1
|
Faggiani I, D’Amico F, Furfaro F, Zilli A, Parigi TL, Cicerone C, Fiorino G, Peyrin-Biroulet L, Danese S, Allocca M. Small Bowel Cancer in Crohn's Disease. Cancers (Basel) 2024; 16:2901. [PMID: 39199671 PMCID: PMC11352503 DOI: 10.3390/cancers16162901] [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: 07/24/2024] [Revised: 08/16/2024] [Accepted: 08/18/2024] [Indexed: 09/01/2024] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that frequently affects the small bowel. Individuals diagnosed with CD are at increased risk of developing bowel cancer compared to the general population. Small bowel cancer is a rare but significant CD complication. Adenocarcinoma represents the most prevalent of these neoplasms, followed by neuroendocrine tumors and sarcomas. The primary risk factors identified are being of the male sex, disease duration, previous surgical intervention, perianal disease, and chronic inflammation. The precise etiology remains unclear. Another crucial issue concerns the role of immunomodulators and advanced therapies. By inhibiting inflammation, these therapies can reduce the risk of cancer, which is often initiated by the inflammation-dysplasia-adenocarcinoma sequence. In accordance with the most recent guidelines, it is not necessary to conduct surveillance in patients with small bowel cancer among CD patients, as it is considered a rare disease. Nevertheless, it is of significant importance for gastroenterologists to be aware of this potential CD complication, as well as the patients who are most at risk of developing it. The purpose of this review is to provide a comprehensive overview of CD-SBC, focusing on epidemiology, etiopathogenesis, risk factors, diagnosis, and the role of advanced therapies in CD-SBC.
Collapse
Affiliation(s)
- Ilaria Faggiani
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; (I.F.); (F.D.); (F.F.); (A.Z.); (T.L.P.); (C.C.); (S.D.)
| | - Ferdinando D’Amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; (I.F.); (F.D.); (F.F.); (A.Z.); (T.L.P.); (C.C.); (S.D.)
| | - Federica Furfaro
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; (I.F.); (F.D.); (F.F.); (A.Z.); (T.L.P.); (C.C.); (S.D.)
| | - Alessandra Zilli
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; (I.F.); (F.D.); (F.F.); (A.Z.); (T.L.P.); (C.C.); (S.D.)
| | - Tommaso Lorenzo Parigi
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; (I.F.); (F.D.); (F.F.); (A.Z.); (T.L.P.); (C.C.); (S.D.)
| | - Clelia Cicerone
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; (I.F.); (F.D.); (F.F.); (A.Z.); (T.L.P.); (C.C.); (S.D.)
| | - Gionata Fiorino
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France;
- INSERM, NGERE, University of Lorraine, F-54000 Nancy, France
- INFINY Institute, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, F-54500 Vandœuvre-lès-Nancy, France
- Groupe Hospitalier Privè Ambroise Parè-Hartmann, Paris IBD Center, F-92200 Neuilly-sur-Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; (I.F.); (F.D.); (F.F.); (A.Z.); (T.L.P.); (C.C.); (S.D.)
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, 20132 Milan, Italy; (I.F.); (F.D.); (F.F.); (A.Z.); (T.L.P.); (C.C.); (S.D.)
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Baloyiannis I, Perivoliotis K, Sarakatsianou C, Chatzinikolaou C, Tzovaras G. The Reduction of Anastomosis-Related Morbidity Using the Kono-S Anastomosis in Patients with Crohn's Disease: A Meta-Analysis. J Clin Med 2024; 13:2461. [PMID: 38730990 PMCID: PMC11084922 DOI: 10.3390/jcm13092461] [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: 02/22/2024] [Revised: 04/21/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
(1) Background: we conducted this study to evaluate the effect of Kono-S anastomosis on postoperative morbidity after bowel resection for Crohn's disease. (2) Methods: This study adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The primary endpoint was the overall complications rate. Secondary outcomes included specific complications analyses, disease recurrence and efficiency endpoints. A systematic literature screening was performed in major electronic scholar databases (Medline, Scopus, Web of Science), from inception to 17 January 2024. Both Random (RE) and Fixed Effects (FE) models were estimated; the reported analysis was based on the Cochran Q test results. (3) Results: Overall, eight studies and 913 patients were included in this meta-analysis. Pooled analyses confirmed that Kono-S was not superior in terms of overall morbidity (OR: 0.69 [0.42, 1.15], p = 0.16). Kono-S displayed a reduced risk for anastomotic leakage (OR: 0.34 [0.16, 0.71], p = 0.004) and reoperation (OR: 0.12 [0.05, 0.27], p < 0.001), and a shortened length of hospital stay (WMD: -0.54 [-0.73, -0.34], p < 0.001). On the contrary, Kono-S results in higher rates of postoperative SSIs (OR: 1.85 [1.02, 3.35], p = 0.04). (4) Conclusions: This study confirms a comparable morbidity, but a lower risk of anastomotic leak and reoperation of Kono-S over conventional anastomoses. Further high quality studies are required to validate these findings.
Collapse
Affiliation(s)
- Ioannis Baloyiannis
- Department of Surgery, University Hospital of Larissa, 41110 Larissa, Greece; (I.B.); (C.S.); (G.T.)
| | | | - Chamaidi Sarakatsianou
- Department of Surgery, University Hospital of Larissa, 41110 Larissa, Greece; (I.B.); (C.S.); (G.T.)
| | | | - George Tzovaras
- Department of Surgery, University Hospital of Larissa, 41110 Larissa, Greece; (I.B.); (C.S.); (G.T.)
| |
Collapse
|
4
|
Matsumoto H, Hata J, Imuamura H, Yo S, Sasahira M, Misawa H, Oosawa M, Handa O, Umegami E, Shiotani A. Serial Changes in Intestinal Stenotic Stiffness in Patients with Crohn's Disease Treated with Biologics: A Pilot Study Using Ultrasound Shear Wave Elastography. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2023; 34:1006-1013. [PMID: 37603302 PMCID: PMC10645284 DOI: 10.5152/tjg.2023.22768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/07/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND/AIMS Intestinal strictures represent an important serious complication of Crohn's disease. Shear wave elastography is a promising noninvasive ultrasound technique for assessing tissue stiffness. This study aimed to evaluate stiffness in the areas of intestinal stricture in patients with Crohn's disease using shear wave elastography and the changes in stiffness after biologics. MATERIALS AND METHODS We enrolled 21 Crohn's disease patients having intestinal stricture. The patients consisted of 3 groups, which were the infliximab naïve (n = 6) group, the ustekinumab naïve (n = 8), and the bio-switch from infliximab to ustekinumab (n = 7) group. Bowell wall thickness was examined by ultrasound sonography, and the stiffness of Crohn's disease stricture lesions was evaluated using Shear wave speed before and 1 year after anti-tumor necrosis factor-alpha antibody infliximab, anti-interleukin 12/23 antibody ustekinumab, and bio-switch from infliximab to ustekinumab. RESULTS Bowell wall thickness was significantly improved after infliximab, ustekinumab, and the bio-switch. However, shear wave speed indices only in the ustekinumab group significantly decreased after treatment (P = .028), but not in the other group. CONCLUSIONS Shear wave elastography might be a useful method to evaluate stiffness in the areas of intestinal stricture in patients with Crohn's disease treated with biologics. However, a prospective randomized study evaluating the development of obstruction after biological treatment is needed to validate the study findings.
Collapse
Affiliation(s)
- Hiroshi Matsumoto
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Jiro Hata
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Hiroshi Imuamura
- Department of Clinical Pathology and Laboratory Medicine, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Shogen Yo
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Momoyo Sasahira
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Hiraku Misawa
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Motoyasu Oosawa
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Osamu Handa
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Eiji Umegami
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| | - Akiko Shiotani
- Division of Internal Medicine, Department of Gastroenterology, Kawasaki Medical School, Matsushima, Kurashiki, Okayama, Japan
| |
Collapse
|
5
|
Lee J, Myrie NO, Jeong GJ, Han WM, Jang YC, García AJ, Emelianov S. In vivo shear wave elasticity imaging for assessment of diaphragm function in muscular dystrophy. Acta Biomater 2023; 168:277-285. [PMID: 37453552 PMCID: PMC10540053 DOI: 10.1016/j.actbio.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/28/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Abstract
Duchenne muscular dystrophy (DMD) causes patients to suffer from ambulatory disability and cardiorespiratory failure, the latter of which leads to premature death. Due to its role in respiration, the diaphragm is an important muscle for study. A common method for evaluating diaphragm function is ex vivo force testing, which only allows for an end point measurement. In contrast, ultrasound shear wave elastography imaging (US-SWEI) can assess diaphragm function over time; however, US-SWEI studies in dystrophic patients to date have focused on the limbs without preclinical studies. In this work, we used US-SWEI to estimate the shear wave speed (SWS) in diaphragm muscles of healthy (WT) mice, mdx mice, and mdx mice haploinsufficient for utrophin (mdx-utr) at 6 and 12 months of age. Diaphragms were then subjected to ex vivo force testing and histological analysis at 12 months of age. Between 6 and 12 months, a 23.8% increase in SWS was observed in WT mice and a 27.8% increase in mdx mice, although no significant difference was found in mdx-utr mice. Specific force generated by mdx-utr diaphragms was lower than that of WT diaphragms following twitch stimulus. A strong correlation between SWS and collagen deposition was observed, as well as between SWS and muscle fiber size. Together, these data demonstrate the ability of US-SWEI to evaluate dystrophic diaphragm functionality over time and predict the biochemical and morphological make-up of the diaphragm. Additionally, our results highlight the advantage of US-SWEI over ex vivo testing by obtaining longitudinal measurements in the same subject. STATEMENT OF SIGNIFICANCE: In DMD patients, muscles experience cycles of regeneration and degeneration that contribute to chronic inflammation and muscle weakness. This pathology only worsens with time and leads to muscle wasting, including in respiratory and cardiac muscles. Because respiratory failure is a major contributor to premature death in DMD patients, the diaphragm muscle is an important muscle to evaluate and treat over time. Currently, diaphragm function is assessed using ex vivo force testing, a technique that only allows measurement at sacrifice. In contrast, ultrasonography, particularly shear wave elasticity imaging (USSWEI), is a promising tool for longitudinal assessment; however, most US-SWEI in DMD patients aimed for limb muscles only with the absence of preclinical studies. This work broadens the applications of US-SWE imaging by demonstrating its ability to track properties and function of dystrophic diaphragm muscles longitudinally in multiple dystrophic mouse models.
Collapse
Affiliation(s)
- Jeehyun Lee
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Nia O Myrie
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA
| | - Gun-Jae Jeong
- Institute of Cell and Tissue Engineering, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Woojin M Han
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Young C Jang
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA; Department of Orthopedics, Emory Musculoskeletal Institute, Emory School of Medicine, Atlanta, GA 30329, USA.
| | - Andrés J García
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA.
| | - Stanislav Emelianov
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University School of Medicine, Atlanta, GA 30332, USA.
| |
Collapse
|
6
|
Römer C, Legerlotz K, Czupajllo J, Fischer T, Wolfarth B, Lerchbaumer MH. Acute Effects of Running on Shear Wave Elastography Measures of the Achilles Tendon and Calf Muscles in Professional Female Handball and Volleyball Players. Diagnostics (Basel) 2023; 13:2957. [PMID: 37761324 PMCID: PMC10530130 DOI: 10.3390/diagnostics13182957] [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: 07/06/2023] [Revised: 08/27/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
Shear Wave Elastography (SWE) is currently used to detect tissue pathologies, i.e., tendinopathy. For preventive medicine, it is important to examine the sensitivity of SWE and to investigate how stiffness measures are affected by methodological variables. The aim of this study is to examine shear wave elastography (SWE) measures in order to compare the pre- and post-running values and to determine the correlation between the shear wave speed values (m/s). SWE examinations of the Achilles tendon (AT), soleus muscle (MS) and gastrocnemius muscle (MG)) were performed in 24 healthy professional female athletes. Measurements of the shear wave speed (m/s) were taken before and after incremental treadmill running until exhaustion. Correlations were investigated using the Pearson correlation coefficient and were examined for significance using the Student's t-test. The pre- and post-exercise shear wave speed did not differ. The pre-exercise and post-exercise stiffness for MS (r = 0.613), MG (r = 0.609) and AT (r = 0.583) correlated strongly. The pre-exercise values and changes in stiffness showed a significant correlation (p < 0.001). In professional athletes, acute exercise induces different tissue stiffness changes in AT, MS and MG for each individual. Thus, exercise activity immediately prior to the SWE measurement needs to be factored in when evaluating tissue stiffness.
Collapse
Affiliation(s)
- Claudia Römer
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, 10115 Berlin, Germany
| | - Julia Czupajllo
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Thomas Fischer
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
- Department of Radiology, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | - Bernd Wolfarth
- Department of Sports Medicine, Charité Universitätsmedizin Berlin, 10115 Berlin, Germany
| | | |
Collapse
|
7
|
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).
Collapse
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
| |
Collapse
|
8
|
Cebula M, Kufel J, Gruszczyńska K. A single-center, retrospective, cross-sectional study comparing the number of non-diagnostic measurements ratio in the pSWE and SSI ultrasound elastography methods. Medicine (Baltimore) 2023; 102:e33964. [PMID: 37266598 PMCID: PMC10237685 DOI: 10.1097/md.0000000000033964] [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: 02/07/2023] [Revised: 04/24/2023] [Accepted: 05/19/2023] [Indexed: 06/03/2023] Open
Abstract
The point shear wave elastography and supersonic shear imaging methods were compared regarding incorrect measurements during the liver examinations. A report-based, single-center, retrospective analysis of 425 liver elastography examinations was performed. A lower success ratio was observed for the point shear wave elastography method, as well as the older and obese patients pre-dominated in non-diagnostic studies. In our center experience, it is easier to obtain diagnostic data using the supersonic shear imaging method. However, further investigation of the subject is needed.
Collapse
Affiliation(s)
- Maciej Cebula
- Department of Radiodiagnostics, Invasive Radiology and Nuclear Medicine, Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jakub Kufel
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Katarzyna Gruszczyńska
- Department of Diagnostic Imaging, Department of Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| |
Collapse
|
9
|
Quantitative Assessment of Breast-Tumor Stiffness Using Shear-Wave Elastography Histograms. Diagnostics (Basel) 2022; 12:diagnostics12123140. [PMID: 36553148 PMCID: PMC9777730 DOI: 10.3390/diagnostics12123140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose: Shear-wave elastography (SWE) measures tissue elasticity using ultrasound waves. This study proposes a histogram-based SWE analysis to improve breast malignancy detection. Methods: N = 22/32 (patients/tumors) benign and n = 51/64 malignant breast tumors with histological ground truth. Colored SWE heatmaps were adjusted to a 0−180 kPa scale. Normalized, 250-binned RGB histograms were used as image descriptors based on skewness and area under curve (AUC). The histogram method was compared to conventional SWE metrics, such as (1) the qualitative 5-point scale classification and (2) average stiffness (SWEavg)/maximal tumor stiffness (SWEmax) within the tumor B-mode boundaries. Results: The SWEavg and SWEmax did not discriminate malignant lesions in this database, p > 0.05, rank sum test. RGB histograms, however, differed between malignant and benign tumors, p < 0.001, Kolmogorov−Smirnoff test. The AUC analysis of histograms revealed the reduction of soft-tissue components as a significant SWE biomarker (p = 0.03, rank sum). The diagnostic accuracy of the suggested method is still low (Se = 0.30 for Se = 0.90) and a subject for improvement in future studies. Conclusions: Histogram-based SWE quantitation improved the diagnostic accuracy for malignancy compared to conventional average SWE metrics. The sensitivity is a subject for improvement in future studies.
Collapse
|
10
|
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: 10] [Impact Index Per Article: 5.0] [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.
Collapse
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
| |
Collapse
|
11
|
Madsen GR, Wilkens R, Boysen T, Burisch J, Bryant R, Carter D, Gecse K, Maaser C, Maconi G, Novak K, Palmela C, Nayahangan LJ, Tolsgaard M. The knowledge and skills needed to perform intestinal ultrasound for inflammatory bowel diseases-an international Delphi consensus survey. Aliment Pharmacol Ther 2022; 56:263-270. [PMID: 35488472 PMCID: PMC9325538 DOI: 10.1111/apt.16950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/08/2022] [Accepted: 04/17/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intestinal ultrasound (IUS) is a non-invasive modality for monitoring disease activity in inflammatory bowel diseases (IBD). IUS training currently lacks well-defined standards and international consensus on competency criteria. AIM To achieve international consensus on what competencies should be expected from a newly certified IUS practitioner. METHODS A three-round, iterative Delphi process was conducted among 54 IUS experts from 17 countries. Round 1 was a brainstorming phase with an open-ended question to identify the knowledge and skills that experts believe a newly certified IUS practitioner should possess. The experts' suggestions were then organised into statements by a Steering Committee. In round 2, the experts commented upon and rated the statements, which were revised accordingly. In round 3, the experts rated the revised statements. Statements meeting the pre-defined consensus criterion of at least 70% agreement were included in the final list of statements. RESULTS In total, 858 items were suggested by the experts in the first round. Based on these suggestions, 55 statements were organised into three categories: knowledge, technical skills and interpretation skills. After the second round, 53 revised statements remained. After the final round, a total of 41 statements had achieved consensus. CONCLUSIONS We established international, expert consensus on the knowledge and skills that should be expected from newly certified IUS practitioners. These consensus statements are the first step towards mastery learning for IUS training. Educators can utilise these statements to design training programmes and evaluate the competencies of trainees before they engage in independent practice.
Collapse
Affiliation(s)
- Gorm Roager Madsen
- Gastrounit, Medical DivisionCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark,Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and AdultsCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark,Copenhagen Academy for Medical Education and Simulation, Centre for HR and EducationCopenhagenDenmark
| | - Rune Wilkens
- Gastrounit, Medical DivisionCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark,Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and AdultsCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark
| | - Trine Boysen
- Gastrounit, Medical DivisionCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark,Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and AdultsCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark
| | - Johan Burisch
- Gastrounit, Medical DivisionCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark,Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and AdultsCopenhagen University Hospital – Amager and HvidovreHvidovreDenmark
| | - Robert Bryant
- Inflammatory Bowel Disease Service, Department of GastroenterologyThe Queen Elizabeth HospitalAdelaideSouth AustraliaAustralia
| | - Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel and Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Krisztina Gecse
- Department of Gastroenterology and HepatologyAcademic Medical CenterAmsterdamthe Netherlands
| | - Christian Maaser
- Outpatients Department of Gastroenterology, Department of GeriatricsHospital LüneburgLüneburgGermany
| | - Giovanni Maconi
- Gastrointestinal Unit, Department of Clinical Sciences"L.Sacco" University HospitalMilanItaly
| | - Kerri Novak
- Department of Medicine, Division of GastroenterologyUniversity of CalgaryCalgaryAlbertaCanada
| | - Carolina Palmela
- Division of Gastroenterology, Surgical DepartmentHospital Beatriz ÂngeloLouresPortugal
| | - Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and EducationCopenhagenDenmark
| | - Martin Grønnebæk Tolsgaard
- Copenhagen Academy for Medical Education and Simulation, Centre for HR and EducationCopenhagenDenmark,Department of ObstetricsCopenhagen University HospitalCopenhagenDenmark
| |
Collapse
|
12
|
Dal Buono A, Faita F, Peyrin-Biroulet L, Danese S, Allocca M. Ultrasound Elastography in Inflammatory Bowel Diseases: A Systematic Review of Accuracy Compared with Histopathological Assessment. J Crohns Colitis 2022; 16:1637-1646. [PMID: 35696668 PMCID: PMC9624288 DOI: 10.1093/ecco-jcc/jjac082] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/09/2022] [Accepted: 06/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Ultrasound elastography [USE] is an innovative, non-invasive, promptly available, ancillary technique that has been proposed in the evaluation of intestinal fibrosis as a monitorable biomarker, in terms of stiffness. The non-invasive estimate of fibrosis by USE appears appealing for dedicated physicians, in order to optimise the treatments for inflammatory bowel disease [IBD] patients [surgical vs non-surgical]. We aimed to systematically review literature evidence on ultrasound elastography in IBD patients. METHODS For this qualitative systematic review, we searched PubMed, EMBASE, and Scopus to identify all studies, published until October 2021, investigating the application of USE in IBD patients compared with histopathological assessment. RESULTS Overall, 12 papers published between 2011 and 2019 were included. A total of 275 IBD patients were included: 272 Crohn's disease [CD] [98.9%] and three ulcerative colitis [UC] [1.1%]. Seven [58.3%] and four [41.6%] studies investigated strain elastography [SE] and shear wave elastography [SWE], respectively; in one study [0.1%] both techniques were addressed. The histological evaluation was largely conducted on surgical specimens and in two studies endoscopic biopsies were also included. The histological assessment was semi-quantitative in all the included studies, except for two where the fibrosis was evaluated only qualitatively. In 10/12 publications USE could accurately distinguish inflammation from fibrosis in the examined bowel tracts. CONCLUSIONS From the preliminary available data, an overall moderate-to-good accuracy of USE in detecting histological fibrosis [10/12 studies] was found. Point-shear wave elastography has been shown to perform superiorly. Further studies are needed to confirm these evidences.
Collapse
Affiliation(s)
- Arianna Dal Buono
- IBD Center, Department of Gastroenterology, Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | - Francesco Faita
- Italian National Research Council Institute of Clinical Physiology, Pisa, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm NGERE U1256, University Hospital of Nancy, University of Lorraine, Vandoeuvre-lès-Nancy, France
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, and University Vita-Salute San Raffaele, Milan, Italy
| | - Mariangela Allocca
- Corresponding author: Mariangela Allocca, MD, PhD, IBD Center, Department of Gastroenterology, Ospedale Vita-Salute San Raffaele, IRCCS, Milan, Italy. Tel.: +39026432069; E-mail:
| |
Collapse
|