title: Bowel perfusion measured with dynamic contrast-enhanced ultrasound predicts treatment outcome in patients with Crohn's disease.
abstract: BACKGROUND
  To improve management of patients with Crohn's disease (CD), objective measurements of the degree of local inflammation in the gastrointestinal wall are needed. Increased microvessel density and perfusion are typical features of acute inflammation and can be estimated with contrast-enhanced ultrasound (CEUS). The aim of the study was to investigate whether CEUS can provide prognostic information about patients treated medically for an acute exacerbation of CD.
  
  
  METHODS
  Fourteen patients with CD who received medical treatment for acute exacerbation with systemic steroids or tumor necrosis factor-α inhibitors were prospectively recruited. The patients were examined with clinical scoring, blood tests, and CEUS at time 0, 1, 3, and 12 months after initiation of the treatment. Outcome was treatment efficacy or treatment failure defined as change in medical treatment after 1 month or later. The perfusion analysis was performed with a commercially available software program that analyzes the contrast intensity in a selected area, fits the data to a standardized time-intensity curve, and derives several relative perfusion parameters.
  
  
  RESULTS
  Six of the 14 patients had treatment failure during the study period. There was a significant difference between the groups for peak contrast enhancement (P = 0.013), rate of wash-in (P = 0.020) and wash-out (P = 0.008), and the area under the time-intensity curve in the wash-in phase (0.013) at the examination 1 month after the start of treatment.
  
  
  CONCLUSIONS
  Perfusion analysis of the intestinal wall with CEUS 1 month after starting treatment in patients with CD can provide prognostic information regarding treatment efficacy.
authors.affiliation: *Department of Clinical Medicine, University of Bergen, Bergen, Norway; and †National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Saevik
authors.forename: Kim
authors.initials: K
authors.lastname: Nylund
authors.forename: Trygve
authors.initials: T
authors.lastname: Hausken
authors.forename: Svein
authors.initials: S
authors.lastname: Ødegaard
authors.forename: Odd H
authors.initials: OH
authors.lastname: Gilja
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D019540:Area Under Curve; D003287:Contrast Media / Q000008:administration & dosage*; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D000069285:Infliximab; D007422:Intestines; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color / Q000379:methods*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003287:Contrast Media; D005765:Gastrointestinal Agents; D000069285:Infliximab; D000068879:Adalimumab