Abstract
PurposeWe evaluated ileal bowel wall thickness and semiquantitative vascularization by ultrasound in correlation with the presence or absence of histopathological inflammation in patients with Crohn’s disease (CD).MethodsWe conducted a retrospective analysis of 221 ultrasound examinations of the terminal ileum or neoterminal ileum in CD patients with biopsies of the ileum during colonoscopies within 8 weeks of the ultrasound. Ultrasound data were obtained from an inflammatory bowel disease ultrasound register from 2011 to 2017. Bowel wall ultrasound was performed by a high-frequency, linear transducer (7–12 MHz). Presence of bowel wall thickening (> 3 mm), vascularization by the Limberg score, and presence of ileal histopathological inflammation were analyzed.ResultsIn 221 bowel wall ultrasound examinations of CD patients (128 female, 93 male, mean age 37.5 years), a thickened bowel wall was found in 140 (63.3%) and hypervascularization (corresponding to a Limberg score ≥ 2) in 96 (43.4%) cases. In 187 (84.6%) cases, ileal inflammation was confirmed by histopathology and in 34 (15.4%) cases no inflammation was shown. Bowel wall thickening showed a sensitivity of 70.1%, a negative predictive value (NPV) of 30.9%, a specificity of 73.5% and a positive predictive value (PPV) of 93.6% for the detection of histopathological ileal inflammation. Hypervasularization had a low sensitivity (49.7%) and NPV (24.8%), but high specificity (91.2%) and PPV (96.9%).ConclusionIn this CD subcohort of an ultrasound register, pathologic ultrasound findings were quite common. Bowel wall thickening (> 3 mm) and hypervascularization are good predictors of histopathological inflammation within the terminal ileum or neoterminal ileum. Normal ultrasound findings without bowel wall thickening and without hypervascularization do not rule out histopathological inflammation.
Highlights
Diagnosis of Crohn’s disease (CD) is based on the clinical appearance and course of the disease as well as a combination of endoscopic, histological, sonographic/radiological and laboratory data [1]
221 patients with 221 bowel wall ultrasounds and coherent, conclusive histology of theterminal ileum were included in the final analysis
The 221 ultrasound examinations with colonoscopic ileal histology corresponded to 128 female and 93 male CD patients with a mean age of 37.5 years and with a clinically scored (HBI) mild to moderate disease activity (Table 1)
Summary
Diagnosis of Crohn’s disease (CD) is based on the clinical appearance and course of the disease as well as a combination of endoscopic, histological, sonographic/radiological and laboratory data [1]. During follow-up of patients with CD or search for extramural complications, ultrasound of the abdomen and the bowel wall is regularly an easy diagnostic step [2, 3]. High-frequency Ultrasound identifies wall thickening of the small bowel or the colon as well as the extent and location of inflammation. It can detect complications such as lymph nodes, ascites, mesenteric fat tissue or abscesses, fistulas and stenosis [4]. For bowel wall thickening a cut-off of > 3 mm is recommended for the detection of disease activity in CD with high sensitivity (up to 89%), while a cut-off of > 4 mm serves for better specificity (up to 98%) [1, 5].
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