title: Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease.
abstract: OBJECTIVE
  To evaluate the accuracy of quantitative analysis of bowel wall enhancement in inflammatory bowel disease (IBD) with contrast enhanced ultrasound (CEUS) by comparing the results with vascular density in a biopsy sample from the same area of the intestinal tract, and to determine the usefulness of this analysis for the prediction of disease activity.
  
  
  METHODS
  This prospective study was approved by our institute's ethics committee and all patients gave written informed consent. We enrolled 33 consecutive adult patients undergoing colonoscopy and biopsy for IBD. All patients underwent CEUS and the results were quantitatively analyzed. Vessel count per high-power field on biopsy specimens was compared with colonoscopy, baseline ultrasonography, and CEUS findings, and with analysis of peak intensity, time to peak, regional blood volume, mean transit time, and regional blood flow. Results in patients with high and low vascular density were compared using Fisher's test, t-test, Pearson's correlation test, and receiver operating characteristic curve (ROC) analysis. Cutoff values were determined using ROC analysis, and sensitivity and specificity were calculated.
  
  
  RESULTS
  High vascular density (>265 vessels per field) on histological examination was significantly correlated with active disease on colonoscopy, baseline ultrasonography, and CEUS (p<.0001). Quantitative analysis showed a higher enhancement peak, a shorter time to peak enhancement, a higher regional blood flow and regional blood volume in patients with high vascular density than in those with low vascular density. Cutoff values to distinguish between active and inactive disease were identified for peak enhancement (>40.5%), and regional blood flow (>54.8 ml/min).
  
  
  CONCLUSIONS
  Quantitative analysis of CEUS data correlates with disease activity as determined by vascular density. Quantitative parameters of CEUS can be used to predict active disease with high sensitivity and specificity.
authors.affiliation: Department of Radiology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy. Electronic address: laura.romanini@libero.it.
authors.forename: Laura
authors.initials: L
authors.lastname: Romanini
authors.affiliation: Department of Radiology-AO Provincia di Lodi, Via Fissiraga, 15, 26900 Lodi, Italy. Electronic address: matteopassamonti@gmail.com.
authors.forename: Matteo
authors.initials: M
authors.lastname: Passamonti
authors.affiliation: Department of Radiology-ASL Vallecamonica-Sebino, Via Manzoni 142, 25040 Esine, BS, Italy. Electronic address: navarria.mario@tiscali.it.
authors.forename: Mario
authors.initials: M
authors.lastname: Navarria
authors.affiliation: Department of Gastroenterology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy. Electronic address: francesco.lanzarotto@spedalicivili.brescia.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Lanzarotto
authors.affiliation: Department of Pathology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy. Electronic address: villanac@alice.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Villanacci
authors.affiliation: Department of Radiology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy. Electronic address: radiologia1@spedalicivili.brescia.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Grazioli
authors.affiliation: Department of Radiology, University of Pavia, Viale Camillo Golgi 19, 27100 Pavia, Italy. Electronic address: fabrizio.calliada@gmail.com.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Calliada
authors.affiliation: Department of Radiology, University of Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy. Electronic address: rmaroldi@gmail.com.
authors.forename: Roberto
authors.initials: R
authors.lastname: Maroldi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003113:Colonoscopy; D003287:Contrast Media; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D015212:Inflammatory Bowel Diseases / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010743:Phospholipids; D011237:Predictive Value of Tests; D011446:Prospective Studies; D013459:Sulfur Hexafluoride; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D010743:Phospholipids; C420843:contrast agent BR1; D013459:Sulfur Hexafluoride
keywords: Contrast media; Inflammatory bowel diseases; Therapy management; Ultrasonography