title: Ileal Crohn disease: mural microvascularity quantified with contrast-enhanced US correlates with disease activity.
abstract: OBJECTIVE
  To quantitatively assess microvascular activation in the thickened ileal walls of patients with Crohn disease (CD) by using contrast-enhanced ultrasonography (US) and evaluate its correlation with widely used indexes of CD activity.
  
  
  METHODS
  This prospective study was approved by the ethics committee, and written informed consent was obtained from all patients. The authors examined 54 consecutively enrolled patients (mean age, 35.29 years; age range, 18-69 years; 39 men, 15 women) with endoscopically confirmed CD of the terminal ileum. Ileal wall segments thicker than 3 mm were examined with low-mechanical-index contrast-enhanced US and a second-generation US contrast agent. The authors analyzed software-plotted time-enhancement intensity curves to determine the maximum peak intensity (MPI) and wash-in slope coefficient (β) and evaluated their correlation with (a) the composite index of CD activity (CICDA), (b) the CD activity index (CDAI), and (c) the simplified endoscopic score for CD (SES-CD, evaluated in 37 patients) for the terminal ileum. Statistical analysis was performed with the Mann-Whitney test, Spearman rank test, and receiver operating characteristic (ROC) analysis.
  
  
  RESULTS
  MPI and β coefficients were significantly increased in the 36 patients with a CICDA indicative of active disease (P<.0001 for both), the 33 patients with a CDAI of at least 150 (P<.032 and P<.0074, respectively), and the 26 patients with an SES-CD of at least 1 (P<.0001 and P<.002, respectively). ROC analysis revealed accurate identification (compared with CICDA) of active CD with an MPI threshold of 24 video intensity (VI) (sensitivity, 97%; specificity, 83%) and a β coefficient of 4.5 VI/sec (sensitivity, 86%; specificity, 83%).
  
  
  CONCLUSIONS
  Contrast-enhanced US of the ileal wall is a promising method for objective, reproducible assessment of disease activity in patients with ileal CD.
authors.affiliation: Department of Bioimaging and Radiologic Science, Radiodiagnostics-Echography Service, Complesso Integrato Columbus, Università Cattolica del Sacro Cuore, Largo Francesco Vito 8, 00161 Rome, Italy. antonio.defranco3@tin.it
authors.forename: Antonio
authors.initials: A
authors.lastname: De Franco
authors.forename: Alessandra
authors.initials: A
authors.lastname: Di Veronica
authors.forename: Alessandro
authors.initials: A
authors.lastname: Armuzzi
authors.forename: Italia
authors.initials: I
authors.lastname: Roberto
authors.forename: Manuela
authors.initials: M
authors.lastname: Marzo
authors.forename: Barbara
authors.initials: B
authors.lastname: De Pascalis
authors.forename: Italo
authors.initials: I
authors.lastname: De Vitis
authors.forename: Alfredo
authors.initials: A
authors.lastname: Papa
authors.forename: Enrico
authors.initials: E
authors.lastname: Bock
authors.forename: Francesco M
authors.initials: FM
authors.lastname: Danza
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
authors.forename: Luisa
authors.initials: L
authors.lastname: Guidi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003287:Contrast Media; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007079:Ileitis / Q000000981:diagnostic imaging*; D008297:Male; D055806:Microvessels / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010743:Phospholipids; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D013459:Sulfur Hexafluoride; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride