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Contrast-enhanced ultrasound in the assessment of Crohn’s disease activity: comparison with computed tomography enterography

  • Abdominal Radiology
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Background and objective

Continuous assessment of disease activity remains a huge challenge during the follow-ups of patients with Crohn’s disease (CD). In this paper, we aimed to evaluate the performance of contrast-enhanced ultrasound (CEUS) by comparing with computed tomography enterography (CTE) in the assessment of disease activity in CD.

Materials and methods

Fifty-two patients diagnosed with CD were included in this study, using the CEUS and CTE as imaging methods for comparison. The selected parameters included the location and thickness of the thickest part of the intestinal wall, mesenteric fat proliferation, mesenteric vessels change, enhancement pattern and the presence of complications. Patients were clinically assessed using the Crohn's disease activity index (CDAI), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). Simple endoscopic score for Crohn’s disease (SES-CD) was regarded as the reference standard.

Results

The location of the thickest part of the intestinal wall (κ = 0.653), bowel wall thickness (ICC = 0.795), mesenteric vessels change (κ = 0.692) and complications (κ = 0.796) displayed substantial agreement (0.61–0.80) between CEUS and CTE, while the detection of mesenteric fat proliferation (κ = 0.395) and enhancement pattern (κ = 0.288) showed fair consistency (0.21–0.40) for comparison. In CEUS, bowel wall thickness, mesenteric fat proliferation, enhancement pattern and mesenteric vessels change were statistically significant in assessing CD activity, while bowel wall thickness, mesenteric fat proliferation and mesenteric vessels change in CTE. Bowel wall thickness showed the best diagnostic performance in the assessment of CD activity at CEUS and CTE.

Conclusion

CEUS provides a radiation-free and effective way to assess the CD activity in comparison with CTE, which also avoids frequent colonoscopy examinations, improves tolerance of patients, and reduces the cost of medical care, thereby serving as a useful tool for CD follow-up.

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Abbreviations

CD:

Crohn's disease

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

CDAI:

Crohn's disease activity index

SES-CD:

Simple endoscopic score for Crohn’s disease

CEUS:

Contrast-enhanced ultrasound

CTE:

Computed tomography enterography

ICC:

Intra-group correlation coefficient

PPV:

Positive predict value

NPV:

Negative predict value

AUROC:

Area under the receiver operating characteristic

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Acknowledgements

This work was supported in part from the National Natural Science Foundation of China (Grant 82102048); Shanghai Municipal Health Commission (Grants 2019LJ21 and SHSLCZDZK03502), and the Science and Technology Commission of Shanghai Municipality (Grants 19DZ2251100, and 19441903200), and  the Talent Project of Shanghai Tenth People's Hospital (Grant 2021SYPDRC067).

Funding

This work was supported in part from the National Natural Science Foundation of China (Grant 82102048); Shanghai Municipal Health Commission (Grants 2019LJ21 and SHSLCZDZK03502), and the Science and Technology Commission of Shanghai Municipality (Grants 19DZ2251100, and 19441903200), and  the Talent Project of Shanghai Tenth People's Hospital (Grant 2021SYPDRC067).

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Author notes

  1. Shi-Si Ding and Chang Liu have contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai, 200072, China

    Shi-Si Ding, Chang Liu, Yi-Feng Zhang, Li-ping Sun, Li-Hua Xiang, Hui Liu, Yan Fang, Wei-Wei Ren, Hui Zhao & Kun Zhang

  2. Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai, 200072, China

    Shi-Si Ding, Chang Liu, Yi-Feng Zhang, Li-ping Sun, Li-Hua Xiang, Hui Liu, Yan Fang, Wei-Wei Ren, Hui Zhao & Kun Zhang

  3. Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, National Clinical Research Center for Interventional Medicine, Shanghai, China

    Shi-Si Ding, Chang Liu, Yi-Feng Zhang, Li-ping Sun, Li-Hua Xiang, Hui Liu, Yan Fang, Wei-Wei Ren, Hui Zhao & Kun Zhang

  4. Department of Gastroenterology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, 200072, China

    Xiao-Min Sun & Xiao-Rong Xu

  5. Department of Radiology, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, 200072, China

    Chang-Bao Zhang

  6. Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Hui-Xiong Xu

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  1. Shi-Si Ding
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Contributions

DSS, LC and XHX were involved in study design; LC, DSS and XXR contributed to patient recruitment, data collection, statistical analysis and data interpretation; DSS was involved in writing of the first draft of the paper; LC and XHX contributed to revision of the manuscript for important intellectual content; ZYF, SLP, LH, XLH, RWW, ZH, FY, SXM and ZK were involved in providing administrative, technical and material support; XHX and XXR contributed to supervising the study.

Corresponding authors

Correspondence to Xiao-Rong Xu or Hui-Xiong Xu.

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Ding, SS., Liu, C., Zhang, YF. et al. Contrast-enhanced ultrasound in the assessment of Crohn’s disease activity: comparison with computed tomography enterography. Radiol med 127, 1068–1078 (2022). https://doi.org/10.1007/s11547-022-01535-z

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