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Kumar S, De Kock I, Blad W, Hare R, Pollok R, Taylor SA. Magnetic Resonance Enterography and Intestinal Ultrasound for the Assessment and Monitoring of Crohn's Disease. J Crohns Colitis 2024; 18:1450-1463. [PMID: 38554104 PMCID: PMC11369078 DOI: 10.1093/ecco-jcc/jjae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/20/2024] [Indexed: 04/01/2024]
Abstract
Magnetic resonance enterography [MRE] and intestinal ultrasound [IUS] have developed rapidly in the past few decades, emerging as the primary non-invasive options for both diagnosing and monitoring Crohn's disease [CD]. In this review, we evaluate the pertinent data relating to the use of MRE and IUS in CD. We summarise the key imaging features of CD activity, highlight their increasing role in both the clinical and the research settings, and discuss how these modalities fit within the diagnostic pathway. We discuss how they can be used to assess disease activity and treatment responsiveness, including the emergence of activity scores for standardised reporting. Additionally, we address areas of controversy such as the use of contrast agents, the role of diffusion-weighted imaging, and point-of-care ultrasound. We also highlight exciting new developments, including the applications of artificial intelligence. Finally, we provide suggestions for future research priorities.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | | | - William Blad
- Department of Gastroenterology, University College Hospitals NHS Foundation Trust, London, UK
| | - Richard Hare
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Pollok
- Department of Gastroenterology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
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Mihai VC, Gheorghe L, Rezuș II, Jucan AE, Andronic MC, Gavrilescu O, Dranga M, Andronic AM, Prelipcean CC, Rezuș C, Mihai C. Novelties and Perspectives of Intestinal Ultrasound in the Personalised Management of Patients with Inflammatory Bowel Diseases-A Systematic Review. Diagnostics (Basel) 2024; 14:812. [PMID: 38667458 PMCID: PMC11049436 DOI: 10.3390/diagnostics14080812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 03/29/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Inflammatory bowel diseases (IBDs) affect over 4.9 million individuals worldwide. Colonoscopy (CS) is the gold-standard technique for diagnosis. The remissive-recurrent pattern of evolution raises the need for non-invasive techniques to monitor disease activity. This review aims to present the advantages of intestinal ultrasound (IUS) in managing IBDs. Our search was conducted on the PubMed, Embase, and Cochrane (CENTRAL) databases, selecting original studies comparing IUS with other imaging and invasive monitoring methods. Our search yielded 8654 results, of which 107 met the inclusion criteria. Increased bowel wall thickness (BWT) and colour Doppler signal (CDS) are discriminative for disease activity. IUS can predict disease outcomes and detect response to treatment or postoperative recurrence. Contrast-enhanced ultrasound (CEUS) and elastography help differentiate fibrotic from inflammatory stenoses. The difficult rectal assessment limits the use of IUS in ulcerative colitis (UC). Transmural healing may develop as a therapeutic target as it is associated with better outcomes. Patients are compliant with this technique, and its results correlate well with CS and other imaging methods. In conclusion, IUS proves to be essential in assessing IBD activity and treatment response, predicting outcomes and detecting complications. CEUS and elastography are researched to improve the diagnostic values of IUS.
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Affiliation(s)
- Vasile-Claudiu Mihai
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Liliana Gheorghe
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Ioana-Irina Rezuș
- Department of Radiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania
- Radiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Alina Ecaterina Jucan
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Mihaela-Cristiana Andronic
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Otilia Gavrilescu
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Mihaela Dranga
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Andrei-Mihai Andronic
- Discipline of Medical Semiology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Cristina Cijevschi Prelipcean
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
| | - Ciprian Rezuș
- Discipline of Internal Medicine, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
- 3rd Internal Medicine Clinic, “Sf. Spiridon” Emergency County Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania
| | - Cătălina Mihai
- Discipline of Gastroenterology, Medical Department I, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (A.E.J.); (M.-C.A.); (O.G.); (M.D.); (C.M.)
- Institute of Gastroenterology and Hepatology, “St. Spiridon” County Clinical Emergency Hospital, Bulevardul Independentei 1, 700111 Iasi, Romania;
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Brodersen JB, Jensen MD, Juel MA, Kjeldsen J, Knudsen T, Rafaelsen SR. Intestinal ultrasound in patients with suspected Crohn's disease - results of a prospective evaluation by trainees. Scand J Gastroenterol 2023; 58:1405-1411. [PMID: 37459054 DOI: 10.1080/00365521.2023.2234538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/05/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND AIMS Intestinal ultrasound (IUS) performed by experts is a valuable tool for the diagnostic work-up and monitoring of Crohn's disease (CD). However, concern about insufficient training and perceived high inter-observer variability limit the adoption of IUS in CD. We examined the diagnostic accuracy of trainee-performed IUS in patients with suspected CD. METHOD Patients recruited to a prospective trial investigating the diagnostic accuracy of magnetic resonance enterocolonography (MREC) in patients with clinically suspected CD underwent IUS performed by trainees. The primary end-point was IUS per-patient sensitivity and specificity for ileocolonic CD determined by ileocolonoscopy. RESULTS 129 patients with clinically suspected CD and a complete IC and IUS were included in the analysis. IUS detected signs of CD in 49 cases (small bowel 31, colon 15, small bowel, and colon 3). The sensitivity and specificity for detection of ileocolonic CD by trainee performed IUS improved during the first to the second half of the study period from 57.1% (CI 34.0-78.2) to 73.1% (CI 52.2-88.4) and 76.5% (CI 58.8-89.3) to 89.7% (CI 72.6-97.8). The overall sensitivity and specificity of diagnosing CD with IUS were 65.4% (CI 50.9-78.0) and 80.5% (CI 69.9-88.7). There was no difference in diagnostic performance between IUS and MREC for the detection of CD. CONCLUSION Trainees improved during the study, and IUS performance in disease detection corresponded to expert-evaluated MREC.Registered at ClinicalTrials.gov (NCT03134586).
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Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Michael Dam Jensen
- Department of Regional Health Research, University of Southern Denmark, Denmark
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Mie Agerbæk Juel
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern, Denmark
- OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Torben Knudsen
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Søren Rafael Rafaelsen
- Department of Regional Health Research, University of Southern Denmark, Denmark
- Department of Radiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
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Bohra A, Van Langenberg DR, Vasudevan A. Intestinal Ultrasound in the Assessment of Luminal Crohn’s Disease. GASTROINTESTINAL DISORDERS 2022; 4:249-262. [DOI: 10.3390/gidisord4040024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Crohn’s disease is a chronic inflammatory disease affecting the gastrointestinal tract. Expert guidelines now recommend regular objective assessments as part of a treat-to-target approach. Intestinal ultrasound provides a noninvasive, patient-friendly modality for assessing Crohn’s disease without the risk of radiation exposure and does not require fasting or bowel preparation. Enhancement techniques, including oral and intravenous contrast, can improve disease-activity and complication detection. Due to its acceptability, intestinal ultrasound can be performed frequently, allowing for closer disease-activity monitoring and treatment adjustments. There have been significant advances in the utility of intestinal ultrasound; particularly for assessing disease activity during pregnancy and fibrosis detection utilising elastography. This review provides a comprehensive overview of performing intestinal ultrasound, the diagnostic accuracy, role in disease-activity monitoring, and recent advances in utilising ultrasound for the assessment of luminal Crohn’s disease.
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