Comparison between preoperative quantitative assessment of bowel wall vascularization by contrast-enhanced ultrasound and operative macroscopic findings and results of histopathological scoring in Crohn's disease.
OBJECTIVE
Patients with Crohn's disease (CD) often undergo several radiological imaging studies, which - with the exception of MRI and US - subject patients to ionizing radiation. Thus, efforts have been made to identify the inflammation activity using ultrasound techniques. The aim of our study was to describe the perfusion pattern of the inflamed bowel wall in CD using contrast-enhanced ultrasound (CEUS) and specific quantification software for perfusion assessment. Moreover, we compared these findings with the operative macroscopic findings as well as with the transparietal histopathological findings of surgical specimens applying an advanced histopathological scoring system.


METHODS
We prospectively performed CEUS in 20 consecutive patients with proven CD and planned bowel surgery due to CD within the next 15 days. We then applied the quantification software Qontrast to obtain contrast-enhanced sonographic perfusion maps. The surgeon defined the clinical behavior of CD according to the Vienna classification. The resected segments were then assessed by a pathologist using an advanced scoring system. We compared the results of CEUS, macroscopic findings and histopathological scoring.


RESULTS
We found a strong negative correlation (r = - 0.677, p < 0.01) between the histopathological score and the time-to-peak (TTP). Moreover, we detected a strong correlation between TTP and single parameters of the histopathological scoring system.


CONCLUSIONS
Ultrasound as a widely available radiation-free imaging method would be preferable for assessing inflammatory activity of CD, particularly since the ultrasound findings correlate significantly with a histopathological scoring system.
Girlich
C
C
Department of Internal Medicine I, University of Regensburg, Germany. christiane.girlich@klinik.uniregensburg.de
Jung
E M
EM
Huber
E
E
Ott
C
C
Iesalnieks
I
I
Schreyer
A
A
Schacherer
D
D
D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D001783:Blood Flow Velocity / Q000502:physiology; D001810:Blood Volume / Q000502:physiology; D002932:Cineangiography; D003287:Contrast Media / Q000008:administration & dosage; D003424:Crohn Disease / Q000145:classification / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007089:Image Enhancement; D007091:Image Processing, Computer-Assisted; D007413:Intestinal Mucosa / Q000098:blood supply* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011446:Prospective Studies; D012039:Regional Blood Flow / Q000502:physiology; D012680:Sensitivity and Specificity; D012984:Software; D013223:Statistics as Topic; D013459:Sulfur Hexafluoride; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride