Predicting the need for surgery in Crohn's disease with contrast harmonic ultrasound.
OBJECTIVE
Harmonic flash echo imaging (H-FEI), an intermittent scanning method using injection of Levovist, enables the evaluation of microperfusion of the gastrointestinal wall. The aim of this study was prospectively to investigate the relationship between bowel blood flow and the likelihood of the need for surgery in 70 patients with active Crohn's disease (CD), using conventional ultrasonography (US) and H-FEI.


METHODS
For H-FEI, Levovist injection was followed by scanning of the bowel segment of interest with intermittent harmonic imaging for 2 min (interval, 4 s; transmission pulse at 2.3 MHz; reception at 4.6 MHz). We calculated the mean echo-intensity for the bowel wall showing strongest opacity in the FEI series for each patient. Maximum bowel-wall thickness, wall stratification, maximum echo-intensity obtained by H-FEI, CD activity index, and C-reactive protein concentration were compared between patients treated successfully with medication after H-FEI (group M) and those who proved to need surgery (group S).


RESULTS
No significant differences in clinical variables were evident between groups M (n=45) and S (n=25). The subsequent need for surgery was significantly indicated by multivariate analysis, showing loss of stratification in the bowel wall (odds ratio (OR)=5.98, 95% confidence interval (CI)=1.4-25.1, p=0.015) and high echo-intensity according to H-FEI (OR=1.02, CI=1.005-1.034, p=0.007).


CONCLUSIONS
In active CD, patients with bowel segments showing a loss of stratification and rich perfusion by H-FEI are likely to need surgical treatment.
Kunihiro
Kayoko
K
Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan. km-kuni@has.att.ne.jp
Hata
Jiro
J
Manabe
Noriaki
N
Mitsuoka
Yutaka
Y
Tanaka
Shinji
S
Haruma
Ken
K
Chayama
Kazuaki
K
D000293:Adolescent; D000328:Adult; D003082:Colectomy; D003092:Colitis / Q000000981:diagnostic imaging* / Q000601:surgery; D003106:Colon / Q000000981:diagnostic imaging*; D016001:Confidence Intervals; D003287:Contrast Media / Q000008:administration & dosage*; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D016017:Odds Ratio; D011134:Polysaccharides / Q000008:administration & dosage; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014463:Ultrasonography
D003287:Contrast Media; D011134:Polysaccharides; C059891:SHU 508