Abstract
Background and AimsTo prospectively examine the feasibility and accuracy of Contrast Enhanced Ultrasound (CEUS) in the assessment of Crohn’s disease (CD) activity in the terminal ileum in comparison to Magnetic Resonance Enterography (MRE), using endoscopy as a reference standard.Methods105 consecutive patients with alleged clinically active CD were assessed by MRE and CEUS. CEUS of the terminal ileum was performed using an intravenous microbubble contrast enhancer. Accuracy values of CEUS and MRE for the presence of active terminal ileitis were evaluated using the Receiver Operating Characteristic method, using endoscopic findings as a reference standard. Sensitivity and specificity values of MRE and CEUS were compared by the McNemar test.ResultsCEUS was feasible in 98% of patients, MRE in all. Optimal diagnostic accuracy in CEUS was obtained at a peak intensity value of 10%, showing 100% sensitivity, 92% specificity and an accuracy of 99% in demonstrating ileal mucosal inflammation. For MRE, overall sensitivity, specificity and accuracy were, 87%, 100%, and 88%, respectively. CEUS and MRE were highly correlated in assessing length and wall thickness of the terminal ileum. CEUS identified 11 of 16 MRE-detected strictures, but no fistulae.ConclusionThe accuracy of CEUS is comparable to that of MRE in the assessment of active, uncomplicated terminal ileal CD and therefore a valuable bedside alternative to MRE in the follow-up of these patients.
Highlights
Crohn’s disease (CD) is a chronic transmural inflammatory disease of the gastrointestinal tract characterized by a widespread variation in severity and relapsing episodes of disease activity
Contrast Enhanced Ultrasound (CEUS) and Magnetic Resonance Enterography (MRE) were highly correlated in assessing length and wall thickness of the terminal ileum
The initial diagnosis of CD located in the terminal ileum, colon or both was confirmed in all patients according to the usual clinical, endoscopic and histological criteria [25]
Summary
Crohn’s disease (CD) is a chronic transmural inflammatory disease of the gastrointestinal tract characterized by a widespread variation in severity and relapsing episodes of disease activity. Ileocolonoscopy is considered the gold standard for CD disease activity in the colon and terminal ileum, allowing tissue sampling. This is an invasive and, from patients’ perspective, burdensome method [4]. Complete visualization of the small bowel and of extramural disease manifestations may be performed by CT Enterography and MR Enterography (CTE and MRE) [5,6,7] These two techniques have a similar diagnostic accuracy for CD disease extension and activity, as reported by Panes et al [8]. To prospectively examine the feasibility and accuracy of Contrast Enhanced Ultrasound (CEUS) in the assessment of Crohn’s disease (CD) activity in the terminal ileum in comparison to Magnetic Resonance Enterography (MRE), using endoscopy as a reference standard
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