title: The Role of Ultrasound Elasticity Imaging in Predicting Ileal Fibrosis in Crohn's Disease Patients.
abstract: BACKGROUND
  Bowel wall fibrosis is associated with a complicated disease behavior in patients with Crohn's disease (CD). The quantitative assessment of fibrosis severity in CD-affected bowel can help clinical decision making. Our aim was to evaluate the feasibility, reliability, and reproducibility of ultrasound elasticity imaging (UEI) toward the assessment of ileal fibrosis in CD patients.
  
  
  METHODS
  Twenty-three consecutive patients with ileal or ileocolonic CD, elected for surgical resection of the terminal ileum, underwent bowel ultrasound and UEI. Twenty inflammatory CD patients without complications were enrolled as controls. Bowel wall stiffness was evaluated with UEI by means of color scale and quantitative strain ratio measurement. The severity of bowel wall fibrosis and inflammation were evaluated on histological sections by semiquantitative and quantitative image analysis and used as a reference standard.
  
  
  RESULTS
  The UEI strain ratio measurement was significantly correlated with the severity of bowel fibrosis at both semiquantitative and quantitative histological image analysis: it was characterized by an excellent discriminatory ability for severe bowel fibrosis (area under the receiver operating characteristic curve: 0.917; 95% confidence interval, 0.788-1.000). UEI strain ratio measurements were characterized by an excellent interrater agreement. At multivariate analysis, bowel wall fibrosis proved the only independent determinant of the strain ratio. The ileal strain ratio of inflammatory CD patients was significantly lower than in operated CD patients with severe fibrosis.
  
  
  CONCLUSIONS
  UEI can be used to assess ileal fibrosis in CD patients.
authors.affiliation: *Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; †Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; ‡Pathology Unit, Fondazione IRCCS Cà Granda, Ospedale Policlinico di Milano, Milan, Italy; §Department of Biomedical and Clinical Sciences L. Sacco, Università degli Studi di Milano, Milan, Italy; and ‖General and Emergency Surgery Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Mirella
authors.initials: M
authors.lastname: Fraquelli
authors.forename: Federica
authors.initials: F
authors.lastname: Branchi
authors.forename: Fulvia Milena
authors.initials: FM
authors.lastname: Cribiù
authors.forename: Stefania
authors.initials: S
authors.lastname: Orlando
authors.forename: Giovanni
authors.initials: G
authors.lastname: Casazza
authors.forename: Andrea
authors.initials: A
authors.lastname: Magarotto
authors.forename: Sara
authors.initials: S
authors.lastname: Massironi
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Botti
authors.forename: Ettore
authors.initials: E
authors.lastname: Contessini-Avesani
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.forename: Guido
authors.initials: G
authors.lastname: Basilisco
authors.forename: Flavio
authors.initials: F
authors.lastname: Caprioli
mesh_terms: D000328:Adult; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology*; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology; D054459:Elasticity Imaging Techniques; D005260:Female; D005355:Fibrosis / Q000000981:diagnostic imaging; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging / Q000473:pathology*; D007249:Inflammation / Q000473:pathology*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index; D055815:Young Adult