Research

SMIRG at RSNA 2009

Abstract of oral presentation by SMIRG at the 95th congress of Radiological Society of North America (RSNA 2009).

 

Primary Category: Gastrointestinal
Secondary Category: Ultrasound
Mon Nov 30 2009 8:50AM - 9:00AM ROOM E451A 

02) Ultrasonographic Evaluation of Inflammatory Activity in Crohns Disease: Importance of Contrast Enhancement

V A Migaleddu, MD, Sardinia, ITA; R Prost, MD; D Scanu, MD; D Sirigu, MD; G Campisi, MD; G Virgilio, MD (migaleddu@smirg.org)

PURPOSE

To test accuracy of Ultrasound (US), Color-Doppler US (CDUS) and Contrast-enhanced Ultrasound (CEUS) in the evaluation of inflammatory activity in patients with Crohn’s disease(CD) and to correlate those sonographic approaches findings with inflammatory activity as scored by the Crohn’s disease activity index (CDAI).

METHOD AND MATERIALS

With the Institutional Review Board approval and informed consent, we recruited 47 patients (M/F=20/27; age mean ± SD, 38±14 years, range 16-71) with a CDAI >150 (n=30) or <150 (n=17). Clinical status and CDAI were unknown to the radiologists performing the scans. Baseline US, CDUS and CEUS 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, CDUS and CEUS were calculated by using the endoscopic and histological findings as reference standards. Moreover, baseline US, CDUS and CEUS scans were reviewed by three observers and correlated with the CDAI by using the Pearson's linear correlation coefficient.

RESULTS

CEUS had the higher performance with 93.5% sensitivity, 93.7 % specificity, 96.6% positive predictive value, 88.2% negative predictive value, and 93.6 % overall accuracy. CEUS revealed three bowel wall perfusion patterns after microbubble injection: submucosal enhancement, inward and outward transparietal enhancement .CEUS v/s CDAI yielded Pearson’s linear correlation coefficient of 0.74 (p-value<0.0001); baseline US (thickness, length, multilayer appearance of bowel involved) v/s CDAI were respectively of 0.68 (p-value<0.0001), of 0.47 (p-value=0.0009) and of 0.60 (p-value<0.0001); CDUS v/s CDAI 0.73 (p-value <0.0001).

CONCLUSION

CEUS showed very high performance for evaluating Crohn's disease activity.

CLINICAL RELEVANCE/APPLICATION

To verify the accuracy of Ultrasound, Color-Doppler US  and Contrast-enhanced Ultrasound  in the evaluation of inflammatory activity in patients with Crohn’s disease.