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Contrast Enhanced Abdominal Ultrasound in the Assessment of Ileal Inflammation in Crohn's Disease: A Comparison with MR Enterography.

Horjus Talabur Horje CS, Bruijnen R, Roovers L, Groenen MJ, Joosten FB, Wahab PJ - PLoS ONE (2015)

Bottom Line: Sensitivity and specificity values of MRE and CEUS were compared by the McNemar test.CEUS identified 11 of 16 MRE-detected strictures, but no fistulae.The accuracy of CEUS is comparable to that of MRE in the assessment of active, uncomplicated terminal ileal CD and therefore a valuable bedside alternative to MRE in the follow-up of these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Rijnstate Hospital, Arnhem, the Netherlands.

ABSTRACT

Background and aims: To prospectively examine the feasibility and accuracy of Contrast Enhanced Ultrasound (CEUS) in the assessment of Crohn's disease (CD) activity in the terminal ileum in comparison to Magnetic Resonance Enterography (MRE), using endoscopy as a reference standard.

Methods: 105 consecutive patients with alleged clinically active CD were assessed by MRE and CEUS. CEUS of the terminal ileum was performed using an intravenous microbubble contrast enhancer. Accuracy values of CEUS and MRE for the presence of active terminal ileitis were evaluated using the Receiver Operating Characteristic method, using endoscopic findings as a reference standard. Sensitivity and specificity values of MRE and CEUS were compared by the McNemar test.

Results: CEUS was feasible in 98% of patients, MRE in all. Optimal diagnostic accuracy in CEUS was obtained at a peak intensity value of 10%, showing 100% sensitivity, 92% specificity and an accuracy of 99% in demonstrating ileal mucosal inflammation. For MRE, overall sensitivity, specificity and accuracy were, 87%, 100%, and 88%, respectively. CEUS and MRE were highly correlated in assessing length and wall thickness of the terminal ileum. CEUS identified 11 of 16 MRE-detected strictures, but no fistulae.

Conclusion: The accuracy of CEUS is comparable to that of MRE in the assessment of active, uncomplicated terminal ileal CD and therefore a valuable bedside alternative to MRE in the follow-up of these patients.

No MeSH data available.


Related in: MedlinePlus

Perfusion map obtained by Qontrast software.Left side: contrast uptake based on increased microvascularization of the terminal ileum in a patient with severe endoscopic disease activity. Right side: contrast uptake of the terminal ileum in a patient with normal endoscopic appearance.
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pone.0136105.g001: Perfusion map obtained by Qontrast software.Left side: contrast uptake based on increased microvascularization of the terminal ileum in a patient with severe endoscopic disease activity. Right side: contrast uptake of the terminal ileum in a patient with normal endoscopic appearance.

Mentions: CEUS images were assessed directly after injection of the contrast agent, by recording a videoclip at the level of the most affected terminal ileum loop. After primary imaging, quantification software Qontrast (Bracco, Italy) was applied to obtain contrast-enhanced sonographic perfusion maps, allowing immediate evaluation of the peak intensity (PI), time to peak (TTP), and the regional blood volume (RBV), being proportional to the area under the curve (Fig 1). These parameters, measured within the region of interest (ROI) selected by the operator, have formerly been described as indicators for disease activity [16–19]. Qontrast software is able to quantify the contrast enhancement from a sequence of the perfusion frames and to generate a chromatic map that allows immediate evaluation of the perfusion properties of the selected region (region of interest, ROI). The quantification procedure is being performed for each pixel encompassed by the ROI on the frame sequence. The ultrasound video intensity of the pixels comprised in each ROI is being measured in gray-scale levels, from 0 (black pixels) to 255 (white pixels), and expressed in mean ± SD through histogram analysis. Furthermore a virtual color image of the bowel can be obtained, composed of a primary color scale varying from red (maximum signal intensity) to blue (minimum signal intensity) and correlating with the numeric value of the signal intensity expressed in percentages (maximum intensity = 100%). In each patient two different regions of the color map with the highest echo-signal intensity after contrast injection, were analyzed and the mean value was used for the statistical analysis.


Contrast Enhanced Abdominal Ultrasound in the Assessment of Ileal Inflammation in Crohn's Disease: A Comparison with MR Enterography.

Horjus Talabur Horje CS, Bruijnen R, Roovers L, Groenen MJ, Joosten FB, Wahab PJ - PLoS ONE (2015)

Perfusion map obtained by Qontrast software.Left side: contrast uptake based on increased microvascularization of the terminal ileum in a patient with severe endoscopic disease activity. Right side: contrast uptake of the terminal ileum in a patient with normal endoscopic appearance.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4556376&req=5

pone.0136105.g001: Perfusion map obtained by Qontrast software.Left side: contrast uptake based on increased microvascularization of the terminal ileum in a patient with severe endoscopic disease activity. Right side: contrast uptake of the terminal ileum in a patient with normal endoscopic appearance.
Mentions: CEUS images were assessed directly after injection of the contrast agent, by recording a videoclip at the level of the most affected terminal ileum loop. After primary imaging, quantification software Qontrast (Bracco, Italy) was applied to obtain contrast-enhanced sonographic perfusion maps, allowing immediate evaluation of the peak intensity (PI), time to peak (TTP), and the regional blood volume (RBV), being proportional to the area under the curve (Fig 1). These parameters, measured within the region of interest (ROI) selected by the operator, have formerly been described as indicators for disease activity [16–19]. Qontrast software is able to quantify the contrast enhancement from a sequence of the perfusion frames and to generate a chromatic map that allows immediate evaluation of the perfusion properties of the selected region (region of interest, ROI). The quantification procedure is being performed for each pixel encompassed by the ROI on the frame sequence. The ultrasound video intensity of the pixels comprised in each ROI is being measured in gray-scale levels, from 0 (black pixels) to 255 (white pixels), and expressed in mean ± SD through histogram analysis. Furthermore a virtual color image of the bowel can be obtained, composed of a primary color scale varying from red (maximum signal intensity) to blue (minimum signal intensity) and correlating with the numeric value of the signal intensity expressed in percentages (maximum intensity = 100%). In each patient two different regions of the color map with the highest echo-signal intensity after contrast injection, were analyzed and the mean value was used for the statistical analysis.

Bottom Line: Sensitivity and specificity values of MRE and CEUS were compared by the McNemar test.CEUS identified 11 of 16 MRE-detected strictures, but no fistulae.The accuracy of CEUS is comparable to that of MRE in the assessment of active, uncomplicated terminal ileal CD and therefore a valuable bedside alternative to MRE in the follow-up of these patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Gastroenterology, Rijnstate Hospital, Arnhem, the Netherlands.

ABSTRACT

Background and aims: To prospectively examine the feasibility and accuracy of Contrast Enhanced Ultrasound (CEUS) in the assessment of Crohn's disease (CD) activity in the terminal ileum in comparison to Magnetic Resonance Enterography (MRE), using endoscopy as a reference standard.

Methods: 105 consecutive patients with alleged clinically active CD were assessed by MRE and CEUS. CEUS of the terminal ileum was performed using an intravenous microbubble contrast enhancer. Accuracy values of CEUS and MRE for the presence of active terminal ileitis were evaluated using the Receiver Operating Characteristic method, using endoscopic findings as a reference standard. Sensitivity and specificity values of MRE and CEUS were compared by the McNemar test.

Results: CEUS was feasible in 98% of patients, MRE in all. Optimal diagnostic accuracy in CEUS was obtained at a peak intensity value of 10%, showing 100% sensitivity, 92% specificity and an accuracy of 99% in demonstrating ileal mucosal inflammation. For MRE, overall sensitivity, specificity and accuracy were, 87%, 100%, and 88%, respectively. CEUS and MRE were highly correlated in assessing length and wall thickness of the terminal ileum. CEUS identified 11 of 16 MRE-detected strictures, but no fistulae.

Conclusion: The accuracy of CEUS is comparable to that of MRE in the assessment of active, uncomplicated terminal ileal CD and therefore a valuable bedside alternative to MRE in the follow-up of these patients.

No MeSH data available.


Related in: MedlinePlus