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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

Twenty-five-year-old male patient with Crohn’s disease of the terminal ileum.A: Coronal MR Enterography images (T2-weighted single-shot turbo spin-echo on the left image; T1-weighted fat saturated, spectrally attenuated inversion recovery after Gadoteric acid administration, on the right image) of a patient with ileitis terminalis demonstrating marked wall thickening of the terminal ileum (white arrow) and mild enhancement after contrast administration (white arrow). B: Longitudinal Contrast enhanced ultrasound (Gray scale ultrasound image, on the right side; Contrast enhanced ultrasound image, on the left side), of the same patient showing wall thickening on Gray scale ultrasound (white arrow) and strong enhancement after Sonovue administration on Contrast enhanced ultrasound (white arrow). C: Endoscopic image of the same patient with an ulcerative ileitis terminalis.
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pone.0136105.g005: Twenty-five-year-old male patient with Crohn’s disease of the terminal ileum.A: Coronal MR Enterography images (T2-weighted single-shot turbo spin-echo on the left image; T1-weighted fat saturated, spectrally attenuated inversion recovery after Gadoteric acid administration, on the right image) of a patient with ileitis terminalis demonstrating marked wall thickening of the terminal ileum (white arrow) and mild enhancement after contrast administration (white arrow). B: Longitudinal Contrast enhanced ultrasound (Gray scale ultrasound image, on the right side; Contrast enhanced ultrasound image, on the left side), of the same patient showing wall thickening on Gray scale ultrasound (white arrow) and strong enhancement after Sonovue administration on Contrast enhanced ultrasound (white arrow). C: Endoscopic image of the same patient with an ulcerative ileitis terminalis.

Mentions: The median length of the affected bowel was 6 cm (range 3–20 cm). The median measured wall thickness was 5.5 mm (range 3–13 mm) and a stratified wall appearance was detected in 53 patients (50%) (Fig 5). Furthermore, grey scale US detected stenosis of the terminal ileum with prestenotic dilation, in 11 patients.


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)

Twenty-five-year-old male patient with Crohn’s disease of the terminal ileum.A: Coronal MR Enterography images (T2-weighted single-shot turbo spin-echo on the left image; T1-weighted fat saturated, spectrally attenuated inversion recovery after Gadoteric acid administration, on the right image) of a patient with ileitis terminalis demonstrating marked wall thickening of the terminal ileum (white arrow) and mild enhancement after contrast administration (white arrow). B: Longitudinal Contrast enhanced ultrasound (Gray scale ultrasound image, on the right side; Contrast enhanced ultrasound image, on the left side), of the same patient showing wall thickening on Gray scale ultrasound (white arrow) and strong enhancement after Sonovue administration on Contrast enhanced ultrasound (white arrow). C: Endoscopic image of the same patient with an ulcerative ileitis terminalis.
© Copyright Policy
Related In: Results  -  Collection

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

pone.0136105.g005: Twenty-five-year-old male patient with Crohn’s disease of the terminal ileum.A: Coronal MR Enterography images (T2-weighted single-shot turbo spin-echo on the left image; T1-weighted fat saturated, spectrally attenuated inversion recovery after Gadoteric acid administration, on the right image) of a patient with ileitis terminalis demonstrating marked wall thickening of the terminal ileum (white arrow) and mild enhancement after contrast administration (white arrow). B: Longitudinal Contrast enhanced ultrasound (Gray scale ultrasound image, on the right side; Contrast enhanced ultrasound image, on the left side), of the same patient showing wall thickening on Gray scale ultrasound (white arrow) and strong enhancement after Sonovue administration on Contrast enhanced ultrasound (white arrow). C: Endoscopic image of the same patient with an ulcerative ileitis terminalis.
Mentions: The median length of the affected bowel was 6 cm (range 3–20 cm). The median measured wall thickness was 5.5 mm (range 3–13 mm) and a stratified wall appearance was detected in 53 patients (50%) (Fig 5). Furthermore, grey scale US detected stenosis of the terminal ileum with prestenotic dilation, in 11 patients.

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