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Bezzio C, Saibeni S, Vernero M, Furfaro F, Monteleone M, Ribaldone D, Fiorino G, Friedman AB, Armuzzi A, Scalvini D, Maconi G. The learning curve for using intestinal ultrasonography. Dig Liver Dis 2024:S1590-8658(24)00222-6. [PMID: 38320914 DOI: 10.1016/j.dld.2024.01.192] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/15/2024] [Accepted: 01/17/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND AND AIMS Intestinal ultrasonography (IUS) is challenging to learn. This prospective study examined how the accuracy of IUS increases with operator experience ("learning curve") and if prior abdominal ultrasound experience facilitates the learning process. METHODS The study included two trainees with limited abdominal ultrasound experience (< 50 exams) and two with extensive experience (> 500 exams). Each trainee performed 99 examinations and reported four IUS findings. An expert sonographer repeated the exam, and concordance (k) between the expert and trainees was assessed in three consecutive testing periods of 33 exams each. RESULTS A progressive improvement in concordance was observed for all IUS findings from Period 1 to Period 3, overall and for both groups of trainees, although those with experience in abdominal ultrasound had faster learning curves. The minimum number of examinations required to achieve concordance with the expert operator for detecting increased bowel wall thickness was 84 and detecting bowel dilatation was 79. However, a minimum of 97 examinations was necessary to achieve concordance for detecting intra-abdominal complications, considered an advanced IUS competence. CONCLUSION Basic competence in IUS can be acquired with relatively few examinations, while advanced competence requires more extensive training, particularly for gastroenterologists without abdominal ultrasound experience.
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Affiliation(s)
- Cristina Bezzio
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy.
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, MI, Italy
| | - Marta Vernero
- Division of Gastroenterology, Department of Medical Sciences, Università di Torino, Turin, Italy
| | - Federica Furfaro
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | | | - Davide Ribaldone
- Division of Gastroenterology, Department of Medical Sciences, Università di Torino, Turin, Italy
| | - Gionata Fiorino
- Gastroenterology and Endoscopy Unit, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy; Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, Rome, Italy
| | - Antony B Friedman
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Australia
| | - Alessandro Armuzzi
- IBD Center, IRCCS Humanitas Research Hospital, Rozzano, MI, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Davide Scalvini
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, MI, Italy
| | - Giovanni Maconi
- Gastroenterology Unit, ASST Fatebenefratelli-Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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Abstract
Intestinal ultrasound is an emerging technique for diagnosing and monitoring patients with inflammatory bowel disease (IBD). It is a simple, non-invasive, inexpensive, safe and reliable tool for monitoring patients with IBD. This technique has good diagnostic accuracy in the assessment of the extent and severity of IBD and its complications. The most commonly used parameters are bowel wall thickness, color Doppler flow, bowel wall stratification and peri-bowel inflammation. Various scoring systems have been developed utilizing the above parameters to monitor patients with IBD. It is a good tool to monitor response to therapy and follow-up for post-operative recurrence. Early response on intestinal ultrasound (IUS) predicts long-term clinical remission and mucosal healing in patients with Crohn's disease. In patients with ulcerative colitis (UC), the response to IUS can be assessed as early as two weeks. Recent data has emerged to predict the response to corticosteroids and colectomy in patients with acute severe UC. Point of care IUS in the outpatient clinic is an excellent tool to follow-up patients and guide clinical decision-making and has good acceptability among patients. It is an underutilized technique in spite of its appeal and the availability of evidence. Underutilization can be attributed to the lack of awareness, expertise and training centres. This review discusses the technical details and the evidence to support the use of IUS in IBD. We aim to increase awareness and use of intestinal ultrasound and build local expertise and data.
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Affiliation(s)
- Kayal Vizhi Nagarajan
- Department of Gastroenterology, Hepatology and Clinical Nutrition, Aster CMI Hospital, Bengaluru, 560 092, India.
| | - Naresh Bhat
- Department of Gastroenterology, Hepatology and Clinical Nutrition, Aster CMI Hospital, Bengaluru, 560 092, India
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3
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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.
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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)
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4
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El-Ali AM, Ocal S, Hartwell CA, Goldberg JD, Li X, Prestano J, Kamity R, Martin L, Strubel N, Lala S. Factors associated with diagnostic ultrasound for midgut volvulus and relevance of the non-diagnostic examination. Pediatr Radiol 2023; 53:2199-2207. [PMID: 37589763 DOI: 10.1007/s00247-023-05727-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 07/18/2023] [Accepted: 07/18/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Few reports explore the frequency and factors associated with diagnostic ultrasound (US) for midgut volvulus. OBJECTIVE To evaluate predictive factors for diagnostic US for midgut volvulus and clinical outcomes of patients with non-diagnostic US. MATERIALS AND METHODS This retrospective study included infants imaged for midgut volvulus with US. Exams were rated as diagnostic (midgut volvulus present or absent) or non-diagnostic by a pediatric radiologist, and in cases of disagreement with the original report, an additional pediatric radiologist was the tie-breaker. For each exam, the following were recorded: age, weight, respiratory support, exam indication, sonographer experience, and gaseous dilated bowel loops on radiography. Logistic regression models with "stepwise" variable selection were used to investigate the association of diagnostic US for midgut volvulus with each of the independent variables. RESULTS One hundred nineteen patients were imaged. US was diagnostic in 74% (88/119) of patients. In subsets of patients presenting with bilious emesis or age <28 days, US was diagnostic in 92% (22/24) and 90% (53/59), respectively. Logistic regression suggested that symptom type (bilious vs other) was the best predictor of diagnostic US (type 3 P=0.02). Out of 26 patients with available radiographs, US was diagnostic in 92% (12/13) of patients without bowel dilation on radiographs compared to 62% (8/13) of patients with bowel dilation (P=0.16). Weight, respiratory support, and sonographer experience did not differ between groups. Two sick neonates, ages 2 days and 30 days, in whom the primary clinical concern was dropping hematocrit and sepsis, respectively, had non-diagnostic ultrasounds in the setting of bowel dilation on radiography. Both were found to have midgut volvulus at surgery and both expired. CONCLUSION US was most frequently diagnostic in patients with bilious emesis or age less than 28 days. Non-diagnostic US for midgut volvulus must prompt a predetermined follow-up strategy, such as an additional imaging study (e.g., upper GI series), particularly in a sick child, as non-diagnostic US may miss midgut volvulus.
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Affiliation(s)
- Alexander Maad El-Ali
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA.
| | - Selin Ocal
- NYU Grossman School of Medicine, Long Island Campus, 660 First Avenue, New York, NY, 10016, USA
| | - C Austen Hartwell
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - Judith D Goldberg
- Department of Statistics, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - Xiaochun Li
- Department of Statistics, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - Jaimelee Prestano
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - Ranjith Kamity
- Division of Neonatology, Department of Pediatrics, NYU Long Island School of Medicine, 259 First Street, Mineola, NY, 11501, USA
| | - Laura Martin
- Division of Pediatric Surgery, Department of Surgery, NYU Langone Medical Center, 530 First Avenue, Suite 10W, New York, NY, 10016, USA
| | - Naomi Strubel
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA
| | - Shailee Lala
- Division of Pediatric Radiology, Department of Radiology, NYU Grossman School of Medicine, 660 First Avenue, New York, NY, 10016, USA
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Chen YJ, Chen BL, Liang MJ, Chen SL, Li XH, Qiu Y, Pang LL, Xia QQ, He Y, Zeng ZR, Chen MH, Mao R, Xie XY. Longitudinal Bowel Behavior Assessed by Bowel Ultrasound to Predict Early Response to Anti-TNF Therapy in Patients With Crohn's Disease: A Pilot Study. Inflamm Bowel Dis 2022; 28:S67-S75. [PMID: 34984455 DOI: 10.1093/ibd/izab353] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/05/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Early changes in bowel behavior during anti-tumor necrosis factor (anti-TNF) induction therapy in Crohn's disease (CD) are relatively unknown. We determined (1) the onset of changes in bowel behavior in CD patients receiving anti-TNF therapy by ultrasound and (2) the feasibility of shear wave elastography (SWE) in predicting early response to anti-TNF therapy. METHODS Consecutive ileal or ileocolonic CD patients programmed to initiate anti-TNF therapy were enrolled. Bowel ultrasound was performed at baseline and at weeks 2, 6, and 14. Changes in bowel wall thickness, Doppler signals of the bowel wall (Limberg score), and SWE values were compared using a linear mixed model. Early response to anti-TNF therapy was based on a composite strategy of clinical and colonoscopy assessment at week 14. RESULTS Of the 30 patients enrolled in this study, 20 patients achieved a response to anti-TNF therapy at week 14. The bowel wall thickness and SWE value of the response group showed a significant downward trend compared with the nonresponse group (P = .003 and P = .011, respectively). Bowel wall thickness, the Limberg score, and SWE values were significantly reduced as early as week 2 compared with baseline (P < .001, P < .001, and P = .003, respectively) in the response group. Baseline SWE values (21.3 ± 8.7 kPa vs 15.3 ± 4.7 kPa; P = .022) and bowel wall thickness (8.5 ± 2.3 mm vs 6.9 ± 1.5 mm; P = .027) in the nonresponse group were significantly higher than in the response group. CONCLUSIONS This pilot study suggested that changes in bowel ultrasound behavior could be assessed as early as week 2 after starting anti-TNF therapy. Bowel ultrasound together with elasticity imaging could predict early response to anti-TNF therapy.
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Affiliation(s)
- Yu-Jun Chen
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bai-Li Chen
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mei-Juan Liang
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shu-Ling Chen
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xue-Hua Li
- Department of Radiology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yun Qiu
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lan-Lan Pang
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qing-Qing Xia
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yao He
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhi-Rong Zeng
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Min-Hu Chen
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ren Mao
- Department of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiao-Yan Xie
- Department of Medical Ultrasonics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Yebra Carmona J, Poza Cordón J, Suárez Ferrer C, Martín Arranz E, Lucas Ramos J, Andaluz García I, Sánchez Azofra M, Rueda García JL, Martín Arranz MD. Correlation between endoscopy and intestinal ultrasound for the evaluation of postoperative recurrence of Crohn's disease. Gastroenterol Hepatol 2021; 45:40-46. [PMID: 33746025 DOI: 10.1016/j.gastrohep.2021.02.010] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/01/2021] [Accepted: 02/01/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Intestinal ultrasound is considered to be a valid alternative for the evaluation of post-operative recurrence (POR) of Crohn's disease. The aim of this study is to assess the correlation between ultrasound and endoscopic findings. METHODS Patients with Crohn's disease were retrospectively recruited who had undergone ileocecal resection, and for whom a colonoscopy and intestinal ultrasound had been performed for the detection of POR. Recurrence was assessed using the Rutgeerts score (RS). The ultrasound findings analysed were bowel wall thickness (BWT), parietal hyperaemia using power Doppler, loss of layer pattern and mesenteric fat hypertrophy. RESULTS A total of 31 patients were included, of which 15 (48.4%) had no POR (RS<2b) and 16 (51.6%) had POR (RS≥2b). A statistically significant association was identified between BWT and the presence of endoscopic recurrence (a mean of 2.75mm vs. 5.68mm, P>0.001). There was also a statistically significant difference in hyperaemia between the 2groups (P=0.03). For wall thickness, an area under the ROC curve (AUC) of 92.9% was obtained, and with a cut-off point of 3.4mm, a sensitivity of 100% and specificity of 86.6%. When comparing with the most frequent biomarkers (fecal calprotectin and serum CRP), a higher AUC was obtained for wall thickness (72.3% and 72.3% vs. 92.9%). CONCLUSIONS In our experience, ultrasound has high diagnostic efficacy in the detection of POR and can be considered a valid non-invasive alternative to endoscopy.
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Affiliation(s)
- Jorge Yebra Carmona
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - Joaquín Poza Cordón
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España.
| | - Cristina Suárez Ferrer
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - Eduardo Martín Arranz
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - Javier Lucas Ramos
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - Irene Andaluz García
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - María Sánchez Azofra
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - José Luis Rueda García
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
| | - María Dolores Martín Arranz
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Universitario La Paz, Madrid, España
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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.
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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
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Kamel S, Sakr M, Hamed W, Eltabbakh M, Askar S, Bassuny A, Hussein R, Elbaz A. Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients. World J Gastroenterol 2020; 26:5884-5895. [PMID: 33132642 PMCID: PMC7579751 DOI: 10.3748/wjg.v26.i38.5884] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bowel ultrasound and magnetic resonance enterography (MRE) are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications. They assess the degree of activity, help clinicians to identify patients in need of surgery, and can be used for patient follow-up.
AIM To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease (IBD) patients in Egypt.
METHODS The study was conducted on 40 patients with IBD. All patients were subjected to clinical assessment, laboratory investigations, bowel ultrasound, MRE, and colonoscopy up to the terminal ileum with biopsies for histopathological examination.
RESULTS This study was conducted on 14 patients (35%) with ulcerative colitis and 26 patients (65%) with Crohn's disease; 34 (85%) of these patients had active disease. Bowel ultrasound detected different bowel lesions with the following accuracies: ileum (85%), large bowel (70%), fistula (95%), stricture and proximal dilatation (95%) and abscesses (100%). Also, it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.
CONCLUSION In comparison to MRE, bowel ultrasound is a useful, non-invasive, and feasible bedside imaging tool for the detection of inflammation, detection of complications, and follow-up of IBD patients when performed by the attending physician.
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Affiliation(s)
- Shimaa Kamel
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed Sakr
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Waleed Hamed
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed Eltabbakh
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Safaa Askar
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Ahmed Bassuny
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Rasha Hussein
- Department of Radiology, Ain Shams University and MR Unit of Misr Radiology Center, Cairo 11566, Egypt
| | - Ahmed Elbaz
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
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9
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Kakkadasam Ramaswamy P, Vizhi N K, Yelsangikar A, Krishnamurthy AN, Bhat V, Bhat N. Utility of bowel ultrasound in assessing disease activity in Crohn's disease. Indian J Gastroenterol 2020; 39:495-502. [PMID: 33201441 DOI: 10.1007/s12664-020-01019-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/04/2019] [Accepted: 02/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrointestinal ultrasound (GIUS) has been used increasingly for monitoring inflammatory bowel disease (IBD) patients. The aim of this study was to assess the utility of GIUS in assessing disease activity in Crohn's disease (CD). METHODS Consecutive patients with CD (diagnosis established for at least 6 months) between July 2017 and July 2018 requiring assessment of disease activity were prospectively assessed by magnetic resonance enterography, colonoscopy (CS), and GIUS within a 2-week period and without any change in ongoing treatment. Features on GIUS which correlated with disease activity were assessed. Sensitivity and specificity of the GIUS in assessing disease activity and localization were calculated. RESULTS Thirty-five patients were enrolled in the study. Bowel wall thickness (BWT) ≥ 3 mm and Doppler activity ≥ 2 had the highest sensitivity (100% and 95.6%, respectively) for detecting active disease on CS. BWT ≥ 3 mm had sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 83.3%, 92%, and 100%, respectively for assessing active disease. Combination of median BWT, Doppler activity, and loss of bowel wall stratification correlated with simplified endoscopic score (SES) for CD (r = 0.8, p 0.009) and Harvey-Bradshaw index (HBI, r = 0.76, p 0.04). For localizing active disease in the ileum, GIUS had a sensitivity of 93.7%, 80% for lesions in the right colon, 100% for transverse colon, and 89% for the left colon. Specificity was 100% for ileal and colonic lesions. CONCLUSION Loss of stratification, BWT, and Doppler activity in the bowel wall correlate with endoscopic and clinical disease activity in CD. GIUS is a sensitive modality in assessing disease activity in CD.
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Affiliation(s)
- Pradeep Kakkadasam Ramaswamy
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India.
| | - Kayal Vizhi N
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India
| | - Amit Yelsangikar
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India
| | - Anupama Nagar Krishnamurthy
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India
| | - Vinay Bhat
- Department of Surgery and Allied Sciences, Aster CMI Hospital, Bangalore 560 092, India
| | - Naresh Bhat
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India
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Zacharopoulou E, Craviotto V, Fiorino G, Furfaro F, Zilli A, Gilardi D, Peyrin-Biroulet L, Danese S, Allocca M. Targeting the gut layers in Crohn's disease: mucosal or transmural healing? Expert Rev Gastroenterol Hepatol 2020; 14:775-787. [PMID: 32515627 DOI: 10.1080/17474124.2020.1780914] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/08/2023]
Abstract
INTRODUCTION Although the landmark of Crohn's Disease (CD) is the transmural inflammation, mucosal healing (MH), which is assessed by colonoscopy, is currently the gold standard of CD management. Transmural healing (TH) is a new concept evaluated by cross-sectional imaging (CSI) techniques, such as bowel ultrasound (US), computed tomography enterography (CTE), and magnetic resonance enterography (MRE). Little is known about the clinical significance of persisting mural disease and the predictive value of complete TH. AREAS COVERED The authors reviewed the available literature on TH and its meaning as predictor of long-term outcomes in CD, to explore if TH may be a better target compared to MH in CD patients, in terms of disease outcome, such as medication changes, hospitalization, or surgery. EXPERT OPINION Some evidence suggests that achieving TH has a predictive value in CD management and correlates with better disease outcome than MH, although existing studies are few and with limitations. A definitive definition of TH is not yet established and the frequency or the preferred modality of TH evaluation remains unclear. Implementing TH in treat-to-target approach may enable stricter disease monitoring with noninvasive methods and finally change the disease course, preventing irreversible bowel damage.
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Affiliation(s)
| | - Vincenzo Craviotto
- IBD Centre, Humanitas Clinical and Research Centre, IRCCS , Milan, Italy
| | - Gionata Fiorino
- IBD Centre, Humanitas Clinical and Research Centre, IRCCS , Milan, Italy.,Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Federica Furfaro
- IBD Centre, Humanitas Clinical and Research Centre, IRCCS , Milan, Italy
| | - Alessandra Zilli
- IBD Centre, Humanitas Clinical and Research Centre, IRCCS , Milan, Italy
| | - Daniela Gilardi
- IBD Centre, Humanitas Clinical and Research Centre, IRCCS , Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University , Nancy, France
| | - Silvio Danese
- IBD Centre, Humanitas Clinical and Research Centre, IRCCS , Milan, Italy.,Department of Biomedical Sciences, Humanitas University , Milan, Italy
| | - Mariangela Allocca
- IBD Centre, Humanitas Clinical and Research Centre, IRCCS , Milan, Italy.,Department of Biomedical Sciences, Humanitas University , Milan, Italy
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Revzin MV, Moshiri M, Bokhari J, Pellerito JS, Menias C. Sonographic assessment of infectious diseases of the gastrointestinal tract: from scanning to diagnosis. Abdom Radiol (NY) 2020; 45:261-292. [PMID: 31960117 DOI: 10.1007/s00261-019-02358-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/17/2022]
Abstract
BACKGROUND Sonography of the gastrointestinal (GI) tract is a practical, safe, inexpensive, and reproducible diagnostic tool for the evaluation, diagnosis, and follow-up of infectious bowel disease. The modality is rapidly gaining prominence among clinicians on a global scale. In the United States, however, ultrasound of the bowel remains underutilized primarily due to insufficient experience among radiologists and sonographers in performing sonographic bowel assessment. This lack of experience and knowledge results in misinterpretations, missed diagnoses, and underutilization of this modality in patients with acute abdomen, with the majority of GI pathology on sonography discovered incidentally. OBJECTIVES This article aims to demonstrate the characteristic sonographic findings associated with GI infectious processes as well as provide dedicated ultrasound protocols for evaluation of the GI tract. CONCLUSION This article serves a twofold purpose, raising awareness of the utility of this imaging modality within the radiology community and also providing practical teaching points for sonographic evaluation of infectious disorders of the GI tract.
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Affiliation(s)
- Margarita V Revzin
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT, 06520, USA.
| | - Mariam Moshiri
- Department of Radiology, University of Washington Medical Center, Seattle, WA, USA
| | - Jamal Bokhari
- Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar Street, PO Box 208042, Room TE-2, New Haven, CT, 06520, USA
| | - John S Pellerito
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Christine Menias
- Radiology, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA
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Abstract
Current assessment for and diagnosis of necrotizing enterocolitis (NEC) remain inadequate. The introduction of interrogating bowel with ultrasound when NEC is suspected or when NEC has occurred presents greater opportunity to characterize the physical changes that have occurred in the bowel wall structures. The evaluation of bowel by ultrasound has been shown to have high specificity for bowel necrosis. There are current barriers in adoption of these techniques because they have not been integrated into routine diagnostic imaging and are not well incorporated in neonatal medicine.
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Affiliation(s)
- Jae H Kim
- SPIN Program, San Diego Mothers' Milk Bank, Division of Neonatology, UC San Diego, 9300 Campus Point Drive MC7774, La Jolla, CA 92037, USA; Division of Pediatric Gastroenterology, Hepatology and Nutrition, Rady Children's Hospital-San Diego, 3020 Children's Way, San Diego, CA 92123.
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13
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Giannetti A, Matergi M, Biscontri M, Franci L. Contrast-enhanced ultrasonography in clinical practice in Crohn's disease: feasibility of destruction/replenishment method and software analysis. J Ultrasound 2017; 20:309-319. [PMID: 29204235 DOI: 10.1007/s40477-017-0263-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 06/02/2017] [Accepted: 10/10/2017] [Indexed: 01/01/2023] Open
Abstract
The aim of this Pictorial Essay is to evaluate the feasibility in the clinical practice of CEUS destruction/replenishment method and time intensity curve (TIC) analysis using the available software in patients with Crohn's disease. The ultrasound (US) procedure using contrast agent is briefly described, elaboration and analysis of the US sequences are explained in detail, and some advantages and disadvantages of the method are highlighted. The Authors suggest that the destruction/replenishment method is useful and time-saving in Crohn's disease if multiple measurements are required on intestinal portions adjacent to each other or in different locations.
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Affiliation(s)
- Andrea Giannetti
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100 Grosseto, Italy
| | - Marco Matergi
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100 Grosseto, Italy
| | - Marco Biscontri
- Gastroenterology Unit, Misericordia Hospital, Via Senese 169, 58100 Grosseto, Italy
| | - Luca Franci
- Radiology Department, Misericordia Hospital, Via Senese 169, 58100 Grosseto, Italy
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14
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Cavalcoli F, Zilli A, Fraquelli M, Conte D, Massironi S. Small Bowel Ultrasound beyond Inflammatory Bowel Disease: An Updated Review of the Recent Literature. Ultrasound Med Biol 2017; 43:1741-52. [PMID: 28625560 DOI: 10.1016/j.ultrasmedbio.2017.04.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The use of bowel ultrasonography (US) for the evaluation of gut diseases has increased in recent years and has been proven to provide a widely available, non-invasive and inexpensive method for the initial work-up and follow-up of different intestinal diseases, limited mostly by technical challenges posed by the patient's anatomy. The present review aims to provide an extensive overview of the main pathologic features at US examination of intestinal diseases other than inflammatory bowel disease, both acute (e.g., acute appendicitis, colonic diverticulitis, infectious diseases and ischemic conditions) and chronic (e.g., celiac disease, cystic fibrosis and other enterocolites). The identification of typical US features may help in the diagnostic process and guide the treatment approach. Therefore, the application of knowledge of the US appearance of gastrointestinal diseases is of relevance in enabling greater diagnostic performance and better patient management.
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15
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Conti CB, Giunta M, Gridavilla D, Conte D, Fraquelli M. Role of Bowel Ultrasound in the Diagnosis and Follow-up of Patients with Crohn's Disease. Ultrasound Med Biol 2017; 43:725-734. [PMID: 28185694 DOI: 10.1016/j.ultrasmedbio.2016.12.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 08/13/2016] [Revised: 11/18/2016] [Accepted: 12/20/2016] [Indexed: 06/06/2023]
Abstract
Crohn's disease (CD) is an inflammatory chronic bowel disorder; it can involve the whole gastrointestinal tract, but its localization in the ileum or colon is most common. The reference standard for the diagnosis of CD is ileocolonoscopy with histologic assessment. The reference standard for the detection of any complications is surgery. However, imaging techniques have an important role both in the detection/localization of CD and in the follow-up of CD patients. In the last few years, the technical development of ultrasound equipment, the advent of new technologies such as elastography and mostly the increased expertise of sonographers have boosted the role of bowel ultrasound in assessment of the gastrointestinal tract. In fact, bowel ultrasound is particularly attractive thanks to its widespread availability, non-invasiveness, low cost and good reproducibility, as it can be easily repeated during follow-up. The aim of this article is to provide an extensive overview of the actual role of bowel ultrasound in the detection and follow-up of patients with CD.
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Affiliation(s)
- Clara Benedetta Conti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Organ Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Mariangela Giunta
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Organ Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Daniele Gridavilla
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Organ Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Organ Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; and Department of Pathophysiology and Organ Transplantation, Università degli Studi di Milano, Milan, Italy.
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Fraquelli M, Baccarin A, Corti F, Conti CB, Russo MC, Della Valle S, Pozzi R, Cressoni M, Conte D, Colombo C. Bowel ultrasound imaging in patients with cystic fibrosis: Relationship with clinical symptoms and CFTR genotype. Dig Liver Dis 2016; 48:271-6. [PMID: 26514737 DOI: 10.1016/j.dld.2015.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 05/13/2015] [Revised: 09/08/2015] [Accepted: 09/20/2015] [Indexed: 02/08/2023]
Abstract
BACKGROUND Ultrasound imaging is used to assess bowel abnormalities in gastrointestinal diseases. We aimed to assess the rate of predefined bowel ultrasound signs and their relationship with gastrointestinal symptoms and the cystic fibrosis transmembrane conductance regulator (CFTR) genotype in cystic fibrosis patients in regular follow-up. METHODS Prospective study of 70 consecutive patients with cystic fibrosis and 45 controls who underwent abdominal ultrasound; pertinent findings were related to gastrointestinal symptoms and, in cystic fibrosis patients, to pancreatic status, malabsorption degree, lipase intake, CFTR genotype (classified as severe or mild against functional class of CFTR mutations). RESULTS 96% patients showed at least one abnormal bowel ultrasound sign. Most frequent signs were lymph node enlargement (64%), bowel loop dilatation (55%), thick corpuscular intraluminal content (49%), bowel wall hypervascularization (26%), thickened bowel wall (22%) and intussusception (17%). Patients with recurrent abdominal pain showed more bowel wall hypervascularization than patients without recurrent pain (47% vs. 19%, respectively; p = 0.02) and intussusception (58% vs. 17%, respectively; p < 0.01). Genotype was not associated to specific bowel ultrasound signs. Patients with bowel loop intussusception showed greater lipase intake than those without intussusception (8.118 ± 2.083 vs. 5.994 ± 4.187, respectively; p < 0.01). CONCLUSION Cystic fibrosis patients present a higher rate of bowel ultrasound abnormalities than controls. Bowel ultrasound abnormalities are associated with abdominal symptoms.
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Affiliation(s)
- Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy.
| | - Alessandra Baccarin
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiola Corti
- Regional Referral Centre for Cystic Fibrosis, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Clara Benedetta Conti
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Chiara Russo
- Regional Referral Centre for Cystic Fibrosis, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Serena Della Valle
- S.S.D., Department of Anesthesia and Resuscitation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Roberta Pozzi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Cressoni
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Carla Colombo
- Regional Referral Centre for Cystic Fibrosis, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
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