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Paratore M, Garcovich M, Ainora ME, Del Vecchio LE, Cuccia G, Riccardi L, Pompili M, Gasbarrini A, Zocco MA. The Role of Transabdominal Ultrasound Elastography in Gastrointestinal Non-Liver Diseases: Current Application and Future Prospectives. Diagnostics (Basel) 2023; 13:2266. [PMID: 37443663 DOI: 10.3390/diagnostics13132266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Ultrasound imaging is the first-line investigation for patients with abdominal symptoms, as it effectively depicts the gastrointestinal tract and enables the diagnosis of multiple pathological conditions. Among different recent ultrasound technological advancements, elastography enables the evaluation of various tissue characteristics, such as neoplastic transformation or fibroinflammatory status. In recent years, ultrasound elastography has been utilized extensively for the study of liver diseases and in numerous other clinical settings, including gastrointestinal diseases. Current guidelines suggest the use of transabdominal ultrasound elastography to characterize bowel wall lesions, to assess gastrointestinal contractility, to diagnose and grade chronic pancreatitis; however, no specific indications are provided. In the present paper, we summarize the evidence concerning the application of different ultrasound elastography modalities in gastrointestinal non-liver diseases.
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Affiliation(s)
- Mattia Paratore
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Matteo Garcovich
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maria Elena Ainora
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Livio Enrico Del Vecchio
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Giuseppe Cuccia
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Laura Riccardi
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maurizio Pompili
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Medicina Interna e del Trapianto di Fegato, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maria Assunta Zocco
- Medicina Interna e Gastroenterologia, CEMAD Digestive Disease Center, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
- Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy
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Biomechanical Properties of Strictures in Crohn’s Disease: Can Dynamic Contrast-Enhanced Ultrasonography and Magnetic Resonance Enterography Predict Stiffness? Diagnostics (Basel) 2022; 12:diagnostics12061370. [PMID: 35741180 PMCID: PMC9221822 DOI: 10.3390/diagnostics12061370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/24/2022] [Accepted: 05/31/2022] [Indexed: 11/17/2022] Open
Abstract
Strictures and abdominal pain often complicate Crohn’s disease (CD). The primary aim was to explore whether parameters obtained by preoperative contrast-enhanced (CE) ultrasonography (US) and dynamic CE MR Enterography (DCE-MRE) of strictures associates with biomechanical properties. CD patients undergoing elective small intestinal surgery were preoperatively examined with DCE-MRE and CEUS. The excised intestine was distended utilizing a pressure bag. Luminal and outer bowel wall cross-sectional areas were measured with US. The circumferential stricture stiffness (Young’s modulus E) was computed. Stiffness was associated with the initial slope of enhancement on DCE-MRE (ρ = 0.63, p = 0.007), reflecting active disease, but lacked association with CEUS parameters. For structural imaging parameters, inflammation and stricture stiffness were associated with prestenotic dilatation on US (τb = 0.43, p = 0.02) but not with MRE (τb = 0.01, p = 1.0). Strictures identified by US were stiffer, 16.8 (14.0–20.1) kPa, than those graded as no or uncertain strictures, 12.6 (10.5–15.1) kPa, p = 0.02. MRE global score (activity) was associated with E (ρ = 0.55, p = 0.018). Elastography did not correlate with circumferential stiffness. We conclude that increasing activity defined by the initial slope of enhancement on DCE-MRE and MRE global score were associated with stricture stiffness. Prestenotic dilatation on US could be a potential biomarker of CD small intestinal stricture stiffness.
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Shear Wave and Strain Elastography in Crohn's Disease-A Systematic Review. Diagnostics (Basel) 2021; 11:diagnostics11091609. [PMID: 34573952 PMCID: PMC8468946 DOI: 10.3390/diagnostics11091609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 12/31/2022] Open
Abstract
One modern imaging technique used in the diagnosis of Crohn’s disease (CD) is sonoelastrography of the intestine. Guidelines regarding the use of bowel sonoelastography in CD have still not been specified. The aim of our research was to conduct a systematic review of the use of sonoelastography in the diagnosis, assessment, and monitoring of strictures in the course of CD. A systematic review was conducted according to the PRISMA guidelines statement. The following databases were searched in January 2021: MEDINE via PubMed, Embase and Scopus. The search utilised the following MeSH tags: ‘Ultrasound Shear Wave’, ‘Elastography’, ‘elastogram’, ‘elastographies’ AND ‘Crohn disease’. The inclusion criteria were as follows: from 2010 or later, articles with abstracts, articles in English, human-based studies and original articles. Articles were assessed independently by two reviewers. Out of 181 articles, only 15 met the criteria and were included in the review. Due to a small number of studies and significant methodological differences, the feasibility of using sonoelastography for Crohn’s disease must be proven through further research and analysis. In the future, standardised assessment criteria and cut-off points should be established for both strain elastography (SE) and shear wave elastography (SWE).
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Szabó G, Madár I, Bokor A, Rigó J. Transvaginal Strain Elastosonography May Help in the Differential Diagnosis of Endometriosis? Diagnostics (Basel) 2021; 11:diagnostics11010100. [PMID: 33435488 PMCID: PMC7827570 DOI: 10.3390/diagnostics11010100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 12/28/2022] Open
Abstract
Dear Editor, [...].
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Affiliation(s)
- Gábor Szabó
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Baross utca 27, 1088 Budapest, Hungary; (I.M.); (A.B.); (J.R.J.)
- Correspondence: ; Tel.: +36-20-455-4710
| | - István Madár
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Baross utca 27, 1088 Budapest, Hungary; (I.M.); (A.B.); (J.R.J.)
| | - Attila Bokor
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Baross utca 27, 1088 Budapest, Hungary; (I.M.); (A.B.); (J.R.J.)
| | - János Rigó
- Department of Obstetrics and Gynecology, Faculty of Medicine, Semmelweis University, Baross utca 27, 1088 Budapest, Hungary; (I.M.); (A.B.); (J.R.J.)
- Department of Clinical Studies in Obstetrics and Gynecology, Faculty of Health Sciences, Semmelweis University, Vas utca 17, 1088 Budapest, Hungary
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Fraquelli M, Castiglione F, Calabrese E, Maconi G. Impact of intestinal ultrasound on the management of patients with inflammatory bowel disease: how to apply scientific evidence to clinical practice. Dig Liver Dis 2020; 52:9-18. [PMID: 31732443 DOI: 10.1016/j.dld.2019.10.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 09/27/2019] [Accepted: 10/08/2019] [Indexed: 12/11/2022]
Abstract
Technological improvements and growing sonographers' expertise boost the role of intestinal ultrasound (IUS) in assessing patients with inflammatory bowel diseases (IBD). Non-invasiveness, low cost and good reproducibility make IUS attractive. Leveraging on the Authors' long-term field experience, this review focuses on the IUS role in IBD patients' clinical management. For detecting IBD, particularly Crohn's disease, the IUS parameters - above all the evidence of a thickened bowel wall (BWT) - show very good diagnostic accuracy similar to that of MRI or CT scan. The standard IUS parameters are not accurate enough to detect inflammatory activity, but intravenous contrast-enhanced US (CEUS) is highly accurate in ruling active inflammation out. However, its routinely use remains limited in clinical practice and its parameters need standardization. IUS is accurate in detecting IBD main complications: in particular, fistulae and abscesses. As to stenosis the recent introduction of IUS-based elastographic techniques allows to differentiate prevalently inflammatory from highly fibrotic strictures. IUS proves valid also for monitoring IBD patients. In particular, the evidence of transmural healing, defined as BWT normalization, has got an important prognostic meaning, as associated with better long-term clinical outcomes. Post-surgery CD recurrence can be suggested by early IUS assessment.
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Affiliation(s)
- Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Fabiana Castiglione
- Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine, "Federico II" University of Naples, Naples, Italy
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, ASST Fatebenefratelli Sacco, "Luigi Sacco" Hospital, University of Milan, Italy
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Strain elastography in Crohn's disease: the role of visual observation and semiquantitative parameters. J Ultrasound 2018; 22:227-239. [PMID: 30343355 DOI: 10.1007/s40477-018-0324-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022] Open
Abstract
Strain elastography is a recently developed ultrasound method that seems to contribute to the diagnosis and monitoring of inflammatory bowel diseases. This pictorial essay aims to present the feasibility of strain elastography in clinical practice by comparing visual observation and semiquantitative parameters with endoscopic or radiological images in some common cases of Crohn's disease. In our opinion, strain elastography with visual observation is easily performed in connection with B-mode ultrasound and color Doppler imaging and may provide relevant information. Strain elastography with the elaboration of semiquantitative parameters is not as immediate as the visual observation method, but it seems to provide more objective data and seems more appropriate for monitoring the evolution of the disease. However, for the elastographic method to extensively contribute in inflammatory bowel diseases, standardization and further studies are required to confirm the promising results already reported in the literature.
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Abstract
Ultrasound-based strain imaging is available in several ultrasound (US) scanners. Strain ratio (SR) can be used to quantify the strain recorded simultaneously in two different user-selected areas, ideally exposed to the same amount of stress. The aim of this study was to evaluate SR variability when assessed in an in-vitro setup with a tissue-mimicking phantom on resected tissue samples and in live tissue scanning with endoscopic applications. We performed an in vivo retrospective analysis of SR variability used for quantification of elastic contrasts in a tissue-mimicking phantom containing four homogenous inclusion in 38 resected bowel wall lesions and 48 focal pancreatic lesions. Median SR and the inter-quartile range (IQR) were calculated for all external and endoscopic ultrasound (EUS) applications. The IQR and median provide a measure of SR variability focusing on the two percentiles of the data closest to the median value. The overall SR variability was lowest in a tissue-mimicking phantom (mean QR/median SR: 0.07). In resected bowel wall lesions representing adenomas, adenocarcinomas, or Crohn lesions, the variability increased (mean IQR/Median: 0.62). During an in vivo endoscopic examination of focal pancreatic lesions, the variability increased further (mean IQR/Median: 2.04). SR variability increased when assessed for different targets with growing heterogeneity and biological variability from homogeneous media to live tissues and endoscopic application. This may indicate a limitation for the accuracy of SR evaluation in some clinical applications.
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Pescatori LC, Mauri G, Savarino E, Pastorelli L, Vecchi M, Sconfienza LM. Bowel Sonoelastography in Patients with Crohn's Disease: A Systematic Review. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:297-302. [PMID: 29195757 DOI: 10.1016/j.ultrasmedbio.2017.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/09/2017] [Accepted: 10/12/2017] [Indexed: 06/07/2023]
Abstract
Sonoelastography is an ultrasound-based method for evaluating the biological properties of a target tissue. It is commonly used in the diagnosis of liver and thyroid disease, but recently its use for monitoring the characteristics of bowel wall in patients affected by Crohn's disease (CD) has been proposed. Our aim was a systematic review of the use of sonoelastography in patients with CD. An initial database search retrieved 32 possible articles. On initial screening, 7 articles, concerning a total of 129 patients and 154 lesions of the small and large bowel, were finally included in the review. The age range varied between 6 and 53 y, and disease duration ranged between 1 and 623 mo. We collected data on the examinations performed (type and time), bowel area considered and parameters evaluated. All authors found that elastography correlates well with the degree of fibrosis, as wall strain significantly decreases in segments affected by fibrotic stenosis. Even though the endpoints proposed in the various articles are relatively inhomogeneous and scarcely comparable, we found that sonoelastography is a promising tool in the evaluation of patients with CD as it can differentiate inflammatory and fibrotic strictures in small case series.
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Affiliation(s)
- Lorenzo Carlo Pescatori
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy.
| | - Giovanni Mauri
- Divisione di Radiologia Interventistica, Istituto Europeo di Oncologia, Milan, Italy
| | - Edoardo Savarino
- Divisione di Gastroenterologia, Dipartimenti di Scienze Chirurgiche, Oncologiche e Gastroenterologiche, Università degli Studi di Padova, Padua, Italy
| | - Luca Pastorelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Unità Operativa di Gastroenterologia ed Endoscopia Digestiva, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Maurizio Vecchi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Maria Sconfienza
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy; Diagnostica per Immagini con Servizio di Radiologia Interventistica, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
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Dietrich CF, Barr RG, Farrokh A, Dighe M, Hocke M, Jenssen C, Dong Y, Saftoiu A, Havre RF. Strain Elastography - How To Do It? Ultrasound Int Open 2017; 3:E137-E149. [PMID: 29226273 DOI: 10.1055/s-0043-119412] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 08/27/2017] [Accepted: 08/29/2017] [Indexed: 12/11/2022] Open
Abstract
Tissue stiffness assessed by palpation for diagnosing pathology has been used for thousands of years. Ultrasound elastography has been developed more recently to display similar information on tissue stiffness as an image. There are two main types of ultrasound elastography, strain and shear wave. Strain elastography is a qualitative technique and provides information on the relative stiffness between one tissue and another. Shear wave elastography is a quantitative method and provides an estimated value of the tissue stiffness that can be expressed in either the shear wave speed through the tissues in meters/second, or converted to the Young's modulus making some assumptions and expressed in kPa. Each technique has its advantages and disadvantages and they are often complimentary to each other in clinical practice. This article reviews the principles, technique, and interpretation of strain elastography in various organs. It describes how to optimize technique, while pitfalls and artifacts are also discussed.
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Affiliation(s)
| | - Richard G Barr
- Radiology, Northeastern Ohio Medical University, Rootstown, United States
| | - André Farrokh
- Department of Breast Imaging and Interventions, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Manjiri Dighe
- Department of Biology, University of Washington, Radiology, Seattle, United States
| | - Michael Hocke
- HELIOS Klinikum Meiningen, Internal Medicine II, Meiningen, Germany
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany
| | - Yi Dong
- Zhongshan Hospital, Ultrasound, Shanghai, China
| | - Adrian Saftoiu
- University of Medicine and Pharmacy of Craiova, Research Center of Gastroenterology and Hepatology, Craiova, Romania
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Serra C, Rizzello F, Pratico’ C, Felicani C, Fiorini E, Brugnera R, Mazzotta E, Giunchi F, Fiorentino M, D’Errico A, Morselli-Labate AM, Mastroroberto M, Campieri M, Poggioli G, Gionchetti P. Real-time elastography for the detection of fibrotic and inflammatory tissue in patients with stricturing Crohn's disease. J Ultrasound 2017; 20:273-284. [PMID: 29204231 PMCID: PMC5698189 DOI: 10.1007/s40477-017-0265-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/28/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The distinction between active inflammation and fibrosis of the bowel wall is essential for therapeutic decisions in stricturing Crohn's disease. We aimed to assess whether real-time elastography (RTE) with strain ratio measurement could be useful in differentiating fibrotic from inflamed bowel strictures and to evaluate the possible relationship between US techniques and the histology of the stenotic bowel wall. MATERIALS AND METHODS Bowel ultrasonography (including RTE, color-Doppler and CEUS examination) was prospectively evaluated in 26 patients with symptomatic stricturing Crohn's disease, before surgery. RTE was adopted to evaluate bowel stiffness: five loops of 20 RTE frames were recorded for each stenotic segment and the mean strain ratio (MSR) was obtained. Histology scoring systems both for inflammation and fibrosis were established for surgical specimens. RESULTS No significant correlation was found between MSR and fibrosis score (P = 0.877). Color-Doppler score was significantly related to gut wall and submucosal thicknesses (P = 0.006 and P = 0.032, respectively). There was no significant correlation between the number of vessels counted at histology and color-Doppler and CEUS examinations (P = 0.170 and P = 0.302, respectively). CONCLUSION MSR detection was not able to distinguish fibrotic from inflammatory tissue in our selected population. This result could be influenced by the presence of the superimposed inflammation. Larger cohort of patients, further analysis with shear wave elastography, and validated histopathology classification systems for fibrosis and inflammation are necessary to assess if intestinal fibrosis could be reliably detected on the basis of bowel elastic properties.
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Affiliation(s)
- Carla Serra
- Department of Organ Failure and Transplantation, Ultrasound Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Fernando Rizzello
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Chiara Pratico’
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Cristina Felicani
- Department of Organ Failure and Transplantation, Ultrasound Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Erica Fiorini
- Department of Organ Failure and Transplantation, Ultrasound Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Ramona Brugnera
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Elena Mazzotta
- Department of Organ Failure and Transplantation, Ultrasound Unit, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesca Giunchi
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), “F. Addarii” Institute of Oncology and Transplant Pathology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Michelangelo Fiorentino
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), “F. Addarii” Institute of Oncology and Transplant Pathology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonietta D’Errico
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), “F. Addarii” Institute of Oncology and Transplant Pathology, Alma Mater Studiorum-University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Antonio Maria Morselli-Labate
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Marianna Mastroroberto
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Massimo Campieri
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Gilberto Poggioli
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
| | - Paolo Gionchetti
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum-University of Bologna, Sant’Orsola-Malpighi Hospital, Via Massarenti 9, 40138 Bologna, Italy
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Branchi F, Caprioli F, Orlando S, Conte D, Fraquelli M. Non-invasive evaluation of intestinal disorders: The role of elastographic techniques. World J Gastroenterol 2017; 23:2832-2840. [PMID: 28522902 PMCID: PMC5413779 DOI: 10.3748/wjg.v23.i16.2832] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/27/2017] [Accepted: 03/30/2017] [Indexed: 02/06/2023] Open
Abstract
Over the recent years the non-invasive techniques for the evaluation of the small bowel have been playing a major role in the management of chronic intestinal diseases, such as inflammatory bowel diseases (IBD). The diagnostic performances of magnetic resonance imaging, computed tomography and ultrasound in the field of small bowel disorders, have been assessed and established for more than two decades. Newer sonographic techniques, such as strain elastography and shear wave elastography, have been put forward for the assessment of disease activity and characterization of IBD-related damage in the setting of Crohn's disease and other gastrointestinal disorders. The data from the preliminary research and clinical studies have shown promising results as regards the ability of elastographic techniques to differentiate inflammatory from fibrotic tissue. The distinction between IBD activity (inflammation) and IBD-related damage (fibrosis) is currently considered crucial for the assessment and management of patients. Moreover, all the elastographic techniques are currently being considered in the setting of other intestinal disorders (e.g., rectal tumors, appendicitis). The aim of this paper is to offer both a comprehensive narrative review of the non-invasive techniques available for the assessment of small-bowel disorders, with particular emphasis on inflammatory bowel diseases, and a summary of the current evidence on the use of elastographic techniques in this setting.
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Real-time elastography in Crohn's disease: feasibility in daily clinical practice. J Ultrasound 2017; 20:147-155. [PMID: 28593005 DOI: 10.1007/s40477-017-0243-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/10/2017] [Indexed: 01/07/2023] Open
Abstract
Ultrasound (US) is the first-line investigation in patients with abdominal symptoms and it has a role in the diagnosis and monitoring of inflammatory bowel diseases. Strain elastography (SE) is a US method for estimating tissue elasticity. This method is still not routinely used in clinical practice, although it is suggested by the EFSUMB Guidelines for the characterization of intestinal stenosis in Crohn's disease. The purpose of this Pictorial Essay is to confirm the feasibility of elastography in Crohn's disease in clinical practice by comparing elastography images with corresponding endoscopic or radiological images. At present, diagnostic accuracy of SE is reported in the literature only in connection with detection of bowel wall fibrosis in advanced cases of Crohn's disease. However, in our opinion, SE can add useful diagnostic information to grayscale and color Doppler US by providing a more accurate characterization of the bowel wall in the various manifestations of Crohn's disease.
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Waage JER, Leh S, Røsler C, Pfeffer F, Bach SP, Havre RF, Haldorsen IS, Ødegaard S, Baatrup G. Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Dis 2015; 17:124-31. [PMID: 25407010 PMCID: PMC4312907 DOI: 10.1111/codi.12845] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 04/17/2014] [Indexed: 12/17/2022]
Abstract
AIM Strain elastography is a method for recording tissue hardness. Strain in different areas may be compared using strain ratio (SR). The aims of this study were to validate a previously proposed SR cut-off value of 1.25 for differentiating adenocarcinomas from adenomas and to compare the performance of endorectal ultrasonography (ERUS), strain elastography and MRI in the same patients. METHOD A prospective evaluation of 120 consecutive patients with rectal neoplasia, using a predetermined elastography strain ratio cut-off value, was performed to differentiate adenomas from adenocarcinomas. ERUS and MRI were performed according to standard routine at Haukeland University Hospital, defining T0 as adenomas and T1-T4 as adenocarcinomas. Subsequent histopathology was used as the reference standard. RESULTS Histopathological evaluation revealed 21 adenomas and 99 adenocarcinomas. Sensitivity, specificity and accuracy (with 95% CI) were as follows: ERUS: 0.96 (0.90-0.99), 0.62 (0.40-0.80) and 0.90 (0.83-0.94); elastography SR: 0.96 (0.90-0.99), 0.86 (0.66-0.96) and 0.94 (0.88-0.97); and MRI: 0.99 (0.94-1.00), 0.07 (0.00-0.31) and 0.87 (0.80-0.93). CONCLUSION This study confirms that the elastography SR assessment accurately differentiates sessile adenomas from adenocarcinomas. SR assessment has a superior ability to differentiate adenomas and adenocarcinomas when compared with ERUS and MRI. MRI examination seems unable to recognize adenomas and should be interpreted with care when early-stage rectal neoplasia is suspected.
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Affiliation(s)
- J E R Waage
- Department of Surgery, Haukeland University HospitalBergen, Norway,Department of Clinical Medicine, University of BergenBergen, Norway
| | - S Leh
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Pathology, Haukeland University HospitalBergen, Norway
| | - C Røsler
- Department of Radiology, Haukeland University HospitalBergen, Norway
| | - F Pfeffer
- Department of Surgery, Haukeland University HospitalBergen, Norway,Department of Clinical Medicine, University of BergenBergen, Norway
| | - S P Bach
- Academic Department of Surgery, Queen Elizabeth HospitalEdgbaston, Birmingham, UK
| | - R F Havre
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University HospitalBergen, Norway
| | - I S Haldorsen
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Radiology, Haukeland University HospitalBergen, Norway
| | - S Ødegaard
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Medicine, National Centre for Ultrasound in Gastroenterology, Haukeland University HospitalBergen, Norway
| | - G Baatrup
- Department of Clinical Medicine, University of BergenBergen, Norway,Department of Surgery A, Odense University HospitalSvendborg, Denmark,Institute for Regional Health Science, University of Southern DenmarkOdense, Denmark
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14
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Giannetti A, Randisi P, Stumpo M, Coratti F. Diagnosis of one small bowel tumor: the role of conventional ultrasound and elastography. J Ultrasound 2014; 19:57-60. [PMID: 26941875 DOI: 10.1007/s40477-014-0132-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 01/23/2014] [Indexed: 01/07/2023] Open
Abstract
Neuroendocrine tumors are the most common primary tumors of the small bowel, but diagnosis is usually delayed as the lesions are small and symptoms are mild or nonspecific. Diagnosis of this disease is currently based on radiologic or endoscopic findings. Ultrasound (US) is used as a first-line examination in patients with abdominal symptoms, as this technique permits an overall view of the gastrointestinal tract providing diagnosis of inflammatory and/or neoplastic disorders in a large proportion of patients. The aim of this case report is to describe the feasibility and diagnostic accuracy of elastography in the diagnosis of a tumor of the ileum. The patient underwent conventional gray-scale US and elastography before surgery and these examinations were repeated postoperatively on the surgical specimen confirming preoperative outcome.
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Affiliation(s)
- Andrea Giannetti
- Gastroenterology Unit, Misericordia Hospital, Via Aldo Moro 22, Grosseto, 58100 Italy
| | - Paola Randisi
- Medicine Department, Misericordia Hospital, Grosseto, Italy
| | - Michela Stumpo
- Pathology Department, Misericordia Hospital, Grosseto, Italy
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15
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Feasibility of real-time strain elastography in colonic diseases. J Ultrasound 2014; 17:321-30. [PMID: 25368693 DOI: 10.1007/s40477-014-0124-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/17/2014] [Indexed: 12/20/2022] Open
Abstract
Real-time strain elastography is not routinely performed in clinical practice for characterizing gastrointestinal tract diseases, and there are few studies in the literature on the subject. The recent EFSUMB guidelines suggest the use of this method in the diagnosis of neoplastic lesions and in the characterization of bowel strictures in patients with Crohn's disease. The purpose of this pictorial essay is to evaluate the feasibility of strain elastography in some pathologies of the colon frequently encountered in daily clinical practice and to compare elastography images with corresponding endoscopic and radiographic images. In our opinion, strain elastography is useful for characterizing diseases of the colon as it can add valuable diagnostic information to grayscale ultrasound imaging. However, diagnostic accuracy and clinical relevance of this information should be confirmed by further prospective research-targeted studies.
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