title: Assessment of inflammatory and fibrotic stenoses in patients with Crohn's disease using contrast-enhanced ultrasound and computerized algorithm: a pilot study.
abstract: OBJECTIVE
  The development of stenosis is a typical complication of Crohn's disease and represents a serious diagnostic and therapeutic challenge. The aim of the present study was to define objective quantitative measures of stricture characteristics (fibrostenotic/cicartricial vs. inflammatory) using contrast-enhanced ultrasound (CEUS) in patients with stenotic Crohn's disease.
  
  
  METHODS
  During a period of 18 months, 18 consecutive patients with Crohn's disease and manifestation of a localized significant small bowel stenosis were prospectively recruited. Standardized ultrasound (US) examination, color-coded duplex sonography and CEUS using SonoVue® were performed. Quantitative measurements of bowel wall vascularity were determined using computerized algorithms (Bracco QONTRAST software). The quality of stenosis (fibrostenotic vs. inflammatory) was classified in a 4-point scale, and the diagnostic/prognostic power of the US and clinical tests upon initial presentation were compared.
  
  
  RESULTS
  We established a novel standardized CEUS procedure using computerized algorithms to quantitatively examine stenoses in Crohn's disease. An inflammatory origin of stenosis correlated significantly with a high Crohn's Disease Activity Index (CDAI) (p < 0.01), the length of stenosis (p < 0.01) as well as the Limberg score (p < 0.01). There was no correlation between the type of stenosis and quantitative results of CEUS.
  
  
  CONCLUSIONS
  Although bowel wall vascularity can be quantitatively assessed in stenotic areas by CEUS, this analysis does not improve the diagnostic power for the objective determination of the quality of stenosis at a single measurement. Semiquantitative analysis of bowel wall vascularity, length of stenosis, and CDAI may help to discriminate the origin of small bowel stenosis in Crohn's disease.
authors.affiliation: Department of Medicine III, University Hospital Aachen, RWTH Aachen University, Aachen, Germany.
authors.forename: Ramin
authors.initials: R
authors.lastname: Schirin-Sokhan
authors.forename: Ron
authors.initials: R
authors.lastname: Winograd
authors.forename: Stefanie
authors.initials: S
authors.lastname: Tischendorf
authors.forename: Hermann E
authors.initials: HE
authors.lastname: Wasmuth
authors.forename: Konrad
authors.initials: K
authors.lastname: Streetz
authors.forename: Frank
authors.initials: F
authors.lastname: Tacke
authors.forename: Christian
authors.initials: C
authors.lastname: Trautwein
authors.forename: Jens J W
authors.initials: JJ
authors.lastname: Tischendorf
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D003287:Contrast Media; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D007421:Intestine, Small / Q000098:blood supply / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media