Contrast Enhanced abdominal Ultrasound in IBD. Comparison with Ileocolonoscopy and MR
Enterography
Authors: CS Horjus 1, 3, R Bruijnen2, L Roovers 1 ,DJ de Jong 3 , FBM Joosten 2, MJM
Groenen 1 , PJ Wahab 1
1. Department of Gastroenterology, Rijnstate Hospital, Arnhem, the Netherlands
2. Department of Radiology, Rijnstate Hospital, Arnhem, the Netherlands
3. Department of Gastroenterology, Radboud University Nijmegen Medical Center,
Nijmegen, the Netherlands
Contrast-Enhanced Ultrasound (CE-US) as a diagnostic tool in IBD may be a patient-friendly,
easy applicable and less costly alternative for endoscopy and MR Enterography. CE-US
measures tissue perfusion density which reflects the intensity of inflammation. We compared
quantitative parameters of contrast-enhanced ultrasound (CE-US) examination of the small
bowel with endoscopic inflammatory activity and findings at Magnetic (MRE) in patients
with small bowel Crohn’s disease.
We prospectively evaluated 46 patients with Crohn’s disease in the distal ileum, performing
ileocolonoscopy followed within 14 days by CE-US and MRE. The radiologists were blinded
for the endoscopic disease activity. Standardized ultrasound examination, colour-coded
duplex sonography and CE-US of the small bowel was performed using Sonovue ® .
Contrast-enhanced sonographic perfusion maps were generated to derive the peak intensity
(PI) and the time to peak (TTP), by using the quantification software Qontrast®. We scored
the endoscopic disease activity in the ileum as: none, moderate (aphtous ulcers with normal
mucosa between lesions, or diffuse aphthae) and severe (large ulcers with diffuse inflamed
mucosa, nodule and/or stenosis). The maximum enhancement at MRE was similarly scored as
none, moderate and severe.
The endoscopic disease activity was scored in 46 patients as no lesions: 4 patients; mild:14
patients; severe: 20 patients and stricturizing disease: 8 patiens. A peak intensity value of 10%
at CE-US had an overall sensitivity and specificity of 100% in predicting any inflammation at
endoscopy. For the MRE the overall sensitivity and specificity were, 80% and 100%,
respectively. A peak intensity value of 30% had a sensitivity of 85,7 % and 80% in the
prediction of moderate or severe grade of inflammation at endoscopy, respectively. The
enhancement grade at the MRE showed a sensitivity of 50% and 65% in predicting moderate
and severe inflammation at endoscopy, respectively.
Conclusion: Quantitative bowel enhancement of the terminal ileum obtained by using CE-US
highly correlates with severity grade of inflammation determined at endoscopy. CE-US is
more sensitive than MRE in detecting moderate and severe inflammation of the small bowel
in Crohn’s disease.