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Published on: December 15, 2017
A novel super-resolution contrast-enhanced ultrasound approach for evaluating inflammatory activity in Crohn's
Ying Wang1, Wensong Ge2, Yi Yu1
1Department of Ultrasound, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Objectives:
To investigate the role of super-resolution contrast-enhanced ultrasound (SR-CEUS) in evaluating inflammatory activity in Crohn's disease (CD).
Materials And Methods:
In this prospective study, we consecutively enrolled CD patients confirmed by clinical and ileocolonoscopic findings. All patients underwent B-mode ultrasound (BMUS), color Doppler flow imaging (CDFI), CEUS, and SR-CEUS within 1 week of ileocolonoscopy. SR-CEUS quantitative parameters were recorded, with simple endoscopic score for Crohn's disease (SES-CD) as the reference standard. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.
Results:
52 consecutive CD patients were categorized into active (SES-CD ≥ 3, n = 30) and inactive (SES-CD < 3, n = 22) groups. SR-CEUS clearly visualized the intramural microvascular architecture of the bowel wall. SR-CEUS yielded an AUC of 0.903 with 86.4% sensitivity (95% CI: 66.7-95.3%), and 86.7% specificity (95% CI: 70.3-94.5%) for assessing inflammatory activity, significantly outperforming both CDFI (p = 0.014) and CEUS (p = 0.045), while showing no statistically significant difference in comparison with BMUS (p = 0.988). Furthermore, the combination of BMUS and SR-CEUS achieved an AUC of 0.967 for diagnosing active CD, with 100% sensitivity (95% CI: 85.1-100%) and 86.7% specificity (95% CI: 70.3-94.7%), which was significantly superior to BMUS alone (p = 0.038).
Conclusions:
SR-CEUS provides quantitative microvascular perfusion maps that display vascular density, flow velocity, and direction, offering a non-invasive tool for evaluating inflammatory activity in CD.
Critical Relevance Statement:
This study demonstrates that super-resolution contrast-enhanced ultrasound (SR-CEUS) provides a novel, non-invasive approach for quantitative evaluation of inflammatory activity in Crohn's disease (CD), which serves as a valuable supplement or alternative to endoscopy in routine monitoring.
Key Points:
An unmet need remains for accurate, non-invasive tools to assess CD activity. SR-CEUS outperforms conventional CDFI and CEUS in distinguishing active from inactive CD. Combining SR-CEUS with standard BMUS yields excellent diagnostic accuracy, establishing this combined approach as a promising non-invasive alternative for monitoring inflammatory activity in CD patients.
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