title: Contrast-enhanced ultrasonography: usefulness in the assessment of postoperative recurrence of Crohn's disease.
abstract: OBJECTIVE
  The aim of this study was to assess whether the contrast-enhanced ultrasonography (CEUS) can increase the value of the ultrasonography in the study of postoperative recurrence of Crohn's disease (CD).
  
  
  METHODS
  60 patients with CD who had previously undergone ileocolic resection underwent prospectively both CEUS and colonoscopy within a 3-day period. The sonographic examination included evaluation of bowel wall thickness, transmural complications, colour Doppler grade and contrast-enhanced US. In addition a sonographic score was established. The capacity of CEUS to diagnose endoscopic recurrence, as well as its severity, was assessed by calculating the sensitivity, specificity and positive and negative predictive values, accuracy and odds ratio, with their respective 95% confidence intervals. The areas under the receiver operating characteristic (ROC) curves were also calculated.
  
  
  RESULTS
  49 out of 60 patients showed endoscopic postoperative recurrence. Severe endoscopic recurrence was present in 34 patients (57%). Classic ultrasound parameters (wall thickness >3mm and colour Doppler flow) revealed an accuracy of 88.3% for the diagnosis of recurrence. Sonographic score 2, including thickness >5mm or contrast enhancement >46%, improved the results with a sensitivity, specificity and accuracy of 98%, 100% and 98.3%, respectively, in the diagnosis of endoscopic recurrence. The area under the ROC curve was 0.99, in remarkable agreement with endoscopy (k: 0.946). Sonographic score 3, including thickness >5mm, contrast enhancement >70% or fistula identified 32 out of 34 (94.1%) severe endoscopic recurrences. The area under the ROC curve was 0.836, in good agreement with endoscopy (k: 0.688).
  
  
  CONCLUSIONS
  CEUS shows excellent sensitivity and specificity for the diagnosis of postoperative recurrence in CD and can also detect severe recurrences.
authors.affiliation: Department of Gatroenterology, Hospital Universitario Dr Peset, Universidad de Valencia, Valencia, Spain. paredes_jos@gva.es
authors.forename: José María
authors.initials: JM
authors.lastname: Paredes
authors.forename: Tomás
authors.initials: T
authors.lastname: Ripollés
authors.forename: Xavier
authors.initials: X
authors.lastname: Cortés
authors.forename: Nadia
authors.initials: N
authors.lastname: Moreno
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Martínez
authors.forename: Marco
authors.initials: M
authors.lastname: Bustamante-Balén
authors.forename: Fructuoso
authors.initials: F
authors.lastname: Delgado
authors.forename: Eduardo
authors.initials: E
authors.lastname: Moreno-Osset
mesh_terms: D000293:Adolescent; D000328:Adult; D003082:Colectomy; D003113:Colonoscopy; D003287:Contrast Media; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013459:Sulfur Hexafluoride; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride