title: In-vivo Axial-strain Sonoelastography Helps Distinguish Acutely-inflamed from Fibrotic Terminal Ileum Strictures in Patients with Crohn's Disease: Preliminary Results.
abstract: We tested real-time sonoelastography (RTS) in-vivo to differentiate fibrotic from inflammatory terminal ileum strictures in patients with Crohn's disease (CD), using magnetic resonance enterography (MRE) as a reference standard. Sixteen patients (13 male, 3 female; median [interquartile interval] age = 41 [31-48.5] y; median C-reactive protein (CRP) = 0.95 [0-2.23] mg/dL; median disease duration = 108.5 [35-213.75] mo; median Harvey-Bradshaw Index (HBI) = 3 [3-5.25]) with terminal ileum CD were prospectively included. Short-axis scans were performed; each cross-section was ideally sub-divided into eight circular sectors. Color map provided by RTS was translated into semi-quantitative scale (1 = red; 2 = green; 3 = blue). At MRE, inflammation was seen in nine patients and fibrosis in seven. Total median RTS score was significantly lower in patients with inflammatory stricture (16 [16-18]) than in patients with fibrosis (20 [17.5-22]; p = 0.003). The same happened when the four most superficial quadrants of the loop were considered (8 [7-9] vs. 10 [9-11.5]; p = 0.003). No significant correlation was seen between RTS and HBI (r = 0.467; p = 0.686), RTS and CRP (r = -0.750; p = 0.567) or RTS and disease duration (r = 0.238; p = 0.483). RTS of the terminal ileum in patients with CD is feasible in-vivo, potentially differentiating between fibrotic and inflammatory strictures.
authors.affiliation: Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, San Donato Milanese, Italy. Electronic address: io@lucasconfienza.it.
authors.forename: Luca Maria
authors.initials: LM
authors.lastname: Sconfienza
authors.affiliation: Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Flaminia
authors.initials: F
authors.lastname: Cavallaro
authors.affiliation: Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Valentino
authors.initials: V
authors.lastname: Colombi
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, San Donato Milanese, Italy; Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Pastorelli
authors.affiliation: Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Gianeugenio
authors.initials: G
authors.lastname: Tontini
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Pescatori
authors.affiliation: Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Anastassia
authors.initials: A
authors.lastname: Esseridou
authors.affiliation: Divisione di Gastroenterologia, Dipartimenti di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padova, Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Savarino
authors.affiliation: Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milano, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Messina
authors.affiliation: Area Vasta 3 Marche, Servizio di Radiodiagnostica, Civitanova Marche, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Casale
authors.affiliation: Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Leo
authors.affiliation: Servizio di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, San Donato Milanese, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
authors.affiliation: Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, San Donato Milanese, Italy; Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Vecchi
mesh_terms: D003199:Computer Systems; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000473:pathology; D003424:Crohn Disease / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005355:Fibrosis; D006801:Humans; D007079:Ileitis / Q000175:diagnosis*; D007082:Ileum / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Axial-strain sonoelastography; Crohn's disease; Fibrosis; Inflammation; Stricture