Gastroenterology
Volume 137, Issue 1 , Pages 43-52, July 2009

Contrast-Enhanced Ultrasonographic Evaluation of Inflammatory Activity in Crohn's Disease

  • Vincenzo Migaleddu

      Affiliations

    • Sardinian Mediterranean Imaging Research Group – SMIRG non-profit foundation, Sassari, Italy
    • Corresponding Author InformationReprint requests Address requests for reprints to: Vincenzo Migaleddu, MD, Sardinian Mediterranean Imaging Research Group – SMIRG non-profit foundation, Sassari, Sardinia, Italy. fax: +39.079.291918
    • ,
  • Antonio M. Scanu, MD

      Affiliations

    • Department of General Surgery, University of Sassari, Italy
    • ,
  • Emilio Quaia

      Affiliations

    • Department of Radiology University of Trieste, Italy
    • ,
  • Paolo Cossu Rocca

      Affiliations

    • Department of Pathology, University of Sassari, Italy
    • ,
  • Maria Pina Dore

      Affiliations

    • Department of Internal Medicine, University of Sassari, Italy
    • ,
  • Domenico Scanu

      Affiliations

    • Sardinian Mediterranean Imaging Research Group – SMIRG non-profit foundation, Sassari, Italy
    • ,
  • Lorenza Azzali

      Affiliations

    • Department of Radiology University of Trieste, Italy
    • ,
  • Giuseppe Virgilio

      Affiliations

    • Sardinian Mediterranean Imaging Research Group – SMIRG non-profit foundation, Sassari, Italy

Received 20 July 2008; accepted 10 March 2009. published online 06 May 2009.

Michael B. Wallace, Section Editor

Background & Aims

We sought to test the diagnostic accuracy of ultrasound (US), color Doppler US (CD-US), and contrast-enhanced US (CE-US) in the evaluation of inflammatory activity in patients with Crohn's disease (CD), and to correlate the findings of these sonographic studies with inflammatory activity, as scored by the CD activity index (CDAI).

Methods

Patients with CD were enrolled in the study. Radiologists performing the scans were blinded to clinical status. Baseline US, CD-US, and CE-US examinations were conducted with high-frequency probes (8–14 and 5–7 MHz) before and after injection of sulfur hexafluoride-filled microbubbles. The diagnostic accuracy of baseline US, CD-US, and CE-US were calculated by using the endoscopic and histologic findings as reference standards and correlated with the CDAIs by using the Pearson linear correlation coefficient.

Results

Forty-seven patients (20 men; 27 women; mean age ± SD, 38 ± 14 years) with a CDAI > 150 (n = 30) or < 150 (n = 17), were recruited. CE-US showed the highest performance, with 93.5% sensitivity, 93.7% specificity, and 93.6% overall accuracy. CE-US revealed 3 bowel wall perfusion patterns after microbubble injection: submucosal enhancement and inward and outward transparietal enhancement. The linear correlation coefficient for CE-US versus CDAI was 0.74 (P < .0001); for baseline US (assessing thickness, length, and multilayer appearance of the diseased bowel) versus the CDAI, the coefficients were 0.68 (P < .0001), 0.47 (P = .0009), and 0.60 (P < .0001), respectively; and for CD-US versus CDAI the coefficient was 0.73 (P < .0001).

Conclusions

CE-US has a high sensitivity and specificity in detecting inflammatory activity and a strong correlation with the CDAI.

Abbreviations used in this paper: CDAI, Crohn's disease activity index, CD-US, color Doppler ultrasonography, CE-US, contrast enhanced ultrasonography, CT, computed tomography, US, ultrasonography

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 This article has an accompanying continuing medical education activity on page 372. Learning Objective: Upon completion of this CME exercise, successful learners will be able to demonstrate the achievement of knowledge to choose the best diagnostic approach in the different clinical features that Crohn disease and its progression present, as a non-invasive technique associated with greater patient comfort, CE-US has significant diagnostic accuracy in the assessment of Crohn's disease activity.

 Conflicts of Interest The authors disclose no conflicts.

PII: S0016-5085(09)00735-5

doi:10.1053/j.gastro.2009.03.062

Gastroenterology
Volume 137, Issue 1 , Pages 43-52, July 2009

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