Abstract
PurposeTo evaluate the utility of mural and extramural sonographic features of Crohn’s Disease as potential imaging biomarkers of inflammation and fibrosis against whole-mount histological sections.MethodsTwelve Crohn’s disease patients (Mean age 35(25–69), 7 males) underwent small bowel ultrasound prior to small bowel resection. Two radiologists in consensus graded multiple parameters including mural, mucosal and submucosal thickness, submucosal/mesenteric echogenicity and clarity and mural Doppler signal in 50 selected bowel cross-sections. Matching with histological sampling sites was facilitated via scanning of the resected specimen. A histopathologist scored acute and chronic inflammation, and fibrosis (using histological scoring systems) following analysis of whole mount block sections. The association between sonographic observations and histopathological scores was examined via univariable and multivariable analysis.ResultsIn univariate analyses, bowel wall thickness (regression co-efficient and 95% CI 0.8 (0.3, 1.3) p = 0.001), mesenteric fat echogenicity (8.7(3.0, 14.5) p = 0.005), submucosal layer thickness (7.4(1.2, 13.5) p = 0.02), submucosal layer clarity (4.4(0.6, 8.2) p = 0.02) and mucosal layer thickness (4.6(1.8, 7.4) p = 0.001) were all significantly associated with acute inflammation. Mesenteric fat echogenicity (674(8.67, 52404) p = 0.009), submucosal layer thickness (79.9(2.16, 2951) p = 0.02) and mucosal layer thickness (13.6(1.54, 121) p = 0.02) were significantly associated with chronic inflammation. Submucosal layer echogenicity (p = 0.03), clarity (25.0(1.76, 356) p = 0.02) and mucosal layer thickness (53.8(3.19, 908) p = 0.006) were significantly associated with fibrosis. In multivariate analyses, wall and mucosal thickness remained significantly associated with acute inflammation (p = 0.02), mesenteric fat echogenicity with chronic inflammation (p = 0.009) and mucosal thickness (p = 0.006) with fibrosis.ConclusionMultiple sonographic parameters are associated with histological phenotypes in Crohn’s disease although there is overlap between ultrasonic stigmata of acute inflammation, chronic inflammation and fibrosis.Graphic
Highlights
Cross-sectional imaging assessment of disease activity is fundamental to management of Crohn’s disease (CD) [1, 2]
Thirteen of the 50 sections demonstrated above threshold values for acute inflammation (> 6), chronic inflammation (> 3) and fibrosis (> 0), whilst a further 14 sections demonstrated above threshold values for both acute and chronic inflammation, but not fibrosis
We demonstrate that several sonographic features correlate with histologically graded acute inflammation, chronic inflammation and fibrosis
Summary
Cross-sectional imaging assessment of disease activity is fundamental to management of Crohn’s disease (CD) [1, 2]. Resection specimens have been employed in several studies investigating CT and MRE [13,14,15,16,17], relatively few SBUS studies have used such a standard of reference [18,19,20,21,22]. These have mainly focused on a limited number of mural observations, such as Doppler signal or tested pre-defined definitions of activity. The purpose of our study was to evaluate the utility of multiple mural and extramural sonographic features as potential imaging biomarkers of inflammation and fibrosis against a whole-mount histological section reference standard
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
