title: Predicting the clinical response to cytapheresis in steroid-refractory or -dependent ulcerative colitis using contrast-enhanced ultrasonography.
abstract: OBJECTIVE
  To evaluate the usefulness of transabdominal ultrasound (US), including contrast-enhanced ultrasonography (CEUS), in predicting the response to cytapheresis therapy in patients with steroid-refractory or -dependent ulcerative colitis (UC).
  
  
  METHODS
  Between January 2005 and June 2008, 26 consecutive patients with steroid-refractory or -dependent UC were treated with granulocyte and monocyte adsorption apheresis (GCAP) or leukocytapheresis (LCAP) at our institute. The clinical activity of UC was evaluated by patients' C-reactive protein (CRP) levels and clinical activity index (CAI) scores. All patients were evaluated by grey-scale US, power Doppler US (PDUS), and CEUS. In CEUS, the color signal patterns were classified as 1 of 2 patterns. In pattern 1, color signals were partially detected in the bowel wall (excluding muscularis propria, the outer thin layer of the bowel wall), whereas in pattern 2, color signals were detected in the entire bowel wall (excluding muscularis propria). Differences between remission or clinical response (group R) and no response (group N) were ascertained for clinical features, clinical activities, and US findings.
  
  
  RESULTS
  Differences between the two groups were not considered significant for the clinical features, clinical activities, and grey-scale US and PDUS findings. Using CEUS, 4 patients in group R showed pattern 2 (21%), while in group N, all patients showed this pattern, indicating a significant difference between the two groups (p<0.01).
  
  
  CONCLUSIONS
  CEUS findings may be helpful in predicting the clinical response to cytapheresis for steroid-refractory or -dependent UC.
authors.affiliation: Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Toshiki
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Shigeto
authors.initials: S
authors.lastname: Yoshida
authors.forename: Shinji
authors.initials: S
authors.lastname: Tanaka
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Takemura
authors.forename: Shiro
authors.initials: S
authors.lastname: Oka
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshihara
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Yamada
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D003093:Colitis, Ulcerative / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000628:therapy*; D003287:Contrast Media; D016238:Cytapheresis / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D013256:Steroids / Q000627:therapeutic use; D018608:Ultrasonography, Doppler / Q000379:methods*
chemical_list: D003287:Contrast Media; D013256:Steroids