title: Doppler ultrasound findings correlate with tissue vascularity and inflammation in surgical pathology specimens from patients with small intestinal Crohn's disease.
abstract: BACKGROUND
  Crohn's disease (CD) is routinely evaluated using clinical symptoms, laboratory variables, and the CD activity index (CDAI). However, clinical parameters are often nonspecific and do not precisely reflect the actual activity of CD small-intestinal lesions. The purposes of this prospective study were to compare color Doppler ultrasound (US) findings with histological findings from surgically resected specimens and confirm the hypothesis that color Doppler US can distinguish tissue inflammation and fibrosis.
  
  
  METHODS
  Among 1764 consecutive patients who underwent color Doppler US examinations, 10 patients with CD (12 small-intestinal CD lesions) who underwent US examinations before elective small-intestine resection were evaluated in the present study. Areas of thickened intestinal walls were evaluated in terms of blood flow using color Doppler US imaging. The blood flow was semiquantitatively classified as "hyper-flow" and "hypo-flow" according to the Limberg score. Resected lesions were macroscopically and histopathologically processed. Inflammatory cell infiltration, fibrosis and vascularity were evaluated by myeloperoxidase (granulocytes), CD163 (macrophages), CD79a (B cells), CD3 (T cells), Masson's trichrome (fibrosis), and factor VIII staining (vascular walls). All histopathological images were entered into virtual slide equipment and quantified using a quantitative microscopy integrated system (TissueMorph™).
  
  
  RESULTS
  There were no significant differences in disease features or laboratory findings between "hypo-flow" lesions (n = 4) and "hyper-flow" lesions (n = 8). Histopathologically, "hyper-flow" lesions showed significantly greater bowel wall vascularity (factor VIII) (p = 0.047) and inflammatory cell infiltration, including CD163 macrophages (p = 0.008), CD3 T cells, and CD79a B cells (p = 0.043), than did "hypo-flow" lesions. There was no apparent association between the blood flow and CDAI.
  
  
  CONCLUSIONS
  In this study, active CD lesions were macroscopically visible in surgical specimens of patients with increased blood flow on preoperative color Doppler US imaging. Additionally, these CD lesions exhibited significantly greater vascularity and numbers of inflammatory leukocytes microscopically. Color Doppler US may predict tissue inflammation and fibrosis in small-intenstinal CD lesions.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Sasaki
authors.affiliation: Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan. reikok@urahp.yokohama-cu.ac.jp.
authors.forename: Reiko
authors.initials: R
authors.lastname: Kunisaki
authors.forename: Hiroto
authors.initials: H
authors.lastname: Kinoshita
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kimura
authors.forename: Teruaki
authors.initials: T
authors.lastname: Kodera
authors.forename: Akinori
authors.initials: A
authors.lastname: Nozawa
authors.forename: Akiho
authors.initials: A
authors.lastname: Hanzawa
authors.forename: Naomi
authors.initials: N
authors.lastname: Shibata
authors.forename: Hiromi
authors.initials: H
authors.lastname: Yonezawa
authors.forename: Eiji
authors.initials: E
authors.lastname: Miyajima
authors.forename: Satoshi
authors.initials: S
authors.lastname: Morita
authors.forename: Shoichi
authors.initials: S
authors.lastname: Fujii
authors.forename: Kazushi
authors.initials: K
authors.lastname: Numata
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Tanaka
authors.forename: Masanori
authors.initials: M
authors.lastname: Tanaka
authors.forename: Shin
authors.initials: S
authors.lastname: Maeda
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D005169:Factor VIII / Q000032:analysis; D005260:Female; D005355:Fibrosis; D006801:Humans; D007150:Immunohistochemistry; D007249:Inflammation / Q000473:pathology*; D007421:Intestine, Small / Q000098:blood supply / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010340:Pathology, Surgical / Q000379:methods*; D011379:Prognosis; D015203:Reproducibility of Results; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
chemical_list: D005169:Factor VIII