The Value of Small Bowel Wall Contrast Enhancement After Sulfur Hexafluoride-Filled Microbubble Injection to Differentiate Inflammatory from Fibrotic Strictures in Patients with Crohn's Disease

Quaia, Emilio; Paoli, Luca De; Stocca, Tiziano; Cabibbo, Biagio; Casagrande, Federica; Cova, Maria Assunta

doi:10.1016/j.ultrasmedbio.2012.04.008

Cited by 64 publications

(50 citation statements)

References 22 publications

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“…In patients with fibrotic disease, blood volume and blood flow appear to be reduced [67]. Quaia et al demonstrated that inflammatory versus fibrotic ileal strictures differed in the percentage of maximal enhancement (45 vs. 37%; p \ 0.05) and area under the enhancement curve (1168 vs. 570; p \ 0.05), whereas the difference in time to peak enhancement was not significant (p [ 0.05) [68]. In addition, quantitative CEUS measurements of bowel enhancement correlated with the severity grade determined at endoscopy: mural contrast enhancement was markedly increased compared with enhancement in patients with inactive disease (p \ 0.001); a threshold brightness value of a percentage of increase of 46% had a sensitivity and specificity of 96 and 73%, respectively, in the prediction of moderate or severe grade for endoscopic inflammation [69].…”

Section: Ceusmentioning

confidence: 99%

SICUS and CEUS imaging in Crohn’s disease: an update

et al. 2017

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Endoscopy remains the main technique in the diagnosis and treatment of Crohn's disease (CD); nevertheless, the recent development of innovative and non-invasive imaging techniques has led to a new tool in the exploration of small bowel in CD patients. This paper reviews the available data on ultrasound imaging used for the evaluation of CD, highlighting the role of small intestine contrast-enhanced ultrasonography with the use of oral and intravenous contrast agents.Keywords Crohn's disease Á Contrast-enhanced ultrasound Á Small intestine contrast ultrasonography Sommario Nell'iter diagnostico e terapeutico della malattia di Crohn l'endoscopia rappresenta la principale metodica strumentale. Tuttavia, la recente introduzione di tecniche di imaging innovative e non invasive ha implementato lo studio dell'intestino nelle malattie infiammatorie croniche intestinali. La seguente revisione raccoglie i dati disponibili in letteratura relativi all'utilizzo dell'ecografia con mezzo di contrasto, sia orale (SICUS) sia endovenoso (CEUS), nella valutazione dei pazienti affetti da malattia di Crohn.

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Section: Ceusmentioning

confidence: 99%

SICUS and CEUS imaging in Crohn’s disease: an update

et al. 2017

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“…This pattern indicates reduced elasticity of the intestinal wall inflammatory and fibrotic strictures. The authors also provide cutoff values for an accurate diagnosis [8]. In their study, Nylund et al confirmed that fibrotic strictures present reduced blood volume and blood flow [9].…”

Section: Discussionmentioning

confidence: 90%

“…It has been assumed that CEUS would be useful in the study of bowel obstruction in patients with Crohn's disease in the belief that strictures are caused mainly by inflammation or fibrosis, and that CEUS can evidence inflammation thanks to more intense enhancement of the affected bowel wall [7][8][9][10]. However, studies in the literature are not concordant.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of CEUS and strain elastography in one case of ileum Crohn stricture and literature review

et al. 2016

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Contrast-enhanced ultrasonography (CEUS) and strain elastography (SE) are diagnostic imaging methods, which are still not routinely used in the clinical management of inflammatory bowel diseases. However, there are studies in the literature reporting on the use of both CEUS and SE in patients with bowel obstruction due to Crohn's disease, documenting the usefulness of these two methods in the differentiation between inflammation and fibrosis affecting the bowel wall. The aim of this case report is to evaluate the usefulness of CEUS and SE performed in a patient with Crohn's disease, who was admitted to hospital with bowel obstruction due to terminal ileal stricture and submitted to ileocecal resection. CEUS and SE identified and to some extent also characterized the inflammatory and fibrotic processes affecting the bowel wall. Macroscopic and microscopic examinations of the surgical specimen confirmed the presence of inflammatory phenomena (exudates, ulcers, and fistulas) and fibrosis as suggested by ultrasound (US) imaging methods.Sommario L' ecografia con mezzo di contrasto (CEUS) e la elastografia strain (SE) sono metodiche recenti, ancora poco utilizzate nel management clinico delle malattie infiammatorie croniche intestinali. Riguardo alle stenosi intestinali nel morbo di Crohn, in Letteratura sono pubblicati studi sia con la CEUS che con la SE che hanno documentato l'utilità delle due metodiche nel differenziare la natura flogistica o fibrotica del tratto patologico. Scopo di questo report è di valutare l'utilità delle due metodiche in un paziente affetto da morbo di Crohn, ricoverato per occlusione intestinale da stenosi dell'ultima ansa ileale ed operato di resezione dell'ileo terminale e del ceco. La CEUS e la Elastografia Strain hanno permesso la documentazione ed in un certo grado anche una misura dei processi flogistici e fibrotici a carico della parete intestinale affetta. L'esame macroscopico e microscopico del tratto resecato ha consentito di confermare la presenza dei fenomeni flogistici e fibrotici come ipotizzato con le due metodiche ecografiche.

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“…72 Based on currently available recommendations, CEUS can be used to grade disease activity and extent in adult patients with inflammatory bowel disease and differentiate active inflammation from chronic fibrosis in intestinal loops. 7,73,74 Mural perfusion can be quantified, providing repeatable parameters which accurately represent disease activity, monitor response to treatment 75 and detect post-operative recurrence. 76 Based on the scarce available evidence, CEUS can be used for the same purpose in the paediatric population.…”

Section: Other Applicationsmentioning

confidence: 99%

Enhancing the role of paediatric ultrasound with microbubbles: a review of intravenous applications

Rafailidis¹,

Deganello²,

Watson³

et al. 2017

BJR

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Contrast-enhanced ultrasound (CEUS) represents a complementary technique to greyscale and colour Doppler ultrasonography which allows for real-time visualization and characterization of tissue perfusion. Its inherent advantages in the child makes ultrasonography an ideal imaging modality; repeatability and good tolerance along with the avoidance of CT, a source of ionizing radiation, renders ultrasonography imaging desirable. Although currently paediatric CEUS is principally used in an "off-label" manner, ultrasonography contrast agents have received regulatory approval for assessment of paediatric focal liver lesions (FLL) in the USA. The safety of ultrasound contrast-agents is well documented in adults, as safe as or even surpassing the safety profile of CT and MR contrast agents. Except for the established intracavitary use of CEUS in voiding urosonography, i.v. paediatric applications have been introduced with promising results in the abdominal trauma initial diagnosis and follow-up, characterization and differential diagnosis of FLL and characterization of lung, pleura, renal and splenic pathology. CEUS has also been used to detect complications after paediatric transplantation, evaluate inflammatory bowel disease activity and assess tumour response to antiangiogenic therapy. The purpose of this review was to present these novel i.v. paediatric applications of CEUS and discuss their value.

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The Value of Small Bowel Wall Contrast Enhancement After Sulfur Hexafluoride-Filled Microbubble Injection to Differentiate Inflammatory from Fibrotic Strictures in Patients with Crohn's Disease

Cited by 64 publications

References 22 publications

SICUS and CEUS imaging in Crohn’s disease: an update

SICUS and CEUS imaging in Crohn’s disease: an update

Feasibility of CEUS and strain elastography in one case of ileum Crohn stricture and literature review

Enhancing the role of paediatric ultrasound with microbubbles: a review of intravenous applications

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