Contrast-Enhanced Ultrasound in Inflammatory Bowel Disease

Abstract

Inflammatory bowel disease (IBD) is a chronic inflammatory relapsing disease, which requires frequent re-evaluation and monitoring of the inflammatory activity. Gastrointestinal ultrasound (US), including colour and pulsed Doppler, has been recognised as a valuable imaging tool in the diagnostic workup of children with suspected IBD due to its high negative predictive value. Contrast-enhanced ultrasonography (CEUS) of the bowel wall is an additional tool, which helps to determine the disease activity, essentially by demonstrating hyperaemia of the bowel wall. Although there are no studies which deal with bowel CEUS in children, the experience and studies in adults give an optimistic view of this method. CEUS of the bowel wall in children, according to the European Federation for Societies in Ultrasound in Medicine and Biology (EFSUMB) statement, could be used to accurately determine the extent of the disease, differentiate between actively inflamed bowel and chronic fibrotic strictures, evaluate the response to the treatment and identify the presence of the associated mural and the extramural pathology. Dynamic CEUS enables real-time assessment of the bowel wall vascularity with semi-quantitative and quantitative assessment of contrast enhancement. The protocol for dynamic CEUS of the bowel wall is described and the challenges regarding time-intensity curve analysis are presented. The possible clinical indications, advantages and limitations of this method are discussed. Dynamic CEUS can become a complementary method for IBD activity estimation. In the future, bowel CEUS in children has to be more extensively investigated with control comparable studies or wide multicentric studies.