1
|
Tagliamonte G, Santagata F, Fraquelli M. Current Developments and Role of Intestinal Ultrasound including the Advent of AI. Diagnostics (Basel) 2024; 14:759. [PMID: 38611672 PMCID: PMC11011653 DOI: 10.3390/diagnostics14070759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/14/2024] Open
Abstract
Intestinal ultrasound is a non-invasive, safe, and cost-effective technique to study the small and large intestines. In addition to conventional B-mode and color doppler imaging, new US tools have been developed in more recent years that provide auxiliary data on many GI conditions, improving the diagnosis and assessment of relevant outcomes. We have reviewed the more recent literature (from 2010 onwards) on auxiliary tools in bowel ultrasound such as elastography techniques, CEUS, SICUS, and the potential contribution by artificial intelligence (AI) to overcome current intestinal ultrasound limitations. For this scoping review, we performed an extensive literature search on PubMed and EMBASE to identify studies published until December 2023 and investigating the application of elastography techniques, CEUS, SICUS, and AI in the ultrasonographic assessment of the small and large intestines. Multiparametric intestinal ultrasound shows promising capabilities in Crohn's disease, while less is known about the role in ulcerative colitis. Despite some evidence, the CEUS role as a point-of-care examination tool for rare conditions such as intestinal GvHD and ischemic small bowel disease seems promising, possibly avoiding the need to perform further cross-sectional imaging. The use of AI in intestinal ultrasound is still anecdotical and limited to acute appendicitis.
Collapse
Affiliation(s)
- Gennaro Tagliamonte
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy; (G.T.); (F.S.)
| | - Fabrizio Santagata
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy; (G.T.); (F.S.)
| | - Mirella Fraquelli
- Division of Gastroenterology and Endoscopy, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| |
Collapse
|
2
|
Liu Y, Diao S, Ruan B, Zhou Y, Yu M, Dong G, Xu W, Ning L, Zhou W, Jiang Y, Xie C, Fan Q, Huang J. Molecular Engineering of Activatable NIR-II Hemicyanine Reporters for Early Diagnosis and Prognostic Assessment of Inflammatory Bowel Disease. ACS Nano 2024; 18:8437-8451. [PMID: 38501308 DOI: 10.1021/acsnano.3c13105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Molecular imaging in the second near-infrared window (NIR-II) provides high-fidelity visualization of biopathological events in deep tissue. However, most NIR-II probes produce "always-on" output and demonstrate poor signal specificity toward biomarkers. Herein, we report a series of hemicyanine reporters (HBCs) with tunable emission to NIR-II window (715-1188 nm) and structurally amenable to constructing activatable probes. Such manipulation of emission wavelengths relies on rational molecular engineering by integrating benz[c,d]indolium, benzo[b]xanthonium, and thiophene moieties to a conventional hemicyanine skeleton. In particular, HBC4 and HBC5 possess bright and record long emission over 1050 nm, enabling improved tissue penetration depth and superior signal to background ratio for intestinal tract mapping than NIR-I fluorophore HC1. An activatable inflammatory reporter (AIR-PE) is further constructed for pH-triggered site-specific release in colon. Due to minimized background interference, oral gavage of AIR-PE allows clear delineation of irritated intestines and assessment of therapeutic responses in a mouse model of inflammatory bowel disease (IBD) through real-time NIRF-II imaging. Benefiting from its high fecal clearance efficiency (>90%), AIR-PE can also detect IBD and evaluate the effectiveness of colitis treatments via in vitro optical fecalysis, which outperforms typical clinical assays including fecal occult blood testing and histological examination. This study thus presents NIR-II molecular scaffolds that are not only applicable to developing versatile activatable probes for early diagnosis and prognostic monitoring of deeply seated diseases but also hold promise for future clinical translations.
Collapse
Affiliation(s)
- Yi Liu
- School of Pharmaceutical Sciencese, Sun Yat-sen University, Guangzhou 510006, China
| | - Shanchao Diao
- State Key Laboratory for Organic Electronics and Information Displays & Institute of Advanced Materials IAM, Nanjing University of Posts & Telecommunications, Nanjing 210023, China
| | - Bankang Ruan
- School of Pharmaceutical Sciencese, Sun Yat-sen University, Guangzhou 510006, China
| | - Ya Zhou
- School of Pharmaceutical Sciencese, Sun Yat-sen University, Guangzhou 510006, China
| | - Mengya Yu
- School of Pharmaceutical Sciencese, Sun Yat-sen University, Guangzhou 510006, China
| | - Guoqi Dong
- School of Pharmaceutical Sciencese, Sun Yat-sen University, Guangzhou 510006, China
| | - Weiping Xu
- School of Pharmaceutical Sciencese, Sun Yat-sen University, Guangzhou 510006, China
| | - Lulu Ning
- College of Bioresources Chemical and Materials Engineering, Shaanxi University of Science & Technology, Xi'an 710021, China
| | - Wen Zhou
- State Key Laboratory for Organic Electronics and Information Displays & Institute of Advanced Materials IAM, Nanjing University of Posts & Telecommunications, Nanjing 210023, China
| | - Yuyan Jiang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford 94305, California, United States
| | - Chen Xie
- State Key Laboratory for Organic Electronics and Information Displays & Institute of Advanced Materials IAM, Nanjing University of Posts & Telecommunications, Nanjing 210023, China
| | - Quli Fan
- State Key Laboratory for Organic Electronics and Information Displays & Institute of Advanced Materials IAM, Nanjing University of Posts & Telecommunications, Nanjing 210023, China
| | - Jiaguo Huang
- School of Pharmaceutical Sciencese, Sun Yat-sen University, Guangzhou 510006, China
| |
Collapse
|
3
|
Dudek P, Talar-Wojnarowska R. Current Approach to Risk Factors and Biomarkers of Intestinal Fibrosis in Inflammatory Bowel Disease. Medicina (Kaunas) 2024; 60:305. [PMID: 38399592 PMCID: PMC10889938 DOI: 10.3390/medicina60020305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Inflammatory bowel disease (IBD), especially Crohn's disease (CD), characterized by a chronic inflammatory process and progressive intestinal tissue damage, leads to the unrestrained proliferation of mesenchymal cells and the development of bowel strictures. Complications induced by fibrosis are related to high rates of morbidity and mortality and lead to a substantial number of hospitalizations and surgical procedures, generating high healthcare costs. The development of easily obtained, reliable fibrogenesis biomarkers is essential to provide an important complementary tool to existing diagnostic and prognostic methods in IBD management, guiding decisions on the intensification of pharmacotherapy, proceeding to surgical methods of treatment and monitoring the efficacy of anti-fibrotic therapy in the future. The most promising potential markers of fibrosis include cartilage oligomeric matrix protein (COMP), hepatocyte growth factor activator (HGFA), and fibronectin isoform- extra domain A (ED-A), as well as antibodies against granulocyte macrophage colony-stimulating factor (GM-CSF Ab), cathelicidin (LL-37), or circulatory miRNAs: miR-19a-3p and miR-19b-3p. This review summarizes the role of genetic predisposition, and risk factors and serological markers potentially contributing to the pathophysiology of fibrotic strictures in the course of IBD.
Collapse
|
4
|
Krugliak Cleveland N, St-Pierre J, Kellar A, Rubin DT. Clinical Application of Intestinal Ultrasound in Inflammatory Bowel Disease. Curr Gastroenterol Rep 2024; 26:31-40. [PMID: 38243153 PMCID: PMC11025373 DOI: 10.1007/s11894-024-00915-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
PURPOSE OF REVIEW Intestinal ultrasound (IUS) is a non-invasive, accurate, and well-tolerated tool that provides real-time assessment of inflammatory bowel disease (IBD) activity and is therefore an ideal monitoring tool. This review describes the evolving role of IUS in each phase of clinical management of IBD. RECENT FINDINGS Accumulating evidence has demonstrated that IUS is an excellent tool for the assessment of suspected IBD, with a very high negative predictive value. It accurately assesses disease activity, disease complications, and in the pre-treatment phase, provides a benchmark for subsequent follow-up. IUS can detect early therapeutic response and correlates well with other established monitoring modalities with arguably superior predictive capabilities and ability to assess a deeper degree of remission, transmural healing (TH). IUS has a crucial role in the management of IBD and has ushered in a new era of monitoring with more rapid evaluation and the opportunity for early optimization, deeper therapeutic targets, and improved outcomes.
Collapse
Affiliation(s)
- Noa Krugliak Cleveland
- Inflammatory Bowel Disease Center, University of Chicago, 5841 S. Maryland Ave MC 4076, Chicago, IL, 60637, USA.
| | - Joëlle St-Pierre
- Inflammatory Bowel Disease Center, University of Chicago, 5841 S. Maryland Ave MC 4076, Chicago, IL, 60637, USA
| | - Amelia Kellar
- Inflammatory Bowel Disease Center, University of Chicago, 5841 S. Maryland Ave MC 4076, Chicago, IL, 60637, USA
| | - David T Rubin
- Inflammatory Bowel Disease Center, University of Chicago, 5841 S. Maryland Ave MC 4076, Chicago, IL, 60637, USA
| |
Collapse
|
5
|
Kwon SJ, Khan MS, Kim SG. Intestinal Inflammation and Regeneration-Interdigitating Processes Controlled by Dietary Lipids in Inflammatory Bowel Disease. Int J Mol Sci 2024; 25:1311. [PMID: 38279309 PMCID: PMC10816399 DOI: 10.3390/ijms25021311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, is a disease of chronic inflammatory conditions of the intestinal tract due to disturbance of the inflammation and immune system. Symptoms of IBD include abdominal pain, diarrhea, bleeding, reduced weight, and fatigue. In IBD, the immune system attacks the intestinal tract's inner wall, causing chronic inflammation and tissue damage. In particular, interlukin-6 and interlukin-17 act on immune cells, including T cells and macrophages, to amplify the immune responses so that tissue damage and morphological changes occur. Of note, excessive calorie intake and obesity also affect the immune system due to inflammation caused by lipotoxicity and changes in lipids supply. Similarly, individuals with IBD have alterations in liver function after sustained high-fat diet feeding. In addition, excess dietary fat intake, along with alterations in primary and secondary bile acids in the colon, can affect the onset and progression of IBD because inflammatory cytokines contribute to insulin resistance; the factors include the release of inflammatory cytokines, oxidative stress, and changes in intestinal microflora, which may also contribute to disease progression. However, interfering with de novo fatty acid synthase by deleting the enzyme acetyl-CoA-carboxylase 1 in intestinal epithelial cells (IEC) leads to the deficiency of epithelial crypt structures and tissue regeneration, which seems to be due to Lgr5+ intestinal stem cell function. Thus, conflicting reports exist regarding high-fat diet effects on IBD animal models. This review will focus on the pathological basis of the link between dietary lipids intake and IBD and will cover the currently available pharmacological approaches.
Collapse
Affiliation(s)
| | | | - Sang Geon Kim
- Integrated Research Institute for Drug Development, College of Pharmacy, Dongguk University-Seoul, Goyang-si 10326, Gyeonggi-do, Republic of Korea; (S.J.K.); (M.S.K.)
| |
Collapse
|
6
|
Kumar S, Parry T, Mallett S, Plumb A, Bhatnagar G, Beable R, Betts M, Duncan G, Gupta A, Higginson A, Hyland R, Lapham R, Patel U, Pilcher J, Slater A, Tolan D, Zealley I, Halligan S, Taylor SA. Diagnostic performance of sonographic activity scores for adult terminal ileal Crohn's disease compared to magnetic resonance and histological reference standards: experience from the METRIC trial. Eur Radiol 2024; 34:455-464. [PMID: 37526665 PMCID: PMC10791915 DOI: 10.1007/s00330-023-09958-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES The simple ultrasound activity score for Crohn's disease (SUS-CD) and bowel ultrasound score (BUSS) are promising intestinal ultrasound (IUS) indices of CD, but studied mainly in small settings with few sonographers. We compared SUS-CD and BUSS against histological and magnetic resonance enterography (MRE) reference standards in a post hoc analysis of a prospective multicentre, multireader trial. METHODS Participants recruited to the METRIC trial (ISRCTN03982913) were studied, including those with available terminal ileal (TI) biopsies. Sensitivity and specificity of SUS-CD and BUSS for TI CD activity were calculated with 95% confidence intervals (CI), from the prospective observations of the original METRIC trial sonographers against the histological activity index (HAI) and the simplified magnetic resonance index of activity (sMARIA). RESULTS We included 284 patients (median 31.5 years, IQR 23-46) from 8 centres, who underwent IUS and MRE. Of these, 111 patients had available terminal ileal biopsies with HAI scoring. Against histology, sensitivity and specificity for active disease were 79% (95% CI 69-86%) and 50% (31-69%) for SUS-CD, and 66% (56-75%) and 68% (47-84%) for BUSS, respectively. Compared to sMARIA, the sensitivity and specificity for active CD were 81% (74-86%) and 75% (66-83%) for SUS-CD, and 68% (61-74%) and 85% (76-91%) for BUSS, respectively. The sensitivity of SUS-CD was significantly greater than that of BUSS against HAI and sMARIA (p < 0.001), but its specificity was significantly lower than of BUSS against the MRE reference standard (p = 0.003). CONCLUSIONS Particularly when compared to MRE activity scoring, SUS-CD and BUSS are promising tools in a real-world clinical setting. CLINICAL RELEVANCE STATEMENT When tested using data from a multicentre, multireader diagnostic accuracy trial, the simple ultrasound activity score for Crohn's disease (SUS-CD) and bowel ultrasound score (BUSS) were clinically viable intestinal ultrasound indices that were reasonably sensitive and specific for terminal ileal Crohn's disease, especially when compared to a magnetic resonance reference standard. KEY POINTS The simple ultrasound activity score for Crohn's disease and bowel ultrasound score are promising intestinal ultrasound indices of Crohn's disease but to date studied mainly in small settings with few sonographers. Compared to histology and the magnetic resonance reference standard in a multicentre, multireader setting, the sensitivity of simple ultrasound activity score for Crohn's disease is significantly greater than that of bowel ultrasound score. The specificity of simple ultrasound activity score for Crohn's disease was significantly lower than that of bowel ultrasound score compared to the magnetic resonance enterography reference standard. The specificity of both indices was numerically higher when the magnetic resonance enterography reference standard was adopted.
Collapse
Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Thomas Parry
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Gauraang Bhatnagar
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
- Department of Radiology, Frimley Park Hospital, Surrey, UK
| | - Richard Beable
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Margaret Betts
- Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Gillian Duncan
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Arun Gupta
- Department of Radiology, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Antony Higginson
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rachel Hyland
- Department of Radiology, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Roger Lapham
- Department of Radiology, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Uday Patel
- Department of Radiology, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK
| | - James Pilcher
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK.
| |
Collapse
|
7
|
Malik S, Venugopalan S, Tenorio BG, Khan SR, Loganathan P, Navaneethan U, Mohan BP. Diagnostic accuracy of bowel ultrasonography in patients with inflammatory bowel disease: a systematic review and meta-analysis. Ann Gastroenterol 2024; 37:54-63. [PMID: 38223248 PMCID: PMC10785028 DOI: 10.20524/aog.2024.0842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 09/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background Bowel ultrasonography (BUS) is emerging as a promising noninvasive tool for assessing disease activity in inflammatory bowel disease (IBD) patients. We evaluated the diagnostic accuracy of BUS in IBD patients against the gold standard diagnostic method, standard colonoscopy. Methods Major databases were searched from inception to May 2023 for studies on BUS diagnostic accuracy in IBD. Outcomes of interest were pooled sensitivity, specificity, positive (PPV), and negative (NPV) predictive values. Endoscopic confirmation served as ground truth. Standard meta-analysis methods with a random-effects model and I2 statistics were applied. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. Results Twenty studies (1094 patients) were included in the final analysis. The majority (75%) of studies considered bowel wall thickness >3 mm as abnormal. Endoscopic evaluation was performed between days 3 and 180. The pooled diagnostic accuracy of BUS in IBD was 66% (95% confidence interval [CI] 58-72%; I2=78%), sensitivity was 88.6% (95%CI 85-91%; I2=77%), and specificity 86% (95%CI 81-90%; I2=95%). PPV and NPV were 94% (95%CI 93-96%; I2=25%) and 74% (95%CI 66-80%; I2=95%), respectively. On subgroup analysis, small-intestine contrast-enhanced ultrasonography (SICUS) demonstrated high sensitivity (97%, 95%CI 91-99%; I2=83%), whereas BUS exhibited high specificity (94%, 95%CI 92-96%; I2=0%) and NPV (76%, 95%CI 68-83%; I2=80.9%). Meta-regression revealed a significant relation between side-to-side anastomosis and BUS specificity (P=0.02) and NPV (P=0.004). Conclusion The high diagnostic accuracy of BUS in detecting bowel wall inflammation suggests utilizing regular BUS as the primary modality, with subsequent consideration of SICUS if clinically warranted.
Collapse
Affiliation(s)
- Sheza Malik
- Internal Medicine, Rochester General Hospital, NY, USA (Sheza Malik)
| | - Sruthi Venugopalan
- Division of Infectious Diseases and International Health, Duke University School of Medicine, Durham, NC, USA (Sruthi Venugopalan)
| | | | - Shahab R. Khan
- Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA (Shahab R. Khan)
| | | | | | - Babu P. Mohan
- Gastroenterology and Hepatology, Orlando Gastroenterology PA, Orlando, FL, USA (Babu P. Mohan)
| |
Collapse
|
8
|
De Cristofaro E, Montesano L, Lolli E, Biancone L, Monteleone G, Calabrese E, Zorzi F. Echopattern parameter as an aid to profile Crohn's disease patients. Dig Liver Dis 2023; 55:1652-1657. [PMID: 37258331 DOI: 10.1016/j.dld.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Intestinal ultrasonography (US) allows for the characterization of the intestinal lesions and provides information on transmural inflammation. The aim of the study was to assess the clinical relevance of echopattern and correlation with Crohn's disease (CD) behavior and activity. METHODS We performed a prospective study including CD patients assessed by intestinal US. The echopattern was classified as hypoechoic, hyperechoic and stratified. Color-doppler US was also performed in the thickest segment. RESULTS One hundred CD patients were enrolled. The hypoechoic echopattern was significantly correlated with penetrating behavior (r = 0.44, p<0.0001), active disease (r = 0.21, p = 0.034), C-reactive protein/Fecal Calprotectin (r = 0.31, p = 0.004; r = 0.34, p = 0.031, respectively) and steroids (r = 0.33, p = 0.0008). Hypoechoic echopattern was associated with younger age than stratified (p = 0.046) and hyperechoic (p = 0.018) echopatterns. Bowel wall thickness was greater in the hypoechoic group than in the hyperechoic/stratified groups (p = 0.011 and p<0.0001, respectively). Hypoechoic echopattern was associated with fistulas (r = 0.52, p<0.0001) and increased vascularization (r = 0.32, p = 0.001). The hyperechoic echopattern showed a significant correlation with stricturing disease and an inverse correlation with fistulas. During a follow up period of 6 months, patients with hypoechoic echopattern had an increased risk of biological therapy need or surgery. CONCLUSIONS The characterization of bowel wall echopattern allows for the identification of different CD behaviors.
Collapse
Affiliation(s)
- Elena De Cristofaro
- Unità Operativa di Gastroenterologia, Dipartimento di Medicina, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Laura Montesano
- Unità Operativa di Gastroenterologia, Dipartimento di Medicina, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Elisabetta Lolli
- Unità Operativa di Gastroenterologia, Dipartimento di Medicina, Policlinico Universitario Tor Vergata, Rome, Italy
| | - Livia Biancone
- Unità Operativa di Gastroenterologia, Dipartimento di Medicina, Policlinico Universitario Tor Vergata, Rome, Italy; Cattedra di Gastroenterologia, Dipartimento di Medicina dei Sistemi, Università degli studi di Roma Tor Vergata, Italy
| | - Giovanni Monteleone
- Unità Operativa di Gastroenterologia, Dipartimento di Medicina, Policlinico Universitario Tor Vergata, Rome, Italy; Cattedra di Gastroenterologia, Dipartimento di Medicina dei Sistemi, Università degli studi di Roma Tor Vergata, Italy
| | - Emma Calabrese
- Unità Operativa di Gastroenterologia, Dipartimento di Medicina, Policlinico Universitario Tor Vergata, Rome, Italy; Cattedra di Gastroenterologia, Dipartimento di Medicina dei Sistemi, Università degli studi di Roma Tor Vergata, Italy.
| | - Francesca Zorzi
- Unità Operativa di Gastroenterologia, Dipartimento di Medicina, Policlinico Universitario Tor Vergata, Rome, Italy
| |
Collapse
|
9
|
Dolinger MT, Calabrese E, Pizzolante F, Abreu MT. Current and Novel Uses of Intestinal Ultrasound in Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2023; 19:447-457. [PMID: 37772159 PMCID: PMC10524432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Intestinal ultrasound (IUS) is a patient-centric, noninvasive, real-time, point-of-care tool with the capability to aid in diagnosis and monitoring of disease activity in both Crohn's disease and ulcerative colitis without the need for bowel preparation. IUS can be used as a tool for precision monitoring of inflammatory bowel disease (IBD) treatment response. IUS as a cross-sectional imaging tool is as accurate as magnetic resonance enterography (MRE) for assessing the ileum and is more accurate than MRE for colonic assessment proximal to the rectum. Multiple simple ultrasound-based scoring systems have been internally validated with endoscopy in both Crohn's disease and ulcerative colitis, and changes in IUS parameters can be seen as early as 2 weeks after treatment initiation. IUS also plays a unique role in IBD activity monitoring of patients in whom avoidance of invasive testing is paramount, such as children and pregnant patients. Novel uses go beyond monitoring activity, with potential use of elastography to measure bowel wall stiffness to detect fibrosis and bowel damage for enhanced decision-making. Ultimately, IUS is likely to expand in the United States, facilitated by accessible expert training, access to equipment, and the development of a reimbursement model. This article provides a comprehensive review of the current and novel uses of IUS in IBD.
Collapse
Affiliation(s)
- Michael T. Dolinger
- Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Mount Sinai Hospital, Icahn School of Medicine, New York, New York
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabrizio Pizzolante
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria T. Abreu
- University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| |
Collapse
|
10
|
Hameed M, Taylor SA. Small bowel imaging in inflammatory bowel disease: updates for 2023. Expert Rev Gastroenterol Hepatol 2023; 17:1117-1134. [PMID: 37902040 DOI: 10.1080/17474124.2023.2274926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/20/2023] [Indexed: 10/31/2023]
Abstract
INTRODUCTION Cross-sectional imaging techniques including MR and CT enterography and ultrasound are integral to Crohn's disease management, accurate, responsive, and well tolerated. They assess the full thickness of the bowel wall, perienteric environment, and distant complications. As we strive toward tighter disease control, imaging's role will expand further with transmural healing becoming an increasingly important therapeutic target. AREAS COVERED MEDLINE and Web of Science were searched from 2012 to 2023 inclusive. We review the evidence for cross-sectional imaging in assessing disease activity, phenotyping, and therapeutic response assessment. Emerging novel imaging applications such as quantifying enteric motility and fibrosis, prognostication, and potential utility of artificial intelligence will be covered. Recent international consensus statements highlight the need for standardized imaging reporting and definitions of transmural healing and remission. We will discuss how recent advances may be best integrated into patient care and highlight key outstanding research questions. EXPERT OPINION Cross-sectional imaging is established in Crohn's disease management. Research emphasis should be placed on optimal integration of imaging modalities in clinical care pathways, workforce training, definitions, and evidence for use of imaging based therapeutic targets such as transmural healing, better phenotyping of stricturing disease, and developing novel techniques, including integration of artificial intelligence.
Collapse
Affiliation(s)
- Maira Hameed
- Centre for Medical Imaging, University College London, United Kingdom
- University College London Hospitals NHS Foundation Trust, University College Hospital, United Kingdom
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, United Kingdom
- University College London Hospitals NHS Foundation Trust, University College Hospital, United Kingdom
| |
Collapse
|
11
|
Dolinger MT, Kayal M. Intestinal ultrasound as a non-invasive tool to monitor inflammatory bowel disease activity and guide clinical decision making. World J Gastroenterol 2023; 29:2272-2282. [PMID: 37124889 PMCID: PMC10134421 DOI: 10.3748/wjg.v29.i15.2272] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
Intestinal ultrasound (IUS) is a non-invasive, real-time, cross-sectional imaging tool that can be used at the point-of-care to assess disease activity in patients with Crohn’s disease or ulcerative colitis. IUS promotes quick and impactful treatment decisions that can modify disease progression and enhance patient compliance. This review will summarize the technical aspects of IUS, the evidence to support the use of IUS in disease activity monitoring, the comparison of IUS to current standard of care monitoring modalities such as colonoscopy and calprotectin, and the optimal positioning of IUS in a tight-control monitoring strategy.
Collapse
Affiliation(s)
- Michael T Dolinger
- Department of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Maia Kayal
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| |
Collapse
|
12
|
Cleveland NK, Picker EA, Dolinger MT, Rubin DT. The Arrival of Intestinal Ultrasound for Inflammatory Bowel Disease Care in the United States. Gastroenterol Hepatol (N Y) 2023; 19:147-154. [PMID: 37706105 PMCID: PMC10496276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Intestinal ultrasound (IUS) is a noninvasive and highly reliable point-of-care tool to evaluate inflammation of the bowel. It offers comparable accuracy to endoscopy and magnetic resonance enterography. Although IUS has been incorporated into the management of inflammatory bowel disease (IBD) in other parts of the world, it has only recently arrived in the United States. However, barriers to integration of IUS into IBD care in the United States have included a lack of adoption by leading centers, lack of educational opportunities, and an unclear path for remuneration. This article provides information about the use of IUS in IBD, reviews the data comparing existing modalities of assessment of IBD with IUS, and summarizes strategies to overcome existing barriers to IUS implementation, including the newly available US-based training pathway and appropriate billing practice.
Collapse
Affiliation(s)
| | - Emma A. Picker
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois
| | - Michael T. Dolinger
- Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center, Mount Sinai Hospital, Icahn School of Medicine, New York, New York
| | - David T. Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, Illinois
| |
Collapse
|
13
|
Sakurai K, Katsurada T, Nishida M, Omotehara S, Fukushima S, Otagiri S, Nagashima K, Onishi R, Takagi R, Komatsu Y, Sakamoto N. Characteristics and usefulness of transabdominal ultrasonography in immune-mediated colitis. Intest Res 2023; 21:126-136. [PMID: 35860848 PMCID: PMC9911272 DOI: 10.5217/ir.2021.00166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/06/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND/AIMS The usefulness of ultrasonography (US) in diseases of the gastrointestinal tract has been reported recently. This prospective study aimed to determine the features of US findings in immune-mediated colitis (IMC), an adverse event induced by immune checkpoint inhibitor, and examine the correlation between US findings, colonoscopy (CS) findings, and severity of colitis. METHODS We studied patients examined using CS and US upon suspicion of IMC in Hokkaido University Hospital between April 2018 and February 2021. Endoscopic findings of IMC were assessed using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). The severity of US findings in IMC was evaluated using US grade, which is the ultrasonographic grading scale in ulcerative colitis. Bowel wall thickness and the intensity of the color Doppler signal were also analyzed. Severity of colitis was evaluated using Common Terminology Criteria for Adverse Events (CTCAE) grade version 5. RESULTS Fourteen patients with IMC were enrolled. The US findings were bowel wall thickening, loss of stratification, ulceration and increased blood flow signal. The US grade was moderately correlated with the UCEIS (r=0.687, p=0.009) and CTCAE grade (r=0.628, p=0.035). Bowel wall thickness and UCEIS (r=0.628, p=0.020), as well as color Doppler signal grade and CTCAE grade (r=0.724, p=0.008), were significantly correlated. CONCLUSIONS US findings in IMC were mainly similar to those of ulcerative colitis, but there were some findings that were characteristic only of IMC. Significant correlation was found between US findings, CS findings, and severity of colitis. Hence, US could be useful for the evaluation of IMC.
Collapse
Affiliation(s)
- Kensuke Sakurai
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Takehiko Katsurada
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan,Correspondence to Takehiko Katsurada, Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Kita-15, Nishi-7 Kita-ku, Sapporo 060-8638, Japan. Tel: +81-11-716-1161, Fax: +81-11-706-7999, E-mail:
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan,Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Satomi Omotehara
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan,Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Shinya Fukushima
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Shinsuke Otagiri
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Kazunori Nagashima
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Reizo Onishi
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| | - Ryo Takagi
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Yoshito Komatsu
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan,Depatment of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan
| |
Collapse
|
14
|
Liu X, Esser D, Wagstaff B, Zavodni A, Matsuura N, Kelly J, Diller E. Capsule robot pose and mechanism state detection in ultrasound using attention-based hierarchical deep learning. Sci Rep 2022; 12:21130. [PMID: 36476715 PMCID: PMC9729303 DOI: 10.1038/s41598-022-25572-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Ingestible robotic capsules with locomotion capabilities and on-board sampling mechanism have great potential for non-invasive diagnostic and interventional use in the gastrointestinal tract. Real-time tracking of capsule location and operational state is necessary for clinical application, yet remains a significant challenge. To this end, we propose an approach that can simultaneously determine the mechanism state and in-plane 2D pose of millimeter capsule robots in an anatomically representative environment using ultrasound imaging. Our work proposes an attention-based hierarchical deep learning approach and adapts the success of transfer learning towards solving the multi-task tracking problem with limited dataset. To train the neural networks, we generate a representative dataset of a robotic capsule within ex-vivo porcine stomachs. Experimental results show that the accuracy of capsule state classification is 97%, and the mean estimation errors for orientation and centroid position are 2.0 degrees and 0.24 mm (1.7% of the capsule's body length) on the hold-out test set. Accurate detection of the capsule while manipulated by an external magnet in a porcine stomach and colon is also demonstrated. The results suggest our proposed method has the potential for advancing the wireless capsule-based technologies by providing accurate detection of capsule robots in clinical scenarios.
Collapse
Affiliation(s)
- Xiaoyun Liu
- grid.17063.330000 0001 2157 2938Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S1A8 Canada
| | - Daniel Esser
- grid.152326.10000 0001 2264 7217Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Brandon Wagstaff
- grid.17063.330000 0001 2157 2938University of Toronto Institute of Aerospace Studies, University of Toronto, Toronto, ON M5S1A8 Canada
| | - Anna Zavodni
- grid.17063.330000 0001 2157 2938Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON M5S1A8 Canada
| | - Naomi Matsuura
- grid.17063.330000 0001 2157 2938Department of Materials Science and Engineering and Institute of Biomedical Engineering, University of Toronto, Toronto, ON M5S1A8 Canada
| | - Jonathan Kelly
- grid.17063.330000 0001 2157 2938University of Toronto Institute of Aerospace Studies, University of Toronto, Toronto, ON M5S1A8 Canada
| | - Eric Diller
- grid.17063.330000 0001 2157 2938Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON M5S1A8 Canada
| |
Collapse
|
15
|
Abstract
Crohn’s disease is a chronic inflammatory disease affecting the gastrointestinal tract. Expert guidelines now recommend regular objective assessments as part of a treat-to-target approach. Intestinal ultrasound provides a noninvasive, patient-friendly modality for assessing Crohn’s disease without the risk of radiation exposure and does not require fasting or bowel preparation. Enhancement techniques, including oral and intravenous contrast, can improve disease-activity and complication detection. Due to its acceptability, intestinal ultrasound can be performed frequently, allowing for closer disease-activity monitoring and treatment adjustments. There have been significant advances in the utility of intestinal ultrasound; particularly for assessing disease activity during pregnancy and fibrosis detection utilising elastography. This review provides a comprehensive overview of performing intestinal ultrasound, the diagnostic accuracy, role in disease-activity monitoring, and recent advances in utilising ultrasound for the assessment of luminal Crohn’s disease.
Collapse
|
16
|
Puca P, Del Vecchio LE, Ainora ME, Gasbarrini A, Scaldaferri F, Zocco MA. Role of Multiparametric Intestinal Ultrasound in the Evaluation of Response to Biologic Therapy in Adults with Crohn’s Disease. Diagnostics (Basel) 2022; 12:1991. [PMID: 36010341 PMCID: PMC9407413 DOI: 10.3390/diagnostics12081991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/17/2022] Open
Abstract
Crohn’s disease is one of the two most common types of inflammatory bowel disease. Current medical therapies are based on the use of glucocorticoids, exclusive enteral nutrition, immunosuppressors such as azathioprine and methotrexate, and biological agents such as infliximab, adalimumab, vedolizumab, or ustekinumab. International guidelines suggest regular disease assessment and surveillance through objective instruments to adjust and personalize the therapy, reducing the overall rates of hospitalization and surgery. Although endoscopy represents the gold-standard for surveillance, its frequent use is strongly bordered by associated risks and costs. Consequently, alternative non-invasive tools to objectify disease activity and rule active inflammation out are emerging. Alongside laboratory exams and computed tomography or magnetic resonance enterography, intestinal ultrasonography (IUS) shows to be a valid choice to assess transmural inflammation and to detect transmural healing, defined as bowel wall thickness normalization, no hypervascularization, normal stratification, and no creeping fat. Compared to magnetic resonance imaging (MRI) or computed tomography, CT scan, IUS is cheaper and more widespread, with very similar accuracy. Furthermore, share wave elastography, color Doppler, and contrast-enhanced ultrasonography (CEUS) succeed in amplifying the capacity to determine the disease location, disease activity, and complications. This review aimed to discuss the role of standard and novel ultrasound techniques such as CEUS, SICUS, or share wave elastography in adults with Crohn’s disease, mainly for therapeutic monitoring and follow-up.
Collapse
|
17
|
Biondi M, Bicci E, Danti G, Flammia F, Chiti G, Palumbo P, Bruno F, Borgheresi A, Grassi R, Grassi F, Fusco R, Granata V, Giovagnoni A, Barile A, Miele V. The Role of Magnetic Resonance Enterography in Crohn’s Disease: A Review of Recent Literature. Diagnostics (Basel) 2022; 12:1236. [PMID: 35626391 PMCID: PMC9140029 DOI: 10.3390/diagnostics12051236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022] Open
Abstract
Inflammatory bowel disease (IBD) is the term used to identify a form of chronic inflammation of the gastrointestinal tract that primarily contemplates two major entities: ulcerative colitis (UC) and Crohn’s disease (CD). The classic signs are abdominal pain and diarrhoea that correlate with the localization of gastro-enteric disease, although in this pathology extraintestinal symptoms may coexist. The diagnosis of CD relies on a synergistic combination of clinical, laboratory (stool and biochemical), cross-sectional imaging evaluation, as well as endoscopic and histologic assessments. The purpose of this paper is to prove the role of imaging in the diagnosis and follow-up of patients with CD with particular focus on recent innovations of magnetic resonance enterography (MRE) as a pivotal diagnostic tool, analysing the MRE study protocol and imaging features during the various phases of disease activity and its complications.
Collapse
|
18
|
Sturm A, Atreya R, Bettenworth D, Bokemeyer B, Dignaß A, Ehehalt R, Germer C, Grunert PC, Helwig U, Herrlinger K, Kienle P, Kreis ME, Kucharzik T, Langhorst J, Maaser C, Ockenga J, Ott C, Siegmund B, Zeißig S, Stallmach A. Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004. Z Gastroenterol 2022; 60:332-418. [PMID: 35263784 DOI: 10.1055/a-1713-3941] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Andreas Sturm
- Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie, DRK Kliniken Berlin Westend, Berlin, Deutschland
| | - Raja Atreya
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Deutschland
| | | | - Bernd Bokemeyer
- Gastroenterologische Gemeinschaftspraxis Minden, Deutschland
| | - Axel Dignaß
- Medizinische Klinik I, Agaplesion Markus Krankenhaus, Frankfurt am Main, Deutschland
| | | | - Christoph Germer
- Chirurgische Klinik I, Universitätsklinikum Würzburg, Deutschland
| | - Philip C Grunert
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Deutschland
| | - Ulf Helwig
- Internistische Praxengemeinschaft, Oldenburg, Deutschland
| | | | - Peter Kienle
- Allgemein- und Viszeralchirurgie, Theresienkrankenhaus und Sankt Hedwig-Klinik GmbH, Mannheim, Deutschland
| | - Martin E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité Campus Benjamin Franklin - Universitätsmedizin Berlin, Deutschland
| | - Torsten Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Deutschland
| | - Jost Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Klinikum am Bruderwald, Bamberg, Deutschland
| | | | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen Mitte - Gesundheit Nord, Bremen, Deutschland
| | - Claudia Ott
- Gastroenterologie Facharztzentrum, Regensburg, Deutschland
| | - Britta Siegmund
- Medizinische Klinik I, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutschland
| | - Sebastian Zeißig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Deutschland
| | - Andreas Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Deutschland
| | | |
Collapse
|
19
|
Okuhira T, Yoden A, Kaji E, Otani-Akamatsu M, Inoue K, Aomatsu T, Takitani K, Ashida A. Usefulness of ultrasonography for small intestinal evaluations in pediatric Crohn's disease. Pediatr Int 2022; 64:e15206. [PMID: 35704459 DOI: 10.1111/ped.15206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/18/2022] [Accepted: 03/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Small bowel capsule endoscopy (SBCE) for Crohn's disease is useful; however, its use has some limitations, such as invasiveness when endoscopic assistance is required in patients who cannot swallow the capsule, and the burden of interpretation on a physician. In contrast, intestinal ultrasonography (IUS) is a non-invasive modality for children. The purpose of this study is to evaluate the accuracy of IUS for pediatric patients with established Crohn's disease. METHODS Small bowel capsule endoscopy and IUS findings from the same period in pediatric patients with established Crohn's disease were analyzed retrospectively. First, we compared the Lewis score (LS), small bowel endoscopic activity, and IUS findings by small bowel wall thickness (SBWT) and mesenteric lymph node size (MLNS). Second, we compared the performance of IUS findings with those of some biomarkers. RESULTS In 22 procedures, SBWT and MLNS were correlated with LS (r = 0.52, P < 0.05, and r = 0.45, P < 0.05, respectively). Small bowel wall thickness, erythrocyte sedimentation rate, and fecal calprotectin levels had the highest accuracy (81.8%, 81.8%, and 81.8%, respectively). The combination of SBWT and MLNS had the highest positive predictive value and negative predictive value (100% and 83.3%, respectively). CONCLUSIONS Intestinal ultrasonography findings, including SBWT and MLNS, are useful for monitoring small bowel lesions in pediatric patients with established Crohn's disease. We suggest first evaluating small bowel inflammation by IUS in pediatric patients with Crohn's disease before SBCE because IUS is less invasive than SBCE.
Collapse
Affiliation(s)
- Takeru Okuhira
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.,Department of Pediatrics, Osaka Saiseikai Suita Hospital, Suita, Osaka, Japan
| | - Atsushi Yoden
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan.,Department of Pediatrics, Dainikyoritsu Hospital, Kawanishi, Hyogo, Japan
| | - Emiri Kaji
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | | | - Keisuke Inoue
- Department of Pediatrics, Hirakata City Hospital, Hirakata, Osaka, Japan
| | - Tomoki Aomatsu
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Kimitaka Takitani
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| | - Akira Ashida
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka, Japan
| |
Collapse
|
20
|
Frias-Gomes C, Torres J, Palmela C. Intestinal Ultrasound in Inflammatory Bowel Disease: A Valuable and Increasingly Important Tool. GE Port J Gastroenterol 2021; 29:223-239. [PMID: 35979252 PMCID: PMC9275009 DOI: 10.1159/000520212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/08/2021] [Indexed: 11/19/2022]
Abstract
Background Intestinal ultrasound is emerging as a non-invasive tool for monitoring disease activity in inflammatory bowel disease patients due to its low cost, excellent safety profile, and availability. Herein, we comprehensively review the role of intestinal ultrasound in the management of these patients. Summary Intestinal ultrasound has a good accuracy in the diagnosis of Crohn's disease, as well as in the assessment of disease activity, extent, and evaluating disease-related complications, namely strictures, fistulae, and abscesses. Even though not fully validated, several scores have been developed to assess disease activity using ultrasound. Importantly, intestinal ultrasound can also be used to assess response to treatment. Changes in ultrasonographic parameters are observed as early as 4 weeks after treatment initiation and persist during short- and long-term follow-up. Additionally, Crohn's disease patients with no ultrasound improvement seem to be at a higher risk of therapy intensification, need for steroids, hospitalisation, or even surgery. Similarly to Crohn's disease, intestinal ultrasound has a good performance in the diagnosis, activity, and disease extent assessment in ulcerative colitis patients. In fact, in patients with severe acute colitis, higher bowel wall thickness at admission is associated with the need for salvage therapy and the absence of a significant decrease in this parameter may predict the need for colectomy. Short-term data also evidence the role of intestinal ultrasound in evaluating therapy response, with ultrasound changes observed after 2 weeks of treatment and significant improvement after 12 weeks of follow-up in ulcerative colitis. Key Messages Intestinal ultrasound is a valuable tool to assess disease activity and complications, and to monitor response to therapy. Even though longer prospective data are warranted, intestinal ultrasound may lead to a change in the paradigm of inflammatory bowel disease management as it can be used in a point-of-care setting, enabling earlier intervention if needed.
Collapse
Affiliation(s)
- Catarina Frias-Gomes
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Joana Torres
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
- Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Carolina Palmela
- Gastroenterology Division, Surgical Department, Hospital Beatriz Ângelo, Loures, Portugal
- *Carolina Palmela,
| |
Collapse
|
21
|
Park S, Jung JW, Jang S, Choi BK, Lee E, Lee S, Choi J. Efficacy of a phospholipid-stabilized sulfur hexafluoride microsphere contrast agent and water for hydrosonography of the upper portion of the gastrointestinal tract in dogs. Am J Vet Res 2021; 82:712-721. [PMID: 34432515 DOI: 10.2460/ajvr.82.9.712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the efficacy of a phospholipid-stabilized sulfur hexafluoride microsphere (SHM) contrast agent and water for hydrosonography of the upper portion of the gastrointestinal tract of dogs. ANIMALS 12 healthy adult Beagles. PROCEDURES In a crossover study, each dog was anesthetized and underwent noncontrast ultrasonography then hydrosonography following administration of tap water (30 mL/kg) without (water method) or with SHM (0.1 mL; SHM method) via an orogastric tube. There were at least 3 days between hydrosonographic procedures. Wall thickness, wall layer definition, conspicuity of the mucosal-luminal interface, and image quality were evaluated separately in the near and far fields for the gastric cardia, body, and pylorus and descending duodenum and compared among the 3 scanning methods. RESULTS Mean wall thickness measurements did not differ significantly between the water and SHM methods at any location except the far-field gastric cardia where the mean wall thickness for the SHM method was less than that for the water method. In general, the SHM method improved wall layer definition and conspicuity of the mucosal-luminal interface of structures in the near field, compared with noncontrast method. The water and SHM methods both resulted in superior image quality relative to the noncontrast method for the near-field gastric cardia, far-field gastric cardia, and far-field duodenum. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that, for dogs, gastrointestinal hydrosonography by use of the SHM method improved wall layer definition and mucosal conspicuity, particularly in near-field images of the upper portion of the gastrointestinal tract.
Collapse
|
22
|
Suárez Ferrer C, Poza Cordón J, Crivillén Anguita O, Mayor Delgado P, Rueda García JL, Martín Arranz E, Sánchez Azofra M, Noci Belda J, García Ramírez L, Martín Arranz MD. Prognostic value of ultrasound activity and parietal healing in patients with Crohn's disease. Rev Esp Enferm Dig 2021; 113:494-499. [PMID: 33261499 DOI: 10.17235/reed.2020.7347/2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION the "treat to target" strategy for the management of patients with Crohn's disease (CD) requires simple, reliable and non-invasive tools for continuous monitoring of the disease. Intestinal ultrasound has been proposed as an emerging technique that could be very useful in this field. MATERIAL AND METHODS patients who had undergone an intestinal ultrasound in the clinical practice between February 2013 and October 2018 at our hospital were retrospectively included. The evolution of the patients during follow-up was assessed based on the presence of ultrasound activity and the therapeutic changes based on the results. RESULTS two hundred and seventy-seven CD patients were included and the median follow-up time was 24 months (range 5-73 months). Signs of ultrasound inflammatory activity were identified in 166 patients (60 %), and of them, treatment was escalated in 116 patients (70 %) based on the results of the ultrasound. Among patients with identified ultrasound activity, in 166 patients (60 %) the evolution was less favorable than in those without activity, with a shorter time until the next outbreak. Thus, the median disease-free survival (without outbreaks) after performing the ultrasound was 18 months when ultrasound activity was identified (although in most of the patients [70 %] the treatment had been escalated) vs 47 months in patients without ultrasound activity. However, these differences were not statistically significant (p < 0.0001). Among the 111 patients without ultrasound activity, those who achieved "parietal healing" (74 patients) had a better evolution with a 12 % subsequent outbreak vs 27 % during follow-up (p = 0.05). Thus, 15 % of patients with parietal healing had an outbreak vs 34 % of those who had not normalized the ultrasound findings after three years of follow-up. CONCLUSION intestinal ultrasound is a technique capable of detecting inflammatory activity in patients with Crohn's disease and the presence of ultrasound activity is a risk factor for a new outbreak of activity and/or clinical relapse. Likewise, the presence of "parietal or transmural healing" (PH) is associated with a better evolution of patients during follow-up. Thus, it could be a more precise objective to consider deep remission in CD, with intestinal ultrasound being a useful technique for this purpose.
Collapse
|
23
|
Jauregui-Amezaga A, Rimola J. Role of Intestinal Ultrasound in the Management of Patients with Inflammatory Bowel Disease. Life (Basel) 2021; 11:603. [PMID: 34201630 DOI: 10.3390/life11070603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/13/2021] [Accepted: 06/18/2021] [Indexed: 12/11/2022] Open
Abstract
Intestinal ultrasound (IUS) has gained popularity as a first line technique for the diagnosis and monitoring of patients with inflammatory bowel diseases (IBD) due to its many advantages. It is a non-invasive imaging technique with non-ionizing radiation exposure. It can be easily performed not only by radiologists but also by trained gastroenterologists at outpatient clinics. In addition, the cost of IUS equipment is low when compared with other imaging techniques. IUS is an accurate technique to detect inflammatory lesions and complications in the bowel in patients with suspected or already known Crohn’s disease (CD). Recent evidence indicates that IUS is a convenient and accurate technique to assess extension and activity in the colon in patients with ulcerative colitis (UC), and can be a non-invasive alternative to endoscopy. In patients with IBD, several non-specific pathological ultrasonographic signs can be identified: bowel wall thickening, alteration of the bowel wall echo-pattern, loss of bowel stratification, increased vascularization, decreased bowel peristalsis, fibro-fatty proliferation, enlarged lymph nodes, and/or abdominal free fluid. Considering the transmural CD inflammation, CD complications such as presence of strictures, fistulae, or abscesses can be detected. In patients with UC, where inflammation is limited to mucosa, luminal inflammatory ultrasonographic changes are similar to those of CD. As the technique is related to the operator’s experience, adequate IUS training, performance in daily practice, and a generalized use of standardized parameters will help to increase its reproducibility.
Collapse
|
24
|
Abstract
Intestinal submucosal fibrovascular hamartoma is considered as a rare intestinal lesion. We present the case of a 63-year-old female with abdominal symptoms, bleeding, and increased serum tumor markers. The abdominal ultrasound revealed that the left abdominal intestinal wall and mesentery were thickened with enlarged multiple lymph nodes, suggesting intestinal obstruction. Other imaging findings confirmed the ultrasound findings. Histopathology of the removed lesion provided the diagnosis of intestinal submucosal fibrovascular hamartoma with hemorrhage, inflammation, and amyloidosis. Intestinal submucosal fibrovascular hamartoma is a hemorrhagic lesion with macroscopic tumor due to the abnormal mixing of the organ's normal components, which still remains a challenge for clinicians and pathologists. We consider routine abdominal ultrasonography and contrast-enhanced ultrasonography (SICUS) to be safe and effective in the diagnosis of intestinal neoplastic lesions.
Collapse
Affiliation(s)
- Jin Liu
- Number 155, Nanjing North Street, Heping District, Shenyang City, Liaoning Province, China
| | - Yanjun Liu
- Number 155, Nanjing North Street, Heping District, Shenyang City, Liaoning Province, China
| | - Ziyao Ji
- Number 155, Nanjing North Street, Heping District, Shenyang City, Liaoning Province, China
| |
Collapse
|
25
|
Stenczel ND, Purcarea MR, Tribus LC, Oniga GH. The role of the intestinal ultrasound in Crohn's disease diagnosis and monitoring. J Med Life 2021; 14:310-315. [PMID: 34377195 PMCID: PMC8321617 DOI: 10.25122/jml-2021-0067] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/13/2021] [Indexed: 12/25/2022] Open
Abstract
Crohn's disease is characterized by persistent or recurrent chronic inflammation that may affect any segment of the gastrointestinal tract. It has an oscillating evolution, with periods of activity alternating with periods of remission. Crohn's disease has a significant impact on the economic status due to its increasing prevalence, often affecting young people. Suitable management for these patients involves frequent evaluations. Even though colonoscopy is the gold standard for the assessment of severity and mucosal healing, it is an invasive maneuver, not easily accepted by patients, and it does not have good repeatability. Intestinal ultrasound has the advantage of being non-irradiating, non-invasive, well-tolerated, cheap, and easy to repeat. Ultrasound parameters such as bowel wall thickness, intestinal wall architecture, intramural vascularisation, proliferation of mesenteric fatty conjunctive tissue, and intraperitoneal fluid can provide good information regarding the severity of the disease, the differentiation between remission and relapse, and its complications. Some of the latest studies show good correlations between ultrasound parameters and inflammation markers (C-reactive protein, fecal calprotectin) and clinical severity scores of Crohn's disease. Consequently, the importance of intestinal ultrasound has increased lately, and recent studies support its use to evaluate the severity of inflammation, differentiate between active disease and relapse, monitor therapy response and guide treatment, evaluate prognosis, and diagnose complications.
Collapse
Affiliation(s)
- Norbert Dacian Stenczel
- Department of Healthcare Marketing and Medical Technology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Laura Carina Tribus
- Department of Gastroenterology, Bucharest Emergency University Hospital, Bucharest, Romania
- Department of Gastroenterology, Carol Davila University of Medicine and Pharmacy Bucharest, Romania
- Corresponding Author: Laura Carina Tribus, MD, Emergency University Hospital of Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania. Phone: +40745105155; E-mail:
| | - Gabriela Hofer Oniga
- Department of Healthcare Marketing and Medical Technology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| |
Collapse
|
26
|
Lee D, Yoon S, Kim C, Choi J. A comparative study of sono-urethrography using saline, agitated saline, and an ultrasound contrast agent in normal beagles. Vet Radiol Ultrasound 2021; 62:342-349. [PMID: 33476091 DOI: 10.1111/vru.12952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/11/2020] [Accepted: 11/14/2020] [Indexed: 11/30/2022] Open
Abstract
Sono-urethrography is a technique used to evaluate the integrity of the urethra utilizing fluid dilation of the urethral lumen. The purpose of this prospective, method comparison, pilot study was to investigate the feasibility of sono-urethrography in male dogs and to compare the quality of the images obtained using three different contrast solutions. The prostatic, membranous, and penile urethra was evaluated using saline, agitated saline, and ultrasound contrast agent (Sonovue) in 10 adult, male Beagles. Visibility of the urethral wall was better with sono-urethrography than with conventional ultrasonography, and the conspicuity of urethra could be assessed using all solutions. Hyperechoic lines created by agitated saline and Sonovue were more useful than anechoic saline in allowing identification of the urethra. Visibility scores for the internal margin of the urethral wall using sono-urethrography were significantly higher with saline and one-minute post agitated saline injection. However, the individual layers of the urethral wall could not be observed, regardless of the contrast solution used. Shadowing created by the pelvic bone deteriorated the window through which the urethra could be visualized, and this could not be overcome using sono-urethrography. The results of this study indicated that sono-urethrography is a feasible option for the visualization of the male urethra in dogs. The authors recommend sono-urethrography using saline or agitated saline infusion to evaluate the urethral wall and lumen. Sono-urethrography using ultrasound contrast agent can be applied to assess the integrity of the urethra by improving its conspicuity.
Collapse
Affiliation(s)
- Dahae Lee
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Sooa Yoon
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Cheolhyun Kim
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| | - Jihye Choi
- College of Veterinary Medicine and BK 21 Plus Project Team, Chonnam National University, Gwangju, South Korea
| |
Collapse
|
27
|
Abstract
Inflammatory bowel diseases [IBD], including Crohn's disease [CD] and ulcerative colitis [UC], are chronic, relapsing and destructive inflammatory disorders of the gastrointestinal tract which can lead to organ damage and impair quality of life. A 'treat-to-target' strategy based on activity and severity of disease and response to treatment with close monitoring of intestinal inflammation is recommended. Ileocolonoscopy [CS] is considered the first-line procedure for the assessment of IBD, and magnetic resonance enterography [MRE] is the current standard for assessing the small bowel and complications in CD, and has been proposed as an alternative procedure to CS in the evaluation of both ileo-colonic CD and UC. As that both CS and MRE are invasive and expensive procedures and unappealing to patients, they are unfeasible as frequent and repetitive tools for the monitoring of disease activity. Bowel ultrasound [US] represents a well-tolerated, non-invasive and cost-effective modality to manage IBD patients in clinical practice. Compared to CS and MRE, bowel US has been shown to have the same level of accuracy in assessing and monitoring disease activity and severity of both CD and UC. It can be performed at the point-of-care and therefore allow for real-time clinical decision-making. Point-of-care ultrasound [POCUS] is suggested as the stethoscope of the future and is gaining interest and diffusion in the medical field because it can be used for the bedside examination of patients. The aim of this review is to discuss point-of-care bowel ultrasound [POCBUS] in the management of patients with IBD.
Collapse
Affiliation(s)
- Mariangela Allocca
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy
| | - Gionata Fiorino
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Silvio Danese
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| |
Collapse
|
28
|
Kang J, Oh D, Choi J, Kim K, Yoon J, Choi M. Evaluation of a dual-purpose contrast medium for radiography and ultrasonography of the small intestine in dogs. Am J Vet Res 2020; 81:950-957. [PMID: 33251836 DOI: 10.2460/ajvr.81.12.950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate a contrast medium that could be used for radiographic and ultrasonographic assessment of the small intestine in dogs. ANIMALS 8 healthy adult Beagles. PROCEDURES Carboxymethylcellulose (CMC; 0.5% solution) was combined with iohexol (300 mg of iodine/mL) to yield modified contrast medium (MCM). Dogs were orally administered the first of 3 MCMs (10 mL/kg [9.5 mL of CMC/kg plus 0.5 mL of iohexol/kg]). Radiographic and ultrasonographic assessment of the small intestine followed 10 minutes after administration and every 10 minutes thereafter, until MCM was seen within the ascending colon. Minimally, 1 week elapsed between dosing of subsequent MCMs (10 mL/kg [9 mL of CMC/kg plus 1 mL of iohexol/kg and 8.5 mL of CMC/kg plus 1.5 mL of iohexol/kg]) and repeated radiography and ultrasonography. RESULTS Radiographic contrast enhancement of the small intestine was best with MCM that combined 8.5 mL of CMC/kg and 1.5 mL of iohexol/kg. Mean small intestinal transit time for all MCMs was 86 minutes. All MCMs did not interfere with ultrasonographic assessment of the small intestine and may have improved visualization of the far-field small intestinal walls. CONCLUSIONS AND CLINICAL RELEVANCE An MCM that combined 8.5 mL of 0.5% CMC/kg and 1.5 mL of iohexol/kg could be an alternative to barium or iohexol alone for contrast small intestinal radiography in dogs, especially when abdominal ultrasonography is to follow contrast radiography.
Collapse
|
29
|
Abstract
Over recent years, inflammatory bowel diseases have become an issue of increased attention in daily clinical practice, due to both a rising incidence and improved imaging capability in detection. In particular, the diagnosis of Crohn's disease is based on clinical picture, laboratory tests and colonoscopy with biopsy. However, colonoscopic evaluation is limited to the mucosal layer. Thus, imaging modalities play a pivotal role in enriching the clinical picture, delivering information on intestinal and extraintestinal involvement. All the imaging modalities can be employed in evaluation of Crohn's disease patients, each of them with specific strengths as well as limitations. In this wide selection, the choice of a proper diagnostic framework can be challenging for the clinician. Therefore, the aim of this work is to offer an overview of the different imaging techniques, with brief technical details and diagnostic potential related to each intestinal tract.
Collapse
Affiliation(s)
- Giuseppe Cicero
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Silvio Mazziotti
- Section of Radiological Sciences, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| |
Collapse
|
30
|
Martínez Pérez M, Blanc García E, Merino Bonilla J. Bowel ultrasound: Examination techniques and normal and pathologic patterns. Radiología (English Edition) 2020; 62:517-27. [DOI: 10.1016/j.rxeng.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
31
|
Martínez Pérez MJ, Blanc García E, Merino Bonilla JA. Bowel ultrasound: examination techniques and normal and pathologic patterns. Radiologia (Engl Ed) 2020; 62:517-527. [PMID: 33127091 DOI: 10.1016/j.rx.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Ultrasound is being increasingly used to study the digestive tract because it has certain advantages over other techniques such as endoscopy, CT enterography, and MR enterography. Ultrasound can be used to evaluate the bowel wall and the elements that surround it without the need for contrast agents; its ability to evaluate the elasticity and peristalsis of these structures is increasing interest in its use. This article describes the techniques and modalities of bowel ultrasound, as well as the normal features of the bowel wall and contiguous structures. It uses a practical approach to review the main pathological findings and their interpretation, and the different patterns of presentation, which will help orient the diagnosis.
Collapse
Affiliation(s)
- M J Martínez Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España.
| | - E Blanc García
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España
| | - J A Merino Bonilla
- Servicio de Radiodiagnóstico, Hospital Santiago Apóstol, Miranda de Ebro, Burgos, España
| |
Collapse
|
32
|
Taylor SA, Mallett S, Bhatnagar G, Morris S, Quinn L, Tomini F, Miles A, Baldwin-Cleland R, Bloom S, Gupta A, Hamlin PJ, Hart AL, Higginson A, Jacobs I, McCartney S, Murray CD, Plumb AA, Pollok RC, Rodriguez-Justo M, Shabir Z, Slater A, Tolan D, Travis S, Windsor A, Wylie P, Zealley I, Halligan S. Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn's disease patients: the METRIC diagnostic accuracy study. Health Technol Assess 2020; 23:1-162. [PMID: 31432777 DOI: 10.3310/hta23420] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Magnetic resonance enterography and enteric ultrasonography are used to image Crohn's disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn's disease was compared. OBJECTIVE To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn's disease. DESIGN Prospective multicentre cohort study. SETTING Eight NHS hospitals. PARTICIPANTS Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn's disease or with established Crohn's disease and suspected relapse. INTERVENTIONS Magnetic resonance enterography and ultrasonography. MAIN OUTCOME MEASURES The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn's disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease extent, and sensitivity and specificity for small bowel Crohn's disease and colonic Crohn's disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. RESULTS Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn's disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn's disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn's disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn's disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn's disease presence and extent were similar in the two cohorts. For colonic Crohn's disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn's disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. LIMITATIONS Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. CONCLUSIONS Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn's disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn's disease. TRIAL REGISTRATION Current Controlled Trials ISRCTN03982913. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Sue Mallett
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Stephen Morris
- Applied Health Research, University College London, London, UK
| | - Laura Quinn
- Institute of Applied Health Research, National Institute for Health Research Birmingham Biomedical Research Centre, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Florian Tomini
- Applied Health Research, University College London, London, UK
| | - Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Rachel Baldwin-Cleland
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Stuart Bloom
- Department of Gastroenterology, University College Hospital, London, UK
| | - Arun Gupta
- Intestinal Imaging Centre, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Peter John Hamlin
- Department of Gastroenterology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ailsa L Hart
- Inflammatory Bowel Disease Unit, St Mark's Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Antony Higginson
- Department of Radiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Ilan Jacobs
- Independent patient representative, c/o Centre for Medical Imaging, University College London, London, UK
| | - Sara McCartney
- Department of Gastroenterology, University College Hospital, London, UK
| | - Charles D Murray
- Department of Gastroenterology and Endoscopy, Royal Free London NHS Foundation Trust, London, UK
| | - Andrew Ao Plumb
- Centre for Medical Imaging, University College London, London, UK
| | - Richard C Pollok
- Department of Gastroenterology, St George's Hospital, London, UK
| | | | - Zainib Shabir
- Comprehensive Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Andrew Slater
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Simon Travis
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Peter Wylie
- Department of Radiology, Royal Free London NHS Foundation Trust, London, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| |
Collapse
|
33
|
Bhatnagar G, Quinn L, Higginson A, Plumb A, Halligan S, Tolan D, Lapham R, Mallett S, Taylor SA; METRIC study investigators. Observer agreement for small bowel ultrasound in Crohn's disease: results from the METRIC trial. Abdom Radiol (NY) 2020; 45:3036-45. [PMID: 32037466 DOI: 10.1007/s00261-020-02405-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Purpose To prospectively evaluate interobserver agreement for small bowel ultrasound (SBUS) in newly diagnosed and relapsing Crohn’s disease. Methods A subset of patients recruited to a prospective trial comparing the diagnostic accuracy of MR enterography and SBUS underwent a second SBUS performed by one of a pool of six practitioners, who recorded the presence, activity and location of small bowel and colonic disease. Detailed segmental mural and extra-mural observations were also scored. Interobserver variability was expressed as percentage agreement with a construct reference standard, split by patient cohort, grouping disease as present or absent. Prevalence adjusted bias adjusted kappa (PABAK), and simple percentage agreement between practitioners, irrespective of the reference standard, were calculated. Results Thirty-eight patients (11 new diagnosis, 27 relapse) were recruited from two sites. Overall percentage agreement for small bowel disease presence against the consensus reference was 82% (52–95% (95%CI)), kappa coefficient (κ) 0.64, (substantial agreement) for new diagnosis and 81%, κ 0.63 (substantial agreement) for the relapsing cohort. Agreement for colonic disease presence was 64%, κ 0.27 (fair agreement) in new diagnosis and 78%,κ 0.56 (moderate agreement) in the relapsing cohort. Simple agreement between practitioners was 84% and 87% for small bowel and colonic disease presence respectively. Practitioners agreed on small bowel disease activity in 24/27 (89%) where both identified disease. Kappa agreement for detailed mural observations ranged from κ 0.00 to 1.00. Conclusion There is substantial practitioner agreement for small bowel disease presence in newly diagnosed and relapsing CD patients, supporting wider dissemination of enteric US. Electronic supplementary material The online version of this article (10.1007/s00261-020-02405-w) contains supplementary material, which is available to authorized users.
Collapse
|
34
|
Zorzi F, Ghosh S, Chiaramonte C, Lolli E, Ventura M, Onali S, De Cristofaro E, Fantini MC, Biancone L, Monteleone G, Calabrese E. Response Assessed by Ultrasonography as Target of Biological Treatment for Crohn's Disease. Clin Gastroenterol Hepatol 2020; 18:2030-2037. [PMID: 31866561 DOI: 10.1016/j.cgh.2019.10.042] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Mucosal healing, determined by ileocolonoscopy, is a goal for treatment of Crohn's disease (CD), but this is an invasive assessment procedure. We investigated whether response to tumor necrosis factor (TNF) antagonists, determined by small-intestine contrast ultrasonography, associates with long-term outcomes. METHODS We performed observational study of 80 patients with CD treated with anti-TNF agents for at least 1 year who underwent serial small intestine contrast ultrasonography (SICUS) at the University of Rome, in Italy. SICUS was used to evaluate disease site (based on bowel wall thickness), extent of lesions, and presence of complications. Inclusion criteria required pre-therapy SICUS with follow-up SICUS after 18 months. At second SICUS, patients were assigned to categories of complete or partial responder or non-responder. CD-related outcomes (corticosteroid need, hospitalization, and surgery) were assessed at 1 year from the second SICUS, using multivariate models, and were analyzed after long term follow up (5 years) using Kaplan-Meier survival analysis. RESULTS Based on SICUS, after a median of 18 months, 36 patients (51%) were complete responders, 30 were partial responders (34%), and 13 were non-responders (15%). At 1 year from the second SICUS, no patients with a complete response, based on ultrasonography, underwent surgery, in comparison to partial responders (P = .0003) or non-responders (P = .001). Complete responders used smaller amounts of corticosteroids than partial responders (P = .0001) or non-responders (P < .0001). Complete responders required fewer hospitalizations than non-responders (P = .001). Kaplan-Meier survival analysis of long-term follow up data demonstrated a lower cumulative probability of need for surgery, hospitalization, and need for steroids among SICUS-categorized complete responders (P < .0001, P = .003 and P = .0001 respectively) than SICUS-categorized non-responders. CONCLUSIONS In patients with CD, response to anti-TNF agents, determined by SICUS, is associated with better long-term outcomes than partial or no response. Ultrasonographic assessment therefore provides a relatively non-invasive method for monitoring response to treatment in patients with CD.
Collapse
Affiliation(s)
- Francesca Zorzi
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Subrata Ghosh
- NIHR Biomedical Research Centre Birmingham, University of Birmingham, Birmingham, United Kingdom
| | - Carlo Chiaramonte
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elisabetta Lolli
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Martina Ventura
- Department of Epidemiology, Lazio Regional Health Service, Rome Italy
| | - Sara Onali
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Elena De Cristofaro
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimo C Fantini
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Livia Biancone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
| |
Collapse
|
35
|
Nachand D, Gandhi NS. Imaging of bowel in patients requiring surgery for Crohn's disease. Seminars in Colon and Rectal Surgery 2020. [DOI: 10.1016/j.scrs.2020.100741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
36
|
Lee JH, Traverso G, Ibarra-Zarate D, Boning DS, Anthony BW. Ex Vivo and In Vivo Imaging Study of Ultrasound Capsule Endoscopy. J Med Device 2020; 14:021005. [PMID: 32431763 DOI: 10.1115/1.4046352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
Wireless capsule endoscopy (WCE) has revolutionized the capacity for evaluation of the gastrointestinal (GI) tract, but its evaluation is limited to the mucosal surface. To overcome this, ultrasound capsule endoscopy (UCE) that can evaluate the deeper structures beyond the mucosal surface has been proposed and several studies focusing on technology development have demonstrated promising results. However, investigations of the potential for clinical utility of this technology are lacking. This work had two main goals: perform ex vivo and in vivo imaging studies in a swine model to (1) evaluate if acoustic coupling between a capsule with a specific size and GI tract can be achieved only through peristalsis autonomously without any human control and (2) identify key issues and challenges to help guide further research. The images acquired in these studies were able to visualize the wall of the GI tract as well as the structures within demonstrating that achieving adequate acoustic coupling through peristalsis is possible. Critical challenges were identified including level of visualization and area of coverage; these require further in-depth investigation before potential clinical utility of UCE technology can be concluded.
Collapse
Affiliation(s)
- John H Lee
- Division of Gastroenterology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139
| | - Giovanni Traverso
- Division of Gastroenterology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139; Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115
| | - David Ibarra-Zarate
- Tecnologico de Monterrey, Escuela de Ingenieria y Ciencias, Eugenio Garza Sada 2501 sur col. Tecnológico c.p, Monterrey, Nuevo León 64849, México
| | - Duane S Boning
- Division of Gastroenterology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139
| | - Brian W Anthony
- Division of Gastroenterology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139
| |
Collapse
|
37
|
Allocca M, Danese S, Laurent V, Peyrin-Biroulet L. Use of Cross-Sectional Imaging for Tight Monitoring of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol 2020; 18:1309-1323.e4. [PMID: 31812657 DOI: 10.1016/j.cgh.2019.11.052] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 11/06/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
A treat-to-target strategy with close monitoring of intestinal inflammation is recommended in inflammatory bowel disease (IBD). Ileocolonoscopy remains the gold standard for assessing disease activity in IBD but is a relatively invasive procedure and is impossible to repeat in the context of tight monitoring strategies. In addition to biomarkers, cross-sectional imaging increasingly is used in these patients. Computed tomography is limited by the use of radiation, while the use of magnetic resonance enterography (MRE) is limited by its cost and access. There is growing interest in bowel ultrasound that represents a cost-effective, noninvasive, and well-tolerated modality in clinical practice, but it is operator dependent. Compared with ileocolonoscopy and MRE, bowel US has been shown to have the same level of accuracy in assessing and monitoring disease activity for both CD and UC and thus can be considered a point-of-care test. Diffusion-weighted imaging (DWI) is a MR imaging technique that increasingly is used in both IBD and non-IBD conditions and has been shown to be a valuable and accurate tool for assessing and monitoring IBD activity. Compared with conventional MRE, DWI is quicker, less time consuming, may not require intravenous contrast agent, fasting, bowel cleansing, oral preparation, or rectal preparation. This review discusses the role of these cross-sectional imaging techniques for the management of patients with IBD. In the near future, the value of DWI and ultrasound in assessing IBD will require further investigation in the era of transmural healing in CD and complete mucosal healing, including histologic remission, in ulcerative colitis.
Collapse
Affiliation(s)
- Mariangela Allocca
- Inflammatory Bowel Disease Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Silvio Danese
- Inflammatory Bowel Disease Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy
| | - Valérie Laurent
- Department of Radiology, Nancy University Hospital, Lorraine University, Vandœuvre-lès-Nancy, France
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology, Inserm NGERE, University Hospital of Nancy, Lorraine University, Nancy, France.
| |
Collapse
|
38
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
39
|
Goyal P, Shah J, Gupta S, Gupta P, Sharma V. Imaging in discriminating intestinal tuberculosis and Crohn's disease: past, present and the future. Expert Rev Gastroenterol Hepatol 2019; 13:995-1007. [PMID: 31559871 DOI: 10.1080/17474124.2019.1673730] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Intestinal tuberculosis (ITB) and Crohn's disease (CD) have similar clinical presentation, but require different treatment approaches. Despite advances in various endoscopic, imaging, microbiological, and histological techniques, the differentiation of these two entities is often difficult. Newer radiological and image acquisition modalities have now become indispensable tools for evaluation of these two diseases.Areas covered: This review summarizes the currently available literature on various radiological investigations to differentiate ITB from CD. This review also enumerates the newer modalities in image acquisition techniques and their potential role for differentiating these two diseases. At present abdominal computed tomography (CT) scan is used as a first line investigation for differentiating ITB from CD. Magnetic resonance imaging (MRI) is preferred in pediatric patients and for follow-up studies.Expert opinion: Role of newer modalities like contrast enhanced abdominal ultrasound, perfusion CT, advanced MRI and positron emission tomography (PET) is evolving and requires further exploration. Till further robust studies are available, differentiation between ITB and CD requires use of a combination of clinical, endoscopic, serological, histological, and radiological parameters rather than relying on a single test.
Collapse
Affiliation(s)
- Pradeep Goyal
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sonali Gupta
- Department of Medicine, St. Vincent's Medical Center, Bridgeport, CT, USA.,Department of Medicine, The Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
40
|
Kinoshita K, Katsurada T, Nishida M, Omotehara S, Onishi R, Mabe K, Onodera A, Sato M, Eto K, Suya M, Maemoto A, Hasegawa T, Yamamoto J, Mitsumori D, Yoshii S, Ono K, Sakamoto N. Usefulness of transabdominal ultrasonography for assessing ulcerative colitis: a prospective, multicenter study. J Gastroenterol 2019; 54:521-529. [PMID: 30519747 DOI: 10.1007/s00535-018-01534-w] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 11/27/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Transabdominal ultrasonography (US) has been reported to be a useful tool for evaluating ulcerative colitis (UC) although with less well-established data than for Crohn's disease. This prospective multicenter study aimed to establish the usefulness of US compared with colonoscopy (CS) for assessing disease extent and activity of UC. METHODS Altogether, 173 patients with UC were prospectively enrolled, among whom 156 were eligible for this study. All patients underwent US and CS within 2 days at five facilities. We divided the colon into six segments and examined each segment and the rectum using US and CS. US severity was graded 1-4 regarding bowel wall thickness, stratification, and ulceration. CS severity was also graded 1-4 according to Matts' endoscopic classification. Concordance between US and CS grades for all colonic segments was analyzed using kappa statistics. US and CS findings were also compared with the clinical disease activity index (CAI) and histological grade using Spearman's correlation coefficient. RESULTS There was moderate concordance between US and CS grades in all colonic segments (weighted κ = 0.55, p < 0.001). Concordance was rated moderate for each colonic segment but only slight for the rectum. The US grade was significantly correlated with the CAI score (r = 0.40, p < 0.001) and histological grade (r = 0.35, p < 0.001). CONCLUSIONS This prospective multicenter study showed moderate concordance between US and CS for assessing the disease activity of UC. Hence, US may be used more generally for evaluating UC in daily clinical practice.
Collapse
Affiliation(s)
- Kenji Kinoshita
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7 Kita-ku, Sapporo, 060-8638, Japan.
| | - Takehiko Katsurada
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.,Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Satomi Omotehara
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan.,Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Reizo Onishi
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
| | - Katsuhiro Mabe
- Department of Gastroenterology, National Hospital Organization Hakodate Hospital, Hakodate, Japan
| | - Aki Onodera
- Department of Clinical Laboratory, Tomakomai City Hospital, Tomakomai, Japan
| | - Mami Sato
- Department of Clinical Laboratory, Tomakomai City Hospital, Tomakomai, Japan
| | - Kazunori Eto
- Department of Gastroenterology, Tomakomai City Hospital, Tomakomai, Japan
| | - Mitsutoshi Suya
- Department of Clinical Laboratory, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Atsuo Maemoto
- Inflammatory Bowel Disease Center, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Toru Hasegawa
- Department of Clinical Laboratory, Ohguro Gastroenterological Hospital, Sapporo, Japan
| | | | - Daiki Mitsumori
- Department of Clinical Laboratory, Sapporo Medical Center NTT EC, Sapporo, Japan
| | - Shinji Yoshii
- Department of Gastroenterology, Sapporo Medical Center NTT EC, Sapporo, Japan
| | - Kota Ono
- Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan
| | - Naoya Sakamoto
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Kita-15, Nishi-7 Kita-ku, Sapporo, 060-8638, Japan
| |
Collapse
|
41
|
Biernacka KB, Barańska D, Grzelak P, Czkwianianc E, Szabelska-Zakrzewska K. Up-to-date overview of imaging techniques in the diagnosis and management of inflammatory bowel diseases. Prz Gastroenterol 2019; 14:19-25. [PMID: 30944674 DOI: 10.5114/pg.2019.83423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 10/22/2018] [Indexed: 12/23/2022]
Abstract
Radiological examination occupies a significant role, complementary to endoscopic studies, in the diagnostic process of inflammatory bowel disease (IBD). Both ulcerative colitis and Crohn’s disease, due to multiple remissions and relapses, require repetitive examinations to evaluate the disease extent, severity, and response to pharmacological treatment. Whereas the use of barium contrast studies is progressively reduced, plain radiography confirms its utility as a first-line imaging tool for acute abdomen. Computed tomography remains an easily accessible and effective method to demonstrate disease activity and extraintestinal manifestations. However, the related radiation exposure reduces its applicability to urgent situations. Ultrasound and magnetic resonance, with the great advantage of avoiding ionising radiation, are highly recommended to present the complications of IBD. Use of oral and intravenous contrast in computed tomography enterography and magnetic resonance enterography demonstrates IBD involvement in the small intestine wall, which is difficult to assess in other radiological and endoscopic examinations.
Collapse
|
42
|
Maaser C, Sturm A, Vavricka SR, Kucharzik T, Fiorino G, Annese V, Calabrese E, Baumgart DC, Bettenworth D, Borralho Nunes P, Burisch J, Castiglione F, Eliakim R, Ellul P, González-Lama Y, Gordon H, Halligan S, Katsanos K, Kopylov U, Kotze PG, Krustinš E, Laghi A, Limdi JK, Rieder F, Rimola J, Taylor SA, Tolan D, van Rheenen P, Verstockt B, Stoker J. ECCO-ESGAR Guideline for Diagnostic Assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis 2019; 13:144-164. [PMID: 30137275 DOI: 10.1093/ecco-jcc/jjy113] [Citation(s) in RCA: 821] [Impact Index Per Article: 164.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Christian Maaser
- Outpatients Department of Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Andreas Sturm
- Department of Gastroenterology, DRK Kliniken Berlin I Westend, Berlin, Germany
| | | | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Hospital Lüneburg, Lüneburg, Germany
| | - Gionata Fiorino
- Department of Gastroenterology, Humanitas Clinical and Research Institute, Milan, Italy
| | - Vito Annese
- Department of Gastroenterology, Valiant Clinic & American Hospital, Dubai, UAE
| | - Emma Calabrese
- Department of Systems Medicine, University of Rome, Tor Vergata, Italy
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, AB, Canada
| | - Dominik Bettenworth
- Department of Medicine B, Gastroenterology and Hepatology, University Hospital Münster, Münster, Germany
| | - Paula Borralho Nunes
- Department of Anatomic Pathology, Hospital Cuf Descobertas; Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Johan Burisch
- Department of Gastroenterology, North Zealand University Hospital; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Fabiana Castiglione
- Department of Clinical Medicine and Surgery, "Federico II" University of Naples, Naples, Italy
| | - Rami Eliakim
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Pierre Ellul
- Department of Medicine, Mater Dei Hospital, Msida, Malta
| | - Yago González-Lama
- Department of Gastroenterology, University Hospital Puerta De Hierro, Majadahonda [Madrid], Spain
| | - Hannah Gordon
- Department of Gastroenterology, Royal London Hospital, London, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London, London, UK
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Uri Kopylov
- Department of Gastroenterology, Sheba Medical Center, Sackler School of Medicine, Tel Aviv, Israel
| | - Paulo G Kotze
- Colorectal Surgery Unit, Catholic University of Paraná [PUCPR], Curitiba, Brazil
| | - Eduards Krustinš
- Department of of Gastroenterology, Hepatology and Nutrition, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrea Laghi
- Department of Clinical and Surgical Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Jimmy K Limdi
- Department of Gastroenterology, Pennine Acute Hospitals NHS Trust, Manchester; Manchester Academic Health Sciences Centre, University of Manchester, UK
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jordi Rimola
- Department of Radiology, Hospital Clínic Barcelona, Barcelona, Spain
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Damian Tolan
- Clinical Radiology, St James's University Hospital, Leeds, UK
| | - Patrick van Rheenen
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram Verstockt
- Department of Gastroenterology and Hepatology, University Hospitals Leuven and CHROMETA - Translational Research in Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Center [AMC], University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
43
|
Barber J, Shah N, Watson T. Early onset inflammatory bowel disease – What the radiologist needs to know. Eur J Radiol 2018; 106:173-182. [DOI: 10.1016/j.ejrad.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
|
44
|
Calabrese E, Kucharzik T, Maaser C, Maconi G, Strobel D, Wilson SR, Zorzi F, Novak KL, Bruining DH, Iacucci M, Watanabe M, Lolli E, Chiaramonte C, Hanauer SB, Panaccione R, Pallone F, Ghosh S, Monteleone G. Real-time Interobserver Agreement in Bowel Ultrasonography for Diagnostic Assessment in Patients With Crohn's Disease: An International Multicenter Study. Inflamm Bowel Dis 2018; 24:2001-2006. [PMID: 29718450 DOI: 10.1093/ibd/izy091] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND The unavailability of standardized parameters in bowel ultrasonography (US) commonly used in Crohn's disease (CD) and the shortage of skilled ultrasonographers are 2 limiting factors in the use of this imaging modality around the world. The aim of this study is to evaluate interobserver agreement among experienced sonographers in the evaluation of bowel US parameters in order to improve standardization in imaging reporting and interpretation. METHODS Fifteen patients with an established diagnosis of CD underwent blinded bowel US performed by 6 experienced sonographers. Prior to the evaluation, the sonographers and clinical and radiological IBD experts met to formally define the US parameters. Interobserver agreement was tested with the Quatto method (s). RESULTS All operators agreed on the presence/absence of CD lesions and distinguished absence of/mild activity or moderate/severe lesions in all patients. S values were moderate for bowel wall thickness (s = 0.48, P = n.s.), bowel wall pattern (s = 0.41, P = n.s.), vascularization (s = 0.52, P = n.s.), and presence of lymphnodes (s = 0.61, P = n.s.). Agreement was substantial for lesion location (s = 0.68, P = n.s.), fistula (s = 0.74, P = n.s.), phlegmon (s = 0.78, P = 0.04), and was almost perfect for abscess (s = 0.95, P = 0.02). Poor agreement was observed for mesenteric adipose tissue alteration, lesion extent, stenosis, and prestenotic dilation. CONCLUSIONS In this study, the majority of the US parameters used in CD showed moderate/substantial agreement. The development of shared US imaging interpretation patterns among sonographers will lead to improved comparability of US results among centers and facilitate the development of multicenter studies and the spread of bowel US training, thereby allowing a wider adoption of this useful technique.
Collapse
Affiliation(s)
- Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Torsten Kucharzik
- Department of Internal Medicine and Gastroenterology, Staedtisches Klinikum Lueneburg, Lueneburg, Germany
| | - Christian Maaser
- Ambulanzzentrum Gastroenterologie am Klinikum Lüneburg, Lüneburg, Germany
| | - Giovanni Maconi
- Department of Clinical Sciences, L. Sacco University Hospital, Milan, Italy
| | | | - Stephanie R Wilson
- Department of Radiology and **Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada.,Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Francesca Zorzi
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Kerri L Novak
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - David H Bruining
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, Japan
| | - Marietta Iacucci
- Institute of Translational of Medicine, University of Birmingham, Birmingham, UK
| | - Mamoru Watanabe
- Northwestern University Feinberg School of Medicine, Digestive Disease Center, Chicago, Illinois, USA
| | - Elisabetta Lolli
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Carlo Chiaramonte
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Stephen B Hanauer
- Northwestern University Feinberg School of Medicine, Digestive Disease Center, Chicago, Illinois, USA
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Francesco Pallone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| | - Subrata Ghosh
- Institute of Translational of Medicine, University of Birmingham, Birmingham, UK
| | - Giovanni Monteleone
- Gastroenterology Unit, Department of Systems Medicine, University of Rome "Tor Vergata," Italy
| |
Collapse
|
45
|
Abstract
As Crohn's disease (CD) is predominantly located within the small bowel, imaging of the small bowel plays an intriguing role in the primary diagnosis as well as in the monitoring of patients with CD. Intestinal ultrasound (IUS) offers several advantages over endoscopy and other imaging modalities. Obvious advantages of IUS include noninvasiveness, rapid availability and cost effectiveness. IUS has been shown to have high accuracy in detecting small bowel CD and determining intra- and extramural complications such as stenoses, fistulae and abscesses. IUS has also been shown to be highly effective in determining postoperative disease recurrence and in follow up of patients under treatment. The following review summarizes current developments in the use of IUS for the detection of small bowel lesions and complications. The aim of this review is to suggest algorithms on how to use IUS in managing patients with small bowel CD in clinical practice. Suggested applications on the use of high frequency IUS in CD are extended by discussing new developments such as contrast-enhanced ultrasonography and elastography.
Collapse
|
46
|
Bryant RV, Friedman AB, Wright EK, Taylor KM, Begun J, Maconi G, Maaser C, Novak KL, Kucharzik T, Atkinson NSS, Asthana A, Gibson PR. Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application. Gut 2018; 67:973-985. [PMID: 29437914 DOI: 10.1136/gutjnl-2017-315655] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 12/20/2022]
Abstract
Evolution of treatment targets in IBD has increased the need for objective monitoring of disease activity to guide therapeutic strategy. Although mucosal healing is the current target of therapy in IBD, endoscopy is invasive, expensive and unappealing to patients. GI ultrasound (GIUS) represents a non-invasive modality to assess disease activity in IBD. It is accurate, cost-effective and reproducible. GIUS can be performed at the point of care without specific patient preparation so as to facilitate clinical decision-making. As compared with ileocolonoscopy and other imaging modalities (CT and MRI), GIUS is accurate in diagnosing IBD, detecting complications of disease including fistulae, strictures and abscesses, monitoring disease activity and detecting postoperative disease recurrence. International groups increasingly recognise GIUS as a valuable tool with paradigm-changing application in the management of IBD; however, uptake outside parts of continental Europe has been slow and GIUS is underused in many countries. The aim of this review is to present a pragmatic guide to the positioning of GIUS in IBD clinical practice, providing evidence for use, algorithms for integration into practice, training pathways and a strategic implementation framework.
Collapse
Affiliation(s)
- Robert Venning Bryant
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, Australia.,Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, Australia
| | - Antony B Friedman
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Emily Kate Wright
- Department of Gastroenterology, St Vincent's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Kirstin M Taylor
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Jakob Begun
- Department of Gastroenterology, Mater Hospital, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Giovanni Maconi
- Department of Gastroenterology, Luigi Sacco University Hospital, Milan, Italy
| | - Christian Maaser
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg, Germany
| | - Kerri L Novak
- Division of Gastroenterology, University of Calgary, Calgary, Canada
| | - Torsten Kucharzik
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lueneburg, Lueneburg, Germany
| | | | - Anil Asthana
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter R Gibson
- Department of Gastroenterology, Alfred Hospital, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| |
Collapse
|
47
|
Andrzejewska M, Grzymisławski M. The role of intestinal ultrasound in diagnostics of bowel diseases. Prz Gastroenterol 2018; 13:1-5. [PMID: 29657604 DOI: 10.5114/pg.2018.74554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/07/2017] [Indexed: 12/16/2022]
Abstract
Intestinal ultrasound is a safe and inexpensive method that allows visualisation of the gastrointestinal tract and detection of abnormalities. This examination involves the use of two different ultrasound transducers: a low-frequency convex probe and high-frequency linear probe. When needed, the performance of these methods can be enhanced by the use of contrast media or Doppler techniques. Intestinal ultrasound is mostly utilised for the diagnosis and follow-up of patients with inflammatory bowel diseases, helping to avoid frequent use of invasive and expensive diagnostic procedures and leading to early implementation of suitable treatment. This technique can also serve to detect other pathologic conditions that are present in the gastrointestinal tract. It is a promising method with high sensitivity and specificity, which has gained popularity in recent years and has the potential to become the method of choice in the diagnostics of many intestinal disorders.
Collapse
|
48
|
Pita I, Magro F. Advanced imaging techniques for small bowel Crohn's disease: what does the future hold? Therap Adv Gastroenterol 2018; 11:1756283X18757185. [PMID: 29467827 PMCID: PMC5813850 DOI: 10.1177/1756283x18757185] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/03/2018] [Indexed: 02/04/2023] Open
Abstract
Treatment of Crohn's disease (CD) is intrinsically reliant on imaging techniques, due to the preponderance of small bowel disease and its transmural pattern of inflammation. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are the most widely employed imaging methods and have excellent diagnostic accuracy in most instances. Some limitations persist, perhaps the most clinically relevant being the distinction between inflammatory and fibrotic strictures. In this regard, several methodologies have recently been tested in animal models and human patients, namely US strain elastography, shear wave elastography, contrast-enhanced US, magnetization transfer MRI and contrast dynamics in standard MRI. Technical advances in each of the imaging methods may expand their indications. The addition of oral contrast to abdominal US appears to substantially improve its diagnostic capabilities compared to standard US. Ionizing dose-reduction methods in CT can decrease concern about cumulative radiation exposure in CD patients and diffusion-weighted MRI may reduce the need for gadolinium contrast. Clinical indexes of disease activity and severity are also increasingly relying on imaging scores, such as the recently developed Lémann Index. In this review we summarize some of the recent advances in small bowel CD imaging and how they might affect clinical practice in the near future.
Collapse
Affiliation(s)
- Inês Pita
- Department of Gastroenterology, Portuguese Institute of Oncology, Porto, Portugal
| | | |
Collapse
|
49
|
Abstract
Objectives: To investigate the diagnostic accuracy of ultrasound for evaluation of inflammatory activity in patients with Crohn’s disease (CD). Methods: Fifty-six patients with histologically proven CD (39 with active, 17 with inactive disease) and 30 healthy volunteers as a control group were enrolled in the study at WeiFang People’s Hospital, Weifang Province, China from October 2012 to December 2014. Bowel wall thickness, and vascularity pattern were measured by Doppler ultrasound. Results: There was a significant difference in flow volume of the superior mesenteric artery (585 ± 235 ml/min) in the patients with active disease, compared with those with inactive disease (401 ± 238 ml/min) and the control group (390 ± 189 ml/min, p<0.001). Wall thickness was 5.1 ± 1.5 mm in the active CD group, 3.3 ± 1.6 mm in the inactive disease group (p<0.001) and <3 mm in the control group. Resistance index in the thickened bowel wall showed some differences: 0.68 ± 0.05 in the active disease group, 0.78 ± 0.08 in the inactive disease group, and 0.85 ± 0.07 in the control group (p<0.05). Conclusion: Doppler ultrasound is a useful diagnostic tool in detecting CD and assessing inflammatory activity.
Collapse
Affiliation(s)
- Ying Na
- Department of Ultrasound, Weifang People's Hospital, Weifang, Shandong Province, China. E-mail.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Atkinson NSS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Asthana AK, Blaivas M, Goudie A, Gilja OH, Nuernberg D, Schreiber-Dietrich D, Dietrich CF. How to perform gastrointestinal ultrasound: Anatomy and normal findings. World J Gastroenterol 2017; 23:6931-6941. [PMID: 29097866 PMCID: PMC5658311 DOI: 10.3748/wjg.v23.i38.6931] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/30/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal ultrasound is a practical, safe, cheap and reproducible diagnostic tool in inflammatory bowel disease gaining global prominence amongst clinicians. Understanding the embryological processes of the intestinal tract assists in the interpretation of abnormal sonographic findings. In general terms, the examination principally comprises interrogation of the colon, mesentery and small intestine using both low-frequency and high-frequency probes. Interpretation of findings on GIUS includes assessment of bowel wall thickness, symmetry of this thickness, evidence of transmural changes, assessment of vascularity using Doppler imaging and assessment of other specific features including lymph nodes, mesentery and luminal motility. In addition to B-mode imaging, transperineal ultrasonography, elastography and contrast-enhanced ultrasonography are useful adjuncts. This supplement expands upon these features in more depth.
Collapse
Affiliation(s)
- Nathan S S Atkinson
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - Robert V Bryant
- School of Medicine, University of Adelaide, Adelaide, South Australia, 5005, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Christian Maaser
- Ambulanzzentrum Gastroenterologie, Klinikum Lüneburg, 21339 Lüneburg, Germany
| | - Torsten Kucharzik
- Department of Gastroenterology, Städtisches Klinikum Luneburg gGmbH, 21339 Lüneburg, Germany
| | - Giovanni Maconi
- Gastrointestinal Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” University Hospital, 20157 Milan, Italy
| | - Anil K Asthana
- Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne 3004 Vic, Australia
| | - Michael Blaivas
- Piedmont Hospital, Department of Emergency Medicine, Atlanta, GA 30076, United States
| | - Adrian Goudie
- Fremantle Hospital and Health Service, Emergency Department, Fremantle, WA 6160, United States
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen N-5021, Norway
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Dieter Nuernberg
- Department of Gastroenterology, Brandenburg Medical School, 16816 Neuruppin, Germany
| | | | - Christoph F Dietrich
- Med. Klinik 2, Caritas-Krankenhaus Bad Mergentheim, D-97980 Bad Mergentheim, Germany
| |
Collapse
|