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Ainora ME, Liguori A, Mignini I, Cintoni M, Galasso L, Laterza L, Lopetuso LR, Garcovich M, Riccardi L, Gasbarrini A, Scaldaferri F, Zocco MA. Multimodal dynamic ultrasound approach as predictor of response in patients with Crohn's disease treated with ustekinumab. Therap Adv Gastroenterol 2024; 17:17562848241259289. [PMID: 38912296 PMCID: PMC11193931 DOI: 10.1177/17562848241259289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 05/15/2024] [Indexed: 06/25/2024] Open
Abstract
Background The approval of ustekinumab (UST) has opened new options for the treatment of Crohn's disease (CD), but potential markers predicting the efficacy of this interleukin-12/23 inhibitor are lacking. Contrast-enhanced ultrasound (CEUS) is non-invasive alternative to endoscopy, demonstrating early transmural changes after treatment induction. Objectives We conducted a prospective monocentric study aiming to explore the value of multimodal intestinal ultrasound (IUS) in predicting the response to UST in patients with active CD who have been previously exposed to anti-tumour necrosis factor α (TNFα). Design and methods Consecutive patients with moderate-to-severe CD involving the terminal ileum who were scheduled to begin UST therapy were enrolled between January 2020 and October 2021 in the inflammatory bowel diseases outpatient centre. A complete IUS evaluation, including B-mode, Doppler, dynamic CEUS and elastography, was performed at the time of induction (T0) and after 8 (T1), 16 (T2), 24 (T3) and 48 (T4) weeks of therapy. Each IUS parameter and their variations from baseline were correlated with endoscopic response and mucosal healing after 1 year. Results A total of 52 patients were included, 29 (55.8%) of which reached endoscopic response at T4. The univariate analysis revealed that, between T3 and T0, the percentage changes of bowel wall thickness, Limberg score, mean signal intensity, rise time, wash-in rate, C reactive protein and Harvey-Bradshaw Index were associated with long-term therapeutic outcome. Based on the above parameters, we developed an IUS score that showed a good performance in predicting 1 year-endoscopic response (area under the curve: 0.91). Conclusion Multimodal ultrasound could be helpful to predict long-term therapeutic outcome in patients with CD treated with UST. Registration NCT05987501.
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Affiliation(s)
- Maria Elena Ainora
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Antonio Liguori
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Irene Mignini
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Marco Cintoni
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Linda Galasso
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Lucrezia Laterza
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Loris Riccardo Lopetuso
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Matteo Garcovich
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Laura Riccardi
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Antonio Gasbarrini
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Franco Scaldaferri
- Centro Malattie Apparato Digerente, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore di Roma, Roma, Italy
| | - Maria Assunta Zocco
- Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Università Cattolica del Sacro Cuore – Rome, Largo A. Gemelli, 8, Rome 00168, Italy
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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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Dietrich CF, Correas JM, Cui XW, Dong Y, Havre RF, Jenssen C, Jung EM, Krix M, Lim A, Lassau N, Piscaglia F. EFSUMB Technical Review - Update 2023: Dynamic Contrast-Enhanced Ultrasound (DCE-CEUS) for the Quantification of Tumor Perfusion. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:36-46. [PMID: 37748503 DOI: 10.1055/a-2157-2587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Dynamic contrast-enhanced ultrasound (DCE-US) is a technique to quantify tissue perfusion based on phase-specific enhancement after the injection of microbubble contrast agents for diagnostic ultrasound. The guidelines of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) published in 2004 and updated in 2008, 2011, and 2020 focused on the use of contrast-enhanced ultrasound (CEUS), including essential technical requirements, training, investigational procedures and steps, guidance regarding image interpretation, established and recommended clinical indications, and safety considerations. However, the quantification of phase-specific enhancement patterns acquired with ultrasound contrast agents (UCAs) is not discussed here. The purpose of this EFSUMB Technical Review is to further establish a basis for the standardization of DCE-US focusing on treatment monitoring in oncology. It provides some recommendations and descriptions as to how to quantify dynamic ultrasound contrast enhancement, and technical explanations for the analysis of time-intensity curves (TICs). This update of the 2012 EFSUMB introduction to DCE-US includes clinical aspects for data collection, analysis, and interpretation that have emerged from recent studies. The current study not only aims to support future work in this research field but also to facilitate a transition to clinical routine use of DCE-US.
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Affiliation(s)
- Christoph F Dietrich
- Department General Internal Medicine, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
- Zentrum der Inneren Medizin, Johann Wolfgang Goethe Universitätsklinik Frankfurt, Frankfurt, Germany
| | - Jean-Michel Correas
- Department of Adult Radiology, Assistance Publique Hôpitaux de Paris, Necker University Hospital, Paris, France
- Paris Cité University, Paris, France
- CNRS, INSERM Laboratoire d'Imagerie Biomédicale, Sorbonne Université, Paris, France
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Dong
- Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Roald Flesland Havre
- Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Wriezen, Germany
- Brandenburg Institute for Clinical Ultrasound (BICUS), Medical University Brandenburg, Neuruppin, Brandenburg, Germany
| | - Ernst Michael Jung
- Institute of Diagnostic Radiology, Interdisciplinary Ultrasound Department, University Hospital Regensburg, Regensburg, Germany
| | - Martin Krix
- Global Medical & Regulatory Affairs, Bracco Imaging, Konstanz, Germany
| | - Adrian Lim
- Department of Imaging, Imperial College London and Healthcare NHS Trust, Charing Cross Hospital Campus, London, United Kingdom of Great Britain and Northern Ireland
| | - Nathalie Lassau
- Imaging Department. Gustave Roussy cancer Campus. Villejuif, France. BIOMAPS. UMR 1281. CEA. CNRS. INSERM, Université Paris-Saclay, France
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Dept of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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Saevik F. Prediction of Postoperative Recurrence in Crohn's Disease: Where Do We Go From Here? Clin Gastroenterol Hepatol 2023; 21:3017-3018. [PMID: 36871773 DOI: 10.1016/j.cgh.2023.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/17/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Fredrik Saevik
- Department of Internal Medicine, Sørlandet Hospital, Arendal, Norway
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Dragoni G, Gottin M, Innocenti T, Lynch EN, Bagnoli S, Macrì G, Bonanomi AG, Orlandini B, Rogai F, Milani S, Galli A, Milla M, Biagini MR. Correlation of Ultrasound Scores with Endoscopic Activity in Crohn's Disease: A Prospective Exploratory Study. J Crohns Colitis 2023; 17:1387-1394. [PMID: 37023010 DOI: 10.1093/ecco-jcc/jjad068] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND AIMS Intestinal ultrasound [IUS] is widely accepted as a reliable tool to monitor Crohn's disease [CD]. Several IUS scores have been proposed, but none has been formally accepted by international organizations. Our aim here was to compare the available scores regarding their correlation with endoscopic activity. METHODS Consenting CD patients undergoing ileocolonoscopy at our Unit between September 2021 and February 2023 were included. Endoscopic activity was defined as SES-CD ≥ 3 or Rutgeerts score ≥ i2b for operated patients. IUS was performed within 6 weeks of endoscopy and scored with IBUS-SAS, BUSS, Simple-US and SUS-CD scores. All correlations were performed using Spearman's rank coefficient [rho = ρ]. Receiver operating characteristic [ROC] curves were compared with the Hanley and McNeil method. RESULTS Of 73 CD patients, 45 [61.6%] presented endoscopic activity, of whom 22 were severe [30.1%]. All IUS scores showed a significant positive correlation with endoscopy [p < 0.0001], with IBUS-SAS ranking the highest [ρ = 0.87]. Similarly, IBUS-SAS was the most highly correlated with clinical activity [ρ = 0.58]. ROC analysis of IBUS-SAS for any endoscopic activity showed the highest area under the curve (0.95 [95% confidence interval 0.87-0.99]), with sensitivity of 82.2% and specificity of 100% for a cut-off value of 25.2. IBUS-SAS was statistically superior to all the other scores in detecting severe endoscopic activity [SES-CD ≥ 9 or Rutgeerts i4]. CONCLUSIONS All IUS scores provided solid correlation with endoscopy and clinical symptoms. IBUS-SAS outperformed the others due to a more granular description that might help in stratifying different levels of disease activity. Therefore, the use of IBUS-SAS in centres with well-founded expertise in IUS can be suggested.
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Affiliation(s)
- Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Matteo Gottin
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Tommaso Innocenti
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Erica Nicola Lynch
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Siro Bagnoli
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giuseppe Macrì
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Beatrice Orlandini
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Francesca Rogai
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Stefano Milani
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Galli
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Monica Milla
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Maria Rosa Biagini
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Ripollés T, Martínez-Pérez MJ, Paredes JM, Vizuete J, Martin G, Navarro L. Submucosal fat accumulation in Crohn's disease: evaluation with sonography. Intest Res 2023; 21:385-391. [PMID: 37533267 PMCID: PMC10397555 DOI: 10.5217/ir.2022.00030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/23/2022] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND/AIMS The study objective is to investigate the ultrasound features that allow suspecting the presence of submucosal fat deposition, called the fat halo sign (FHS), in the intestinal wall of patients with Crohn's disease. METHODS Computed tomography (CT) examinations over a period of 10 years were reviewed for the presence of the FHS in the bowel wall. A measurement of less than -10 Hounsfield units was regarded as indicative of fat. We included only patients who had undergone ultrasound examinations 3 months before or after CT. The study cohort group comprised 68 patients. Wall and submucosal thickness were measured on longitudinal ultrasound sections. A receiver operating characteristic curve was constructed to determine the best cutoff of ultrasound submucosal wall thickness value for predicting FHS in the bowel wall determined on CT. RESULTS The FHS was present in 22 patients (31%) on CT. There were significant differences between submucosal thickness of patients with FHS and patients without FHS (4.19 mm vs. 2.41 mm). From the receiver operating characteristic curve, a threshold value of 3.1 mm of submucosal thickness had the best sensitivity and specificity to suspect FHS (95.5% and 89.1%, respectively; area under the curve, 0.962), with an odds ratio of 172. All of 16 patients with a submucosal thickness >3.9 mm had FHS. CONCLUSIONS FHS in patients with Crohn's disease can be suspected on ultrasound in cases with marked thickening of the submucosa layer. In these cases, the activity of the disease should be measured by other parameters such as the color Doppler.
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Affiliation(s)
- Tomás Ripollés
- Department of Radiology Doctor Peset University Hospital, Valencia, Spain
| | | | - José María Paredes
- Department of Gastroenterology, Doctor Peset University Hospital, Valencia, Spain
| | - José Vizuete
- Department of Radiology Doctor Peset University Hospital, Valencia, Spain
| | - Gregorio Martin
- Department of Radiology Doctor Peset University Hospital, Valencia, Spain
| | - Lidia Navarro
- Department of Radiology Doctor Peset University Hospital, Valencia, Spain
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Hameed M, Taylor SA. Small bowel imaging in inflammatory bowel disease: updates for 2023. Expert Rev Gastroenterol Hepatol 2023; 17:1117-1134. [PMID: 37902040 DOI: 10.1080/17474124.2023.2274926] [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: 05/12/2023] [Accepted: 10/20/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Cross-sectional imaging techniques including MR and CT enterography and ultrasound are integral to Crohn's disease management, accurate, responsive, and well tolerated. They assess the full thickness of the bowel wall, perienteric environment, and distant complications. As we strive toward tighter disease control, imaging's role will expand further with transmural healing becoming an increasingly important therapeutic target. AREAS COVERED MEDLINE and Web of Science were searched from 2012 to 2023 inclusive. We review the evidence for cross-sectional imaging in assessing disease activity, phenotyping, and therapeutic response assessment. Emerging novel imaging applications such as quantifying enteric motility and fibrosis, prognostication, and potential utility of artificial intelligence will be covered. Recent international consensus statements highlight the need for standardized imaging reporting and definitions of transmural healing and remission. We will discuss how recent advances may be best integrated into patient care and highlight key outstanding research questions. EXPERT OPINION Cross-sectional imaging is established in Crohn's disease management. Research emphasis should be placed on optimal integration of imaging modalities in clinical care pathways, workforce training, definitions, and evidence for use of imaging based therapeutic targets such as transmural healing, better phenotyping of stricturing disease, and developing novel techniques, including integration of artificial intelligence.
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Affiliation(s)
- Maira Hameed
- Centre for Medical Imaging, University College London, United Kingdom
- University College London Hospitals NHS Foundation Trust, University College Hospital, United Kingdom
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, United Kingdom
- University College London Hospitals NHS Foundation Trust, University College Hospital, United Kingdom
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Diagnostic accuracy of different cross-sectional imaging techniques for disease location and activity in Crohn's disease and external validation and comparison of MARIAs and IBUS-SAS. Abdom Radiol (NY) 2023; 48:821-832. [PMID: 36525049 DOI: 10.1007/s00261-022-03751-7] [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: 08/07/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE The comparative accuracy of cross-sectional imaging techniques for evaluating Crohn's disease (CD) remains uncertain. This study aimed to assess diagnostic accuracy of disease location and activity in different cross-sectional images and validate and compare International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) and Simplified Magnetic Resonance Index of Activity (MARIAs). METHODS CD patients were retrospectively included from August 2018 to May 2021. We compared accuracy of B-mode intestinal ultrasound (B-IUS), computed tomography enterography (CTE), and magnetic resonance enterography (MRE) for the identification of disease location. Meanwhile, disease activity was compared on B-IUS, color Doppler imaging, CTE, and MRE. ROC analyses were used to validate MARIAs and IBUS-SAS. Spearman rank correlation was performed to evaluate the relationships between MARIAs/IBUS-SAS and CDAI, SES-CD, and inflammatory indicators. RESULTS A total of 115 CD patients were evaluated. The diagnostic accuracy of MRE in detecting small bowel disease was superior to that of B-IUS/CTE, showing sensitivity (89.3%), specificity (71.4%), and AUC (0.820). B-IUS had the highest sensitivity (81.2%), specificity (84.8%), and AUC (0.830) for detecting terminal ileal lesions. The diagnostic accuracy for colonic disease and disease activity was not significantly different among these techniques. In the validation of IBUS-SAS, the AUC was 0.860, with an optimal cutoff value to predict active disease of 46.7. MARIAs and IBUS-SAS showed no significant differences in the correlations of CDAI, SES-CD, and inflammatory indicators. CONCLUSION MRE and B-IUS are more sensitive for detecting small bowel CD and terminal ileal CD, respectively. IBUS-SAS has potential for precisely defining CD activity.
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Nancey S, Fumery M, Faure M, Boschetti G, Gay C, Milot L, Roblin X. Use of imaging modalities for decision-making in inflammatory bowel disease. Therap Adv Gastroenterol 2023; 16:17562848231151293. [PMID: 36777362 PMCID: PMC9912556 DOI: 10.1177/17562848231151293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/27/2022] [Indexed: 02/11/2023] Open
Abstract
Cross-sectional magnetic resonance enterography (MRE) and intestinal ultrasonography (IUS) provide valuable and noninvasive information to accurately assess disease activity, severity, and extent; detect complications; and monitor the response to treatment, as well as predict the postoperative recurrence of Crohn's disease and a negative disease course. Therefore, both imaging modalities are emerging as pivotal diagnostic tools to achieve the emerging therapeutic target of transmural healing associated with better disease outcomes. Despite its numerous potential advantages over endoscopy and even MRE and its good availability, IUS is still widely underused to monitor and manage inflammatory bowel disease (IBD) patients and help in making clinical decisions in routine practice. This situation is clearly due to the absence of validated, reliable, and responsive indices, as well as the lack of trained gastroenterologists and radiologists, as IUS is a component of radiologist expertise in several countries but not yet integrated into the training program of gastroenterologists. However, there is an increasing body of evidence in the literature that IUS and MRE are both becoming essential imaging resources to help clinicians in making reliable decisions. Here, we discuss the up-to-date evidence about the usefulness and performance of cross-sectional imaging, focusing on the ability of bowel US and MRE to aid clinical decision-making for the optimal management and monitoring of IBD.
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Affiliation(s)
| | - Mathurin Fumery
- Department of Gastroenterology, University
Hospital of Amiens, Amiens, France
| | | | - Gilles Boschetti
- Department of Gastroenterology, Lyon Sud
Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1,
Pierre-Bénite, France,INSERM U1111, CIRI, Lyon, France
| | - Claire Gay
- Department of Gastroenterology, Lyon Sud
Hospital, Hospices Civils de Lyon, University Claude Bernard Lyon 1,
Pierre-Bénite, France
| | - Laurent Milot
- Department of Radiology, Hospices Civils de
Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Xavier Roblin
- Department of Gastroenterology, Immunology,
University Hospital of Saint-Etienne, Saint-Etienne, France
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Rimola J, Torres J, Kumar S, Taylor SA, Kucharzik T. Recent advances in clinical practice: advances in cross-sectional imaging in inflammatory bowel disease. Gut 2022; 71:2587-2597. [PMID: 35927032 PMCID: PMC9664122 DOI: 10.1136/gutjnl-2021-326562] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/20/2022] [Indexed: 12/17/2022]
Abstract
Endoscopy remains the reference standard for the diagnosis and assessment of patients with inflammatory bowel disease (IBD), but it has several important limitations. Cross-sectional imaging techniques such as magnetic resonance enterography (MRE) and intestinal ultrasound (IUS) are better tolerated and safer. Moreover, they can examine the entire bowel, even in patients with stenoses and/or severe inflammation. A variety of cross-sectional imaging activity scores strongly correlate with endoscopic measures of mucosal inflammation in the colon and terminal ileum. Unlike endoscopy, cross-sectional techniques allow complete visualisation of the small-bowel and assess for extraintestinal disease, which occurs in nearly half of patients with IBD. Extramural findings may predict outcomes better than endoscopic mucosal assessment, so cross-sectional techniques might help identify more relevant therapeutic targets. Coupled with their high sensitivity, these advantages have made MRE and IUS the primary non-invasive options for diagnosing and monitoring Crohn's disease; they are appropriate first-line investigations, and have become viable alternatives to colonoscopy. This review discusses cross-sectional imaging in IBD in current clinical practice as well as research lines that will define the future role of these techniques.
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Affiliation(s)
- Jordi Rimola
- IBD Unit, Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain .,IDIBAPS, Barcelona, Spain
| | - Joana Torres
- Gastroenterology Division, Hospital Beatriz Ângelo, Loures, Portugal,Gastroenterology Division, Hospital da Luz, Lisboa, Portugal
| | - Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Torsten Kucharzik
- Department of Gastroenterology, Stadtisches Klinikum Luneburg gGmbH, Luneburg, Germany
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11
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Xu C, Jiang W, Wang L, Mao X, Ye Z, Zhang H. Intestinal Ultrasound for Differentiating Fibrotic or Inflammatory Stenosis in Crohn's Disease: A Systematic Review and Meta-analysis. J Crohns Colitis 2022; 16:1493-1504. [PMID: 35390137 DOI: 10.1093/ecco-jcc/jjac052] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND AIMS Intestinal ultrasound [IUS] has been increasingly reported to distinguish inflammatory or fibrotic intestinal stenosis in Crohn's disease [CD] patients. However, the diagnostic value is unclear. This systematic review and meta-analysis aimed to assess the diagnostic role of different modes of IUS parameters. METHODS We searched PubMed, Embase, Web of Science, and Cochrane Library from inception to August 2021. Regarding effect sizes, weighted mean differences [WMDs] or standardised mean differences [SMDs] were used. We pooled data using a random-effects or fixed-effects model according to heterogeneity. The diagnostic accuracy of IUS for distinguishing fibrosis was pooled. RESULTS A total of 19 studies were retained for qualitative analysis, and 14 were included in the meta-analysis [with 511 total subjects and 635 bowel segments]. In patients with fibrotic stenosis, the pooled WMDs for bowel wall thickness were 1.30 mm (95% confidence interval [CI]: 0.69-1.91) thicker than in patients with inflammatory stenosis, and the pooled SMDs for strain value and strain ratio were 0.80 [95% CI: 0.41-1.20] and 1.08 [95% CI: 0.55-1.60] harder than in patients with inflammatory stenosis, respectively. The percentage of maximal enhancement of fibrotic stenosis was lower than that of inflammatory stenosis [WMD -10.03; 95% CI: -17.91- -2.16]. The diagnostic accuracy of IUS was not performed because only a few studies provided relevant diagnostic indicators, and these studies used different modes and parameters. CONCLUSIONS IUS currently is inaccurate to differentiate fibrotic or inflammatory stenosis in CD patients, and more studies assessing the significance of each parameter and its cut-off value in different modes of IUS are needed to be conducted in the future.
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Affiliation(s)
- Chenjing Xu
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Wenyu Jiang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Lu Wang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Xiaqiong Mao
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Ziping Ye
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| | - Hongjie Zhang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
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12
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Role of Multiparametric Intestinal Ultrasound in the Evaluation of Response to Biologic Therapy in Adults with Crohn’s Disease. Diagnostics (Basel) 2022; 12:diagnostics12081991. [PMID: 36010341 PMCID: PMC9407413 DOI: 10.3390/diagnostics12081991] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
Crohn’s disease is one of the two most common types of inflammatory bowel disease. Current medical therapies are based on the use of glucocorticoids, exclusive enteral nutrition, immunosuppressors such as azathioprine and methotrexate, and biological agents such as infliximab, adalimumab, vedolizumab, or ustekinumab. International guidelines suggest regular disease assessment and surveillance through objective instruments to adjust and personalize the therapy, reducing the overall rates of hospitalization and surgery. Although endoscopy represents the gold-standard for surveillance, its frequent use is strongly bordered by associated risks and costs. Consequently, alternative non-invasive tools to objectify disease activity and rule active inflammation out are emerging. Alongside laboratory exams and computed tomography or magnetic resonance enterography, intestinal ultrasonography (IUS) shows to be a valid choice to assess transmural inflammation and to detect transmural healing, defined as bowel wall thickness normalization, no hypervascularization, normal stratification, and no creeping fat. Compared to magnetic resonance imaging (MRI) or computed tomography, CT scan, IUS is cheaper and more widespread, with very similar accuracy. Furthermore, share wave elastography, color Doppler, and contrast-enhanced ultrasonography (CEUS) succeed in amplifying the capacity to determine the disease location, disease activity, and complications. This review aimed to discuss the role of standard and novel ultrasound techniques such as CEUS, SICUS, or share wave elastography in adults with Crohn’s disease, mainly for therapeutic monitoring and follow-up.
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13
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Servais L, Boschetti G, Meunier C, Gay C, Cotte E, François Y, Rozieres A, Fontaine J, Cuminal L, Chauvenet M, Charlois AL, Isaac S, Traverse-Glehen A, Roblin X, Flourié B, Valette PJ, Nancey S. Intestinal Conventional Ultrasonography, Contrast-Enhanced Ultrasonography and Magnetic Resonance Enterography in Assessment of Crohn's Disease Activity: A Comparison with Surgical Histopathology Analysis. Dig Dis Sci 2022; 67:2492-2502. [PMID: 34052948 DOI: 10.1007/s10620-021-07074-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/24/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Contrast-enhanced ultrasonography (CEUS) is a potential interesting method for assessing accurately Crohn's disease (CD) activity. We compared the value of intestinal ultrasonography (US) coupled with contrast agent injection with that of magnetic resonance enterography (MRE) in the assessment of small bowel CD activity using surgical histopathology analysis as reference. METHODS Seventeen clinically active CD patients (14 women, mean age 33 years) requiring an ileal or ileocolonic resection were prospectively enrolled. All performed a MRE and a US coupled with contrast agent injection (CEUS) less than 8 weeks prior to surgery. Various imaging qualitative and quantitative parameters were recorded and their respective performance to detect disease activity, disease extension and presence of complications was compared to surgical histopathological analysis. RESULTS The median wall thickness measured by US differed significantly between patients with non-severely active CD (n = 5) and those with severely active CD (n = 12) [7.0 mm, IQR (6.5-9.5) vs 10.0 mm, IQR (8.0-12.0), respectively; p = 0.03]. A non-significant trend was found with MRE with a median wall thickness in severe active CD of 10.0 mm, IQR (8.0-13.7) compared with 8.0 mm, IQR (7.5-10.5) in non-severely active CD (p = 0.07). The area under the ROC curve (AUROC) of the wall thickness assessed by US and MRE to identify patients with or without severely active CD on surgical specimens were 0.85, 95% CI (0.64-1.04), p = 0.03 and 0.80, 95% CI (0.56-1.01), p = 0.07, respectively. Among the parameters derived from the time-intensity curve during CEUS, time to peak and rise time were the two most accurate markers [AUROC = 0.88, 95% CI (0.70-1.04), p = 0.02 and 0.86, 95% CI (0.68-1.04), p = 0.03] to detect patients with severely active CD assessed on surgical specimens. CONCLUSION The accuracy of intestinal CEUS is close to that of conventional US to detect disease activity. A thickened bowel and shortened time to peak and rise time were the most accurate to identify CD patients with severe histological disease activity.
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Affiliation(s)
- L Servais
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - G Boschetti
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - C Meunier
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - C Gay
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - E Cotte
- Department of Digestive Surgery, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Y François
- Department of Digestive Surgery, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - A Rozieres
- INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - J Fontaine
- Department of Pathology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - L Cuminal
- Department of Radiology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - M Chauvenet
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - A L Charlois
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France
| | - S Isaac
- Department of Pathology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - A Traverse-Glehen
- Department of Pathology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - X Roblin
- Department of Gastroenterology, CHU Saint-Etienne, Saint-Etienne, France
| | - B Flourié
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France.,INSERM U1111, International Center for Research in Infectiology, Lyon, France
| | - P J Valette
- Department of Radiology, Lyon-Sud Hospital, Hospices Civils de Lyon, Pierre-Bénite, France
| | - S Nancey
- Department of Gastroenterology, Lyon-Sud Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495, Pierre-Bénite, France. .,INSERM U1111, International Center for Research in Infectiology, Lyon, France.
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14
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Wu S, Zeng L, Li W, Wu YT, Jing JG, Zhuang H, Wang YF. The value of multi-modes of ultrasound in evaluating segmental mucosal healing in patients with Crohn's disease. Dig Liver Dis 2022; 54:763-770. [PMID: 34991975 DOI: 10.1016/j.dld.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/23/2021] [Accepted: 12/08/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mucosal healing, the result of endoscopic remission, is associated with prolonged clinical remission and delayed deterioration of Crohn's disease, which is significant and accompanied by reduced hospitalizations and surgeries. Currently, the relationship between ultrasonic parameters and mucosal healing remains controversial. To establish an ultrasonic regression model to evaluate mucosal healing, we conducted this preliminary study using multiple parameters from B-mode ultrasonography, colour Doppler flow imaging and shear wave elastography systematically. METHODS This study consisted of two single-centre investigations based on development and validation populations who received endoscopies (as the gold standard) and ultrasound. The involved bowel segments were divided into mucosal healing (MH) and nonmucosal healing (NMH) groups according to endoscopic results. Eight ultrasonic parameters were observed, including bowel wall thickness (BWT), mesenteric fat thickness (MFT), median modulus of elasticity (Emean), average shear wave velocity (SWV), Limberg scoring (LG), bowel wall stratification (BWS), ascites (AS) and lymph node enlargement (LN). We developed an ultrasonic regression model in the development phase to evaluate segmental mucosal healing and undertook prospective validation of this model. RESULTS A total of 124 patients with 380 involved bowel segments from the development and validation cohorts were evaluated. Eight ultrasonic parameters were significantly different between the two groups (P<0.05) in the development phase. Four significant parameters with better AUC performance were selected to establish an ultrasonic regression model to predict mucosal healing. The AUCs of this ultrasonic model were 0.975 and 0.942 in the development and validation cohorts, respectively. CONCLUSION The multimodal ultrasonic model has the potential to evaluate segmental mucosal healing in Crohn's disease.
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Affiliation(s)
- Shuang Wu
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li Zeng
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Wei Li
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yu-Ting Wu
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Ji-Gang Jing
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hua Zhuang
- Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
| | - Yu-Fang Wang
- Department of Gastroenterology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
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15
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Sævik F, Gilja OH, Nylund K. Gastrointestinal Ultrasound Can Predict Endoscopic Activity in Crohn's Disease. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:82-89. [PMID: 32330994 DOI: 10.1055/a-1149-9092] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE To explore the ability of gastrointestinal ultrasound (GIUS) to separate patients in endoscopic remission from patients with active disease in a heterogeneous hospital cohort with Crohn's disease (CD). MATERIALS AND METHODS 145 CD patients scheduled for ileocolonoscopy were prospectively included. The endoscopic disease activity was quantified using the Simple Endoscopic Score for Crohn's disease (SES-CD), and mucosal healing was strictly defined as SES-CD = 0. Ultrasound remission was defined as wall thickness < 3 mm (< 4 mm in the rectum). Additionally, SES-CD was compared to color Doppler, Harvey Bradshaw's index (HBI), C-reactive protein (CRP) and calprotectin. 23 patients were examined by two investigators for interobserver assessment. RESULTS 102 had active disease and 43 patients were in remission. GIUS yielded a sensitivity of 92.2 % and a specificity of 86 % for wall thickness and a sensitivity of 66.7 % and a specificity of 97.7 % for color Doppler. The sensitivity and specificity were 34.3 % and 88.4 %, respectively, for HBI, 35.7 % and 82.9 %, respectively, for CRP and 55.9 % and 82.1 %, respectively, for calprotectin. The interobserver analysis revealed excellent agreement for wall thickness (k = 0.90) and color Doppler (k = 0.91) measurements. CONCLUSION GIUS has a high sensitivity for detecting endoscopic activity. Accordingly, bowel ultrasound has the potential to reduce the number of routine ileocolonoscopies in patients with CD.
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Affiliation(s)
- Fredrik Sævik
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
| | - Kim Nylund
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Norway
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16
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Alfarone L, Dal Buono A, Craviotto V, Zilli A, Fiorino G, Furfaro F, D’Amico F, Danese S, Allocca M. Cross-Sectional Imaging Instead of Colonoscopy in Inflammatory Bowel Diseases: Lights and Shadows. J Clin Med 2022; 11:353. [PMID: 35054047 PMCID: PMC8778036 DOI: 10.3390/jcm11020353] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 12/10/2022] Open
Abstract
International guidelines recommend a treat-to-target strategy with a close monitoring of disease activity and therapeutic response in inflammatory bowel diseases (IBD). Colonoscopy (CS) represents the current first-line procedure for evaluating disease activity in IBD. However, as it is expensive, invasive and poorly accepted by patients, CS is not appropriate for frequent and repetitive reassessments of disease activity. Recently, cross-sectional imaging techniques have been increasingly shown as reliable tools for assessing IBD activity. While computed tomography (CT) is hampered by radiation risks, routine implementation of magnetic resonance enterography (MRE) for close monitoring is limited by its costs, low availability and long examination time. Novel magnetic resonance imaging (MRI)-based techniques, such as diffusion-weighted imaging (DWI), can overcome some of these weaknesses and have been shown as valuable options for IBD monitoring. Bowel ultrasound (BUS) is a noninvasive, highly available, cheap, and well accepted procedure that has been demonstrated to be as accurate as CS and MRE for assessing and monitoring disease activity in IBD. Furthermore, as BUS can be quickly performed at the point-of-care, it allows for real-time clinical decision making. This review summarizes the current evidence on the use of cross-sectional imaging techniques as cost-effective, noninvasive and reliable alternatives to CS for monitoring patients with IBD.
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Affiliation(s)
- Ludovico Alfarone
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (L.A.); (A.D.B.); (V.C.); (F.F.)
| | - Arianna Dal Buono
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (L.A.); (A.D.B.); (V.C.); (F.F.)
| | - Vincenzo Craviotto
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (L.A.); (A.D.B.); (V.C.); (F.F.)
| | - Alessandra Zilli
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
| | - Gionata Fiorino
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
| | - Federica Furfaro
- Division of Gastroenterology and Digestive Endoscopy, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy; (L.A.); (A.D.B.); (V.C.); (F.F.)
| | - Ferdinando D’Amico
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele, MI, Italy
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
| | - Mariangela Allocca
- Gastroenterology and Endoscopy, IRCCS Hospital San Raffaele, University Vita-Salute San Raffaele, 20132 Milan, MI, Italy; (A.Z.); (G.F.); (F.D.); (S.D.)
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17
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Allocca M, Furfaro F, Fiorino G, Peyrin-Biroulet L, Danese S. Point-of-Care Ultrasound in Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:143-151. [PMID: 32674146 DOI: 10.1093/ecco-jcc/jjaa151] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel diseases [IBD], including Crohn's disease [CD] and ulcerative colitis [UC], are chronic, relapsing and destructive inflammatory disorders of the gastrointestinal tract which can lead to organ damage and impair quality of life. A 'treat-to-target' strategy based on activity and severity of disease and response to treatment with close monitoring of intestinal inflammation is recommended. Ileocolonoscopy [CS] is considered the first-line procedure for the assessment of IBD, and magnetic resonance enterography [MRE] is the current standard for assessing the small bowel and complications in CD, and has been proposed as an alternative procedure to CS in the evaluation of both ileo-colonic CD and UC. As that both CS and MRE are invasive and expensive procedures and unappealing to patients, they are unfeasible as frequent and repetitive tools for the monitoring of disease activity. Bowel ultrasound [US] represents a well-tolerated, non-invasive and cost-effective modality to manage IBD patients in clinical practice. Compared to CS and MRE, bowel US has been shown to have the same level of accuracy in assessing and monitoring disease activity and severity of both CD and UC. It can be performed at the point-of-care and therefore allow for real-time clinical decision-making. Point-of-care ultrasound [POCUS] is suggested as the stethoscope of the future and is gaining interest and diffusion in the medical field because it can be used for the bedside examination of patients. The aim of this review is to discuss point-of-care bowel ultrasound [POCBUS] in the management of patients with IBD.
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Affiliation(s)
- Mariangela Allocca
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy
| | - Gionata Fiorino
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Silvio Danese
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
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18
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Ripollés T, Poza J, Suarez Ferrer C, Martínez-Pérez MJ, Martín-Algíbez A, de Las Heras Paez B. Evaluation of Crohn's Disease Activity: Development of an Ultrasound Score in a Multicenter Study. Inflamm Bowel Dis 2021; 27:145-154. [PMID: 32507880 DOI: 10.1093/ibd/izaa134] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Our goal in this multicentric prospective study was 2-fold: first, to test the diagnostic accuracy of ultrasound, color Doppler imaging (CDI), and contrast-enhanced ultrasound (CEUS) in identifying disease activity in patients with Crohn's disease (CD) compared with endoscopy as the reference standard; and, second, to construct a sonographic score that allows disease activity to be detected. MATERIALS AND METHODS Seventy-two patients with CD from 3 hospitals underwent within a 30-day period both colonoscopy and ultrasound (US), including mural thickness, CDI, and CEUS, prospectively as part of clinical care. A multivariate analysis was carried out to assess the influence of each of the ultrasound variables in predicting endoscopic activity. We then developed a predictive ultrasound score for disease activity, and a receiver operating characteristic (ROC) curve was constructed to determine the area under the ROC curve (AUC) and the best cut-off score value to discriminate between active and inactive disease. RESULTS Sonographic findings that were independent predictors of the presence of active disease at endoscopy were wall thickness, color grade, and contrast parameters. A score based on those variables showed high accuracy in predicting active disease, with an area under the ROC curve of 0.972. A simpler index, without contrast parameters, also showed high accuracy in detecting disease activity (AUC, 0.923). CONCLUSION A score based on wall thickness, color Doppler grade, and contrast parameters showed high accuracy in predicting active disease. A score without including the use of contrast agent had practically similar results and is easier to use in monitoring response to treatment.
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Affiliation(s)
- Tomás Ripollés
- Department of Radiology, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Joaquín Poza
- Department of Gastroenterology, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Ana Martín-Algíbez
- Department of Gastroenterology, Hospital Universitario 12 Octubre, Madrid, Spain
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19
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Gokli A, Dillman JR, Humphries PD, Ključevšek D, Mentzel HJ, Rubesova E, Takahashi MS, Anupindi SA. Contrast-enhanced ultrasound of the pediatric bowel. Pediatr Radiol 2021; 51:2214-2228. [PMID: 33978797 PMCID: PMC8113288 DOI: 10.1007/s00247-020-04868-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/13/2020] [Accepted: 09/30/2020] [Indexed: 01/03/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) has emerged as a valuable modality for bowel imaging in adults and children. CEUS enables visualization of the perfusion of the bowel wall and of the associated mesentery in healthy and disease states. In addition, CEUS images can be used to make quantitative measurements of contrast kinetics, allowing for objective assessment of bowel wall enhancement. Bowel CEUS is commonly applied to evaluate inflammatory bowel disease and to monitor treatment response. It has also been applied to evaluate necrotizing enterocolitis, intussusception, appendicitis and epiploic appendagitis, although experience with these applications is more limited. In this review article, we present the current experience using CEUS to evaluate the pediatric bowel with emphasis on inflammatory bowel disease, extrapolating the established experience from adult studies. We also discuss emerging applications of CEUS as an adjunct or problem-solving tool for evaluating bowel perfusion.
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Affiliation(s)
- Ami Gokli
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
| | - Jonathan R. Dillman
- grid.239573.90000 0000 9025 8099Department of Radiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Paul D. Humphries
- grid.420468.cUniversity College London Hospital NHS Trust, Great Ormond Street Hospital for Children, London, UK
| | - Damjana Ključevšek
- grid.29524.380000 0004 0571 7705Department of Radiology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | - Hans-Joachim Mentzel
- grid.275559.90000 0000 8517 6224Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital Jena, Jena, Germany
| | - Erika Rubesova
- grid.240952.80000000087342732Department of Radiology, Lucile Packard Children’s Hospital, Stanford University Medical Center, Stanford, CA USA
| | - Marcelo S. Takahashi
- Pediatric Radiology Department, Diagnósticos da America (DASA), São Paulo, Brazil
| | - Sudha A. Anupindi
- grid.25879.310000 0004 1936 8972Department of Radiology, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA 19104 USA
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20
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Gonzalez-Montpetit E, Ripollés T, Martinez-Pérez MJ, Vizuete J, Martín G, Blanc E. Ultrasound findings of Crohn's disease: correlation with MR enterography. Abdom Radiol (NY) 2021; 46:156-167. [PMID: 32607648 DOI: 10.1007/s00261-020-02622-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/08/2020] [Accepted: 06/13/2020] [Indexed: 12/17/2022]
Abstract
Crohn's disease is a chronic inflammatory bowel disease characterized by periods of relative inactivity alternating with acute flare-ups. Imaging techniques play a fundamental role in the diagnosis and follow-up of Crohn's disease, providing information on the extent of disease, disease activity, and the presence of extramural complications. Because of the frequent re-evaluation required by the relapsing nature of Crohn's disease and the relative young age at which most patients are diagnosed, techniques that use ionizing radiation are best avoided in monitoring this population. Thus, magnetic resonance enterography (MRE) and ultrasonography (US) are the preferable techniques. Various studies have demonstrated that US is accurate in assessing the gut. Despite some clear advantages over MRE, US has long been underused in the evaluation of intestinal disease. This review presents an overview of the main imaging findings in Crohn's disease, correlating representative US images with MRE and surgical pathology specimens. We conclude that US reliably depicts both bowel-related and mesenteric features of Crohn's disease and US findings correlate strongly with MRE findings.
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Affiliation(s)
- Estefania Gonzalez-Montpetit
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain.
- Abdominal Imaging, Centre IDI Girona, Hospital Universitario Doctor Josep Trueta, Avinguda de França s/n, 17007, Girona, Spain.
| | - Tomás Ripollés
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - María J Martinez-Pérez
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - José Vizuete
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Gregorio Martín
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Esther Blanc
- Section of Abdominal Imaging at the Radiology Department, Hospital Universitario Doctor Peset, Valencia, Spain
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21
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Ripollés T, Muñoz F, Martínez-Pérez M, de Miguel E, Poza Cordón J, de la Heras Páez de la Cadena B. Usefulness of intestinal ultrasound in inflammatory bowel disease. RADIOLOGIA 2021. [DOI: 10.1016/j.rxeng.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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22
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Muñoz F, Ripollés T, Poza Cordón J, de Las Heras Páez de la Cadena B, Martínez-Pérez MJ, de Miguel E, Zabana Y, Mañosa Ciria M, Beltrán B, Barreiro-de Acosta M. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the use of abdominal ultrasound in inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:158-174. [PMID: 33309386 DOI: 10.1016/j.gastrohep.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 10/22/2022]
Abstract
Ultrasound has an excellent diagnostic performance when Crohn's disease is suspected, when performing an activity assessment, or determining the extension and location of Crohn's disease, very similar to other examinations such as MRI or CT. It has a good correlation with endoscopic lesions and allows the detection of complications such as strictures, fistulas or abscesses. It complements colonoscopy in the diagnosis and, given its tolerance, cost and immediacy, it can be considered as a good tool for disease monitoring. In ulcerative colitis, its role is less relevant, being limited to assessing the extent and activity when it is not possible with other diagnostic techniques or if there are doubts with these. Despite its advantages, its use in inflammatory bowel disease (IBD) is not widespread in Spain. For this reason, this document reviews the advantages and disadvantages of the technique to promote knowledge about it and implementation of it in IBD Units.
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Affiliation(s)
- Fernando Muñoz
- Servicio de Digestivo. Complejo Asistencial Universitario de Salamanca, España.
| | - Tomás Ripollés
- Servicio Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, España
| | - Joaquín Poza Cordón
- Servicio de Aparato Digestivo del Hospital Universitario La Paz, Madrid, España
| | | | | | - Enrique de Miguel
- Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Yamile Zabana
- Servicio de Gastroenterología, Unidad de Enfermedad Inflamatoria Intestinal, Hospital Universitari Mútua de Terrassa, CIBERehd, Barcelona, España
| | - Miriam Mañosa Ciria
- Unidad de EII. Servei d'Aparell digestiu. Hospital Universitari Germans Trias i Pujol, CIBERehd, Barcelona, España
| | - Belén Beltrán
- Servicio de Medicina Digestiva, Hospital Universitario La Fe, CIBERehd, Valencia, España
| | - Manuel Barreiro-de Acosta
- Unidad EII. Servicio de Aparato Digestivo. Hospital Clínico Universitario de Santiago, A Coruña, España
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23
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Martín Algíbez A, de Las Heras Páez de la Cadena B. The use of contrast-enhanced ultrasound for chronic inflammatory bowel disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 113:286-291. [PMID: 33261502 DOI: 10.17235/reed.2020.7499/2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Intestinal ultrasound is a non-invasive, inexpensive, accessible imaging technique that is appropriate for the study of patients with inflammatory bowel disease (IBD). It provides an assessment of inflammatory activity and complications with a diagnostic accuracy similar to that of magnetic resonance imaging (MRI) and computed tomography (CT). Furthermore, it has proven to be of great value for the follow-up and monitoring of these patients. The addition of contrast enhancement has improved the diagnostic ability of intestinal ultrasound in the assessment of both inflammatory activity and complications. The development of dynamic studies able to quantify contrast arrival and determine a number of parameters in time-intensity curves (TICs) has increased the capability of intestinal ultrasound to identify inflammation and predict response to biologic therapy.
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24
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Ripollés T, Muñoz F, Martínez-Pérez MJ, de Miguel E, Cordón JP, de la Heras Páez de la Cadena B. Usefulness of intestinal ultrasound in inflammatory bowel disease. RADIOLOGIA 2020; 63:89-102. [PMID: 33189372 DOI: 10.1016/j.rx.2020.10.001] [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: 05/27/2020] [Revised: 08/30/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023]
Abstract
Imaging techniques play a fundamental role in the initial diagnosis and follow-up of inflammatory bowel disease. Intestinal ultrasound has high sensitivity and specificity in patients with suspected Crohn's disease and in the detection of inflammatory activity. This technique enables the early diagnosis of intra-abdominal complications such as stenosis, fistulas, and abscesses. It has also proven useful in monitoring the response to treatment and in detecting postsurgical recurrence. Technical improvements in ultrasound scanners, technological advances such as ultrasound contrast agents and elastography, and above all increased experience have increased the role of ultrasound in the evaluation of the gastrointestinal tract. The features that make ultrasound especially attractive include its wide availability, its noninvasiveness and lack of ionizing radiation, its low cost, and its good reproducibility, which is important because it is easy to repeat the study and the study is well tolerated during follow-up. This review summarizes the role of intestinal ultrasound in the detection and follow-up of inflammatory bowel disease.
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Affiliation(s)
- T Ripollés
- Servicio de Radiología, Hospital Dr. Peset, Valencia, España.
| | - F Muñoz
- Servicio de Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | | | - E de Miguel
- Servicio de Radiología, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - J Poza Cordón
- Servicio de Digestivo, Hospital Universitario La Paz, Madrid, España
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25
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Fraquelli M, Castiglione F, Calabrese E, Maconi G. Impact of intestinal ultrasound on the management of patients with inflammatory bowel disease: how to apply scientific evidence to clinical practice. Dig Liver Dis 2020; 52:9-18. [PMID: 31732443 DOI: 10.1016/j.dld.2019.10.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/27/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022]
Abstract
Technological improvements and growing sonographers' expertise boost the role of intestinal ultrasound (IUS) in assessing patients with inflammatory bowel diseases (IBD). Non-invasiveness, low cost and good reproducibility make IUS attractive. Leveraging on the Authors' long-term field experience, this review focuses on the IUS role in IBD patients' clinical management. For detecting IBD, particularly Crohn's disease, the IUS parameters - above all the evidence of a thickened bowel wall (BWT) - show very good diagnostic accuracy similar to that of MRI or CT scan. The standard IUS parameters are not accurate enough to detect inflammatory activity, but intravenous contrast-enhanced US (CEUS) is highly accurate in ruling active inflammation out. However, its routinely use remains limited in clinical practice and its parameters need standardization. IUS is accurate in detecting IBD main complications: in particular, fistulae and abscesses. As to stenosis the recent introduction of IUS-based elastographic techniques allows to differentiate prevalently inflammatory from highly fibrotic strictures. IUS proves valid also for monitoring IBD patients. In particular, the evidence of transmural healing, defined as BWT normalization, has got an important prognostic meaning, as associated with better long-term clinical outcomes. Post-surgery CD recurrence can be suggested by early IUS assessment.
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Affiliation(s)
- Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, "Luigi Sacco" Hospital, University of Milan, Italy
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26
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Sathananthan D, Rajagopalan A, Van De Ven L, Martin S, Fon J, Costello S, Bryant RV. Point-of-care gastrointestinal ultrasound in inflammatory bowel disease: An accurate alternative for disease monitoring. JGH OPEN 2019; 4:273-279. [PMID: 32280777 PMCID: PMC7144799 DOI: 10.1002/jgh3.12269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/23/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022]
Abstract
Background and Aim Point‐of‐care ultrasound (POCUS) is a noninvasive alternative to ileocolonoscopy for monitoring disease activity in inflammatory bowel disease (IBD) but is underutilized in practice. Accuracy data are needed to engender clinician confidence in POCUS and increase uptake. The aim of this study was to evaluate the accuracy of POCUS compared to ileocolonoscopy in detecting active disease and extent in patients with IBD. Methods A prospective, blinded study was performed at a single tertiary center in South Australia between May 2017 and May 2018. Consecutive patients with a formal diagnosis of IBD who underwent both POCUS and ileocolonoscopy within 30 days of one another, performed to evaluate IBD disease activity, were eligible for participation. The accuracy of POCUS compared to ileocolonoscopy was assessed using sensitivity, specificity, and Cohen's kappa coefficient analyses. Results A total of 74 patients were included in the final analysis, 35 (47%) of whom had Crohn's disease and 39 (53%) ulcerative colitis; 37 subjects (50%) underwent a POCUS and ileocolonoscopy on the same day. POCUS demonstrated 91% sensitivity and 83% specificity for detecting endoscopically active IBD, correlating with a positive predictive value (PPV) of 89%, a negative predictive value (NPV) of 86%, and a kappa coefficient of 0.74 (88%). POCUS defined disease extent with 87% sensitivity and 81% specificity, correlating with a PPV of 85% and NPV of 83% and a kappa coefficient of 0.70 (85%). Conclusion POCUS is accurate in defining disease activity and extent in IBD compared to ileocolonoscopy. POCUS represents an appealing, noninvasive alternative to ileocolonoscopy for monitoring disease activity in IBD.
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Affiliation(s)
- Dharshan Sathananthan
- Gastroenterology DepartmentQueen Elizabeth HospitalAdelaideSouth AustraliaAustralia
- School of MedicineThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Arvind Rajagopalan
- Gastroenterology DepartmentQueen Elizabeth HospitalAdelaideSouth AustraliaAustralia
| | - Lucinda Van De Ven
- Gastroenterology DepartmentQueen Elizabeth HospitalAdelaideSouth AustraliaAustralia
| | - Serena Martin
- Gastroenterology DepartmentQueen Elizabeth HospitalAdelaideSouth AustraliaAustralia
| | - James Fon
- Gastroenterology DepartmentQueen Elizabeth HospitalAdelaideSouth AustraliaAustralia
| | - Samuel Costello
- Gastroenterology DepartmentQueen Elizabeth HospitalAdelaideSouth AustraliaAustralia
- School of MedicineThe University of AdelaideAdelaideSouth AustraliaAustralia
| | - Robert V Bryant
- Gastroenterology DepartmentQueen Elizabeth HospitalAdelaideSouth AustraliaAustralia
- School of MedicineThe University of AdelaideAdelaideSouth AustraliaAustralia
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