Abstract
The evaluation of the degree of inflammation and fibrosis, intrinsic elements in intestinal wall damage of Crohn’s disease, is essential to individuate the extent of the lesions and the presence of strictures. This information will contribute to the choice of the appropriate therapeutic approach, the prediction of the response to therapy and the course of the disease. The accurate evaluation of the extent and severity of inflammation and/or fibrosis in Crohn’s disease currently requires histopathological analysis of the intestinal wall. However, in clinical practice and research, transmural assessment of the intestinal wall with cross sectional imaging is increasingly used for this purpose. The B-mode ultrasonograhic characteristics of the intestinal wall, the assessment of its vascularization by color Doppler and I.V. contrast agents, and the evaluation of the mechanical and elastic properties by sonoelastography, may provide useful and accurate information on the severity and extent of inflammation and intestinal fibrosis in Crohn’s disease. The purpose of this review is to provide an update on current sonographic methods to discriminate inflammation and fibrosis in Crohn’s disease.
Highlights
Crohn’s disease (CD) is characterized by chronic inflammation and progressive fibrosis
In this review we evaluated the reliability of intestinal ultrasound (IUS) in assessing inflammation and fibrosis, mainly focusing on the available studies that have used pathological features or the response to treatment as direct and indirect reference parameters
Despite the high accuracy of US in detecting strictures, and the promising results obtained with the novel sonographic techniques such as contrast-enhanced ultrasound (CEUS) and sonoelastography, several limitations are still present and more studies are needed before using these technique in routine clinical practice and trials
Summary
Crohn’s disease (CD) is characterized by chronic inflammation and progressive fibrosis. Magnetic resonance index of activity (MaRIA) (Rimola et al, 2011) and Clermont score (Buisson et al, 2015; Buisson et al, 2017) are the two main indexes in the assessment and grading of CD severity and mucosal lesions, evaluating the presence of ulcerations, edema, bowel thickness and relative contrast enhancement (MaRIA) or apparent diffusion coefficient (Clermont) Both have been validated compared with endoscopy, both in ileal and colonic CD. A recent study of Bhatnagar et al evaluates different mural and extramural US features as potential imaging predictors of histologic inflammation by comparing IUS findings with resection specimens and confirms a significant association of bowel wall and mucosal layer thickness with acute inflammation, while mesenteric fat echogenicity correlates with chronic inflammation (Bhatnagar et al, 2021). In more recent studies, Serra et al and Dillman et al did not find any significant relationship between elastography parameters and inflammation
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