrasound in daily practice are presented, expanded by new developments such as contrast-enhanced ultrasonography and elastography.

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

“…On the other hand, in the case of CD, the stratification of the intestinal wall can be disorganized as a sign of active inflammation [38]. The evaluation of the surrounding structures is also very important as the proliferation of mesenteric fat tissue near the inflamed bowel is a sign of active CD [37,38]. Usually, these findings totally or partially disappear during remission [31,39,40].…”

“…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. 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].…”

“…They can contain air visible as hyperechoic areas [38]. Comparing with double contrast barium enema US showed a higher sensitivity for diagnosis internal fistulae.…”

“…The role of abdominal US in UC is not as well defined as in CD, mostly because the bowel wall is not always thickened, the inflammation is limited to the mucosa and the bowel wall stratification is preserved in most of the subjects [38,88].…”

“…However, in severe active forms of UC, extramural signs such as fibrofatty proliferation, peritoneal fluid, and even "mesenteric lines" can be visible, even though most of the time, this condition is largely limited to the mucosa [38].…”