Contrast-enhanced ultrasonographic evaluation of inflammatory activity in Crohn's disease.
OBJECTIVE
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.
Sardinian Mediterranean Imaging Research Group, Sassari, Italy. migaleddu@smirg.org
Vincenzo
V
Migaleddu
Antonio M
AM
Scanu
Emilio
E
Quaia
Paolo Cossu
PC
Rocca
Maria Pina
MP
Dore
Domenico
D
Scanu
Lorenza
L
Azzali
Giuseppe
G
Virgilio
D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D045423:Microbubbles; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
D003287:Contrast Media; D013459:Sulfur Hexafluoride