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Bowel Ultrasound Imaging, Protocol and Findings

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Cross-Sectional Imaging in Crohn’s Disease

Abstract

Objective measurement of disease activity in inflammatory bowel disease (IBD) is important to guide targeted therapy. Noninvasive approaches are gaining clinical traction given patient preference and need for cost containment. Ultrasound of the large and small bowel is increasingly recognized as an accurate, non-radiation-based, cost-effective modality useful in both diagnosis and follow-up in IBD. Intestinal ultrasound (IUS) is easily repeated, allowing for serial assessment to evaluate response to therapy, post-operative course and evolution of complications, particularly in Crohn’s disease. Mounting evidence suggesting sonographic response accurately reflects therapeutic efficacy and thus may provide useful insight regarding clinical outcome. It exhibits similar performance in the detection of inflammation associated with Crohn’s disease to both computed tomography (CT) and magnetic resonance (MR). Intestinal US may also provide a noninvasive surrogate to ileocolonoscopy, accurately depicting disease activity and mucosal healing, with better illustration of luminal and extra-luminal disease and complications. Intestinal US may also play a role in depicting the activity, extent of disease as well as risk of surgery in ulcerative colitis. The application of IUS is particularly useful in children with IBD, where risks of radiation are important, while there is a need for anaesthesia for endoscopic examination. To date, however, IUS has remained somewhat underutilized globally, given perceived limitations in inter-rater variability, standardized assessment and anatomic resolution. This however is starting to change: the use of IUS has moved beyond the limited domain of diagnostic imaging specialists and radiologists as it is incorporated into routine clinical assessment at the bedside and now being performed by non-radiologist gastroenterologists. Here, the benefits to patients go well beyond safety, with immediate clinical impact, facilitated through objectively informed clinical decision-making and better patient education and engagement, allowing for optimal patient participation and partnership in the clinical management of this complex, chronic disease.

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References

  1. Holt S, Samuel E. Grey scale ultrasound in Crohn’s disease. Gut. 1979;20(7):590–5.

    Article  CAS  Google Scholar 

  2. Daperno M, Castiglione F, de Ridder L, Dotan I, Färkkilä M, Florholmen J, et al. Results of the 2nd part scientific workshop of the ECCO. II: measures and markers of prediction to achieve, detect, and monitor intestinal healing in inflammatory bowel disease. J Crohns Colitis. 2011;5(5):484–98.

    Article  Google Scholar 

  3. Peyrin-Biroulet L, Reinisch W, Colombel J-F, Mantzaris GJ, Kornbluth A, Diamond R, et al. Clinical disease activity, C-reactive protein normalisation and mucosal healing in Crohn’s disease in the SONIC trial. Gut. 2014;63(1):88–95.

    Article  Google Scholar 

  4. Bouguen G, Levesque BG, Feagan BG, Kavanaugh A, Peyrin-Biroulet L, Colombel J-F, et al. Treat to target: a proposed new paradigm for the management of Crohn’s disease. Clin Gastroenterol Hepatol. 2015;13(6):1042–50.e2.

    Article  Google Scholar 

  5. Greenup A, Bressler B, Rosenfeld G. Medical imaging in small bowel Crohn’s disease—computed tomography enterography, magnetic resonance enterography, and ultrasound:“which one is the best for what?”. Inflamm Bowel Dis. 2016;22(5):1246–61.

    Article  Google Scholar 

  6. Panés J, Bouzas R, Chaparro M, García-Sánchez V, Gisbert JP, Martínez de Guereñu B, et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Aliment Pharmacol Ther. 2011;34(2):125–45.

    Article  Google Scholar 

  7. Calabrese E, Maaser C, Zorzi F, Kannengiesser K, Hanauer SB, Bruining DH, et al. Bowel ultrasonography in the management of Crohnʼs disease. A review with recommendations of an international panel of experts. Inflamm Bowel Dis. 2016;22(5):1168–83.

    Article  Google Scholar 

  8. Fraquelli M, Casazza G, Paggi S, Colucci A, Massironi S, Duca P, et al. Role of US in detection of Crohn disease: meta-analysis. Radiology. 2005;236:95–101.

    Article  Google Scholar 

  9. Horsthuis K, Bipat S, Bennink R, Stoker J. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology. 2008;247(1):64–79.

    Article  Google Scholar 

  10. Zhu C, Ma X, Xue L, Xu J, Li Q, Wang Y, et al. Small intestine contrast ultrasonography for the detection and assessment of Crohn disease: a meta-analysis. Medicine (Baltimore). 2016;95(31):e4235.

    Article  Google Scholar 

  11. Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110(9):1324–38.

    Article  CAS  Google Scholar 

  12. Moreno N, Ripollés T, Paredes JM, Ortiz I, Martínez MJ, López A, et al. Usefulness of abdominal ultrasonography in the analysis of endoscopic activity in patients with Crohn’s disease: changes following treatment with immunomodulators and/or anti-TNF antibodies. J Crohns Colitis. 2014;8(9):1079–87.

    Article  Google Scholar 

  13. Fernandes SR, Rodrigues RV, Bernardo S, Cortez-Pinto J, Rosa I, Da Silva JP, et al. Transmural healing is associated with improved long-term outcomes of patients with Crohn’s disease. Inflamm Bowel Dis. 2017;23(8):1403–9.

    Article  Google Scholar 

  14. Castiglione F, Testa A, Rea M, De Palma GD, Diaferia M, Musto D, et al. Transmural healing evaluated by bowel sonography in patients with Crohn’s disease on maintenance treatment with biologics. Inflamm Bowel Dis. 2013;19(9):1928–34.

    PubMed  Google Scholar 

  15. Castiglione F, Mainenti P, Testa A, Imperatore N, De Palma GD, Maurea S, et al. Cross-sectional evaluation of transmural healing in patients with Crohn’s disease on maintenance treatment with anti-TNF alpha agents. Dig Liver Dis. 2017;49(5):484–9.

    Article  CAS  Google Scholar 

  16. Dillman JR, Dehkordy SF, Smith EA, DiPietro MA, Sanchez R, DeMatos-Maillard V, et al. Defining the ultrasound longitudinal natural history of newly diagnosed pediatric small bowel Crohn disease treated with infliximab and infliximab–azathioprine combination therapy. Pediatr Radiol. Pediatr Radiol. 2017;47(8):924–34.

    Article  Google Scholar 

  17. Ripollés T, Paredes JM, Martínez-Pérez MJ, Rimola J, Jauregui-Amezaga A, Bouzas R, et al. Ultrasonographic changes at 12 weeks of anti-TNF drugs predict 1-year sonographic response and clinical outcome in Crohn’s disease: a multicenter study. Inflamm Bowel Dis. 2016;22(10):2465–73.

    Article  Google Scholar 

  18. Deepak P, Fletcher JG, Fidler JL, Barlow JM, Sheedy SP, Kolbe AB, et al. Radiological response is associated with better long-term outcomes and is a potential treatment target in patients with small bowel Crohn’s disease. Am J Gastroenterol. 2016;111(7):997–1006.

    Article  Google Scholar 

  19. Rispo A, Imperatore N, Testa A, Mainenti P, De Palma GD, Luglio G, et al. Bowel damage in Crohn’s disease: direct comparison of ultrasonography-based and magnetic resonance-based lemann index. Inflamm Bowel Dis. 2017;23(1):143–51.

    Article  Google Scholar 

  20. Ripollés T, Martínez-Pérez MJ, Paredes JM, Vizuete J, García-Martínez E, Jiménez-Restrepo DH. Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in crohn’s disease and other abdominal conditions. Eur J Radiol. 2013;82(10):e525–31.

    Article  Google Scholar 

  21. Zorzi F, Stasi E, Bevivino G, Scarozza P, Biancone L, Zuzzi S, et al. A sonographic lesion index for Crohn’s disease helps monitor changes in transmural bowel damage during therapy. Clin Gastroenterol Hepatol. 2014;12(12):2071–7.

    Article  Google Scholar 

  22. Onali S, Calabrese E, Petruzziello C, Lolli E, Ascolani M, Ruffa A, et al. Post-operative recurrence of Crohn’s disease: a prospective study at 5 years. Dig Liver Dis. 2016;48(5):489–94.

    Article  Google Scholar 

  23. Calabrese E, Petruzziello C, Onali S, Condino G, Zorzi F, Pallone F, et al. Severity of postoperative recurrence in Crohn’s disease: correlation between endoscopic and sonographic findings. Inflamm Bowel Dis. 2009;15(11):1635–42.

    Article  Google Scholar 

  24. Paredes JM, Ripollés T, Cortés X, Moreno N, Martínez MJ, Bustamante-Balén M, et al. Contrast-enhanced ultrasonography: usefulness in the assessment of postoperative recurrence of Crohn’s disease. J Crohns Colitis. 2013;7(3):192–201.

    Article  Google Scholar 

  25. Wright EK, Novak KL, Lu C, Panaccione R, Ghosh S, Wilson SR. Transperineal ultrasonography in perianal Crohn disease: a valuable imaging modality. Can J Gastroenterol Hepatol. 2015;29(8):445–7.

    Article  Google Scholar 

  26. Maconi G, Ardizzone S, Greco S, Radice E, Bezzio C, Bianchi Porro G. Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohn’s disease. Am J Gastroenterol. 2007;102(10):2214–9.

    Article  Google Scholar 

  27. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46–54.e42.

    Article  Google Scholar 

  28. Huang JS, Tobin A, Harvey L, Nelson TR. Diagnostic medical radiation in pediatric patients with inflammatory bowel disease. J Pediatr Gastroenterol Nutr. 2011;53(5):502–6.

    Article  Google Scholar 

  29. Levine A, Koletzko S, Turner D, Escher JC, Cucchiara S, De Ridder L, et al. ESPGHAN revised Porto criteria for the diagnosis of inflammatory bowel disease in children and adolescents. J Pediatr Gastroenterol Nutr. 2014;58(6):795–806.

    CAS  PubMed  Google Scholar 

  30. Yoon H, Suh C, Kim J, Lee J, Jung A, Kim K, et al. Diagnostic performance of magnetic resonance enterography for detection of active inflammation in children and adolescents with inflammatory bowel disease a systematic review and diagnostic meta-analysis. JAMA Pediatr. 2017;171(12):1208–16.

    Article  Google Scholar 

  31. Borthne AS, Abdelnoor M, Rugtveit J, Perminow G, Reiseter T, Kløw NE. Bowel magnetic resonance imaging of pediatric patients with oral mannitol: MRI compared to endoscopy and intestinal ultrasound. Eur Radiol. 2006;16(1):207–14.

    Article  Google Scholar 

  32. Tsai TL, Marine MB, Wanner MR, Cooper ML, Steiner SJ, Ouyang F, et al. Can ultrasound be used as the primary imaging in children with suspected Crohn disease? Pediatr Radiol. 2017;47(8):917–23.

    Article  Google Scholar 

  33. Pallotta N, Civitelli F, Di Nardo G, Vincoli G, Aloi M, Viola F, et al. Small intestine contrast ultrasonography in pediatric crohn’s disease. J Pediatr. 2013;163(3):778–84.

    Article  Google Scholar 

  34. Civitelli F, Di Nardo G, Oliva S, Nuti F, Ferrari F, Dilillo A, et al. Ultrasonography of the colon in pediatric ulcerative colitis: a prospective, blind, comparative study with colonoscopy. J Pediatr. 2014;165(1):78–84.e2.

    Article  Google Scholar 

  35. Parente F, Molteni M, Marino B, Colli A, Ardizzone S, Greco S, et al. Are colonoscopy and bowel ultrasound useful for assessing response to short-term therapy and predicting disease outcome of moderate-to-severe forms of ulcerative colitis: a prospective study. Am J Gastroenterol. 2010;105(5):1150–7.

    Article  Google Scholar 

  36. Kucharzik T, Kannengiesser K, Petersen F. The use of ultrasound in in fl ammatory bowel disease. Ann Gastroenterol. 2017;30(2):135–44.

    PubMed  Google Scholar 

  37. Parente F, Molteni M, Marino B, Colli A, Ardizzone S, Greco S, Sampietro GGS. Bowel ultrasound and mucosal healing in ulcerative colitis. Dig Dis. 2009;27:285–90.

    Article  CAS  Google Scholar 

  38. Nylund K, Maconi G, Hollerweger A, Ripolles T, Pallotta N, Higginson A, et al. EFSUMB recommendations and guidelines for gastrointestinal ultrasound - part 1: examination techniques and normal findings (long version). Ultraschall Med. 2017;38(3):e1–e15.

    Article  Google Scholar 

  39. Ung C, Chang ST, Brooke Jeffrey R, Patel BN, Olcott EW. Sonography of the normal appendix: its varied appearance and techniques to improve its visualization. Ultrasound Q. 2013;29(4):333–41.

    Article  Google Scholar 

  40. Deslandes A. Sonographic demonstration of stomach pathology: reviewing the cases. Australas J Ultrasound Med. 2013;16(4):202–9. https://doi.org/10.1002/j.2205-0140.2013.tb00249.x.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Taylor SA, Avni F, Cronin CG, Hoeffel C, Kim SH, Laghi A, et al. The first joint ESGAR/ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging. Eur Radiol. 2017;27(6):2570–82.

    Article  CAS  Google Scholar 

  42. Limberg B. Diagnosis of acute ulcerative colitis and colonic Crohn’s disease by colonic sonography. J Clin Ultrasound. 1989;17(1):25–31.

    Article  CAS  Google Scholar 

  43. Fraquelli M, Sarno a GC, Laudi C, Buscarini E, Villa C, et al. Reproducibility of bowel ultrasonography in the evaluation of Crohn’s disease. Dig Liver Dis. 2008;40(11):860–6.

    Article  CAS  Google Scholar 

  44. Rieder F, Latella G, Magro F, Yuksel ES, Higgins PDR, Di Sabatino A, et al. European Crohn’s and colitis organisation topical review on prediction, diagnosis and management of fibrostenosing Crohn’s disease. J Crohns Colitis. 2016;10(8):873–85.

    Article  Google Scholar 

  45. Coelho R, Ribeiro H, Maconi G. Bowel thickening in Crohn’s disease: fibrosis or inflammation? Diagnostic ultrasound imaging tools. Inflamm Bowel Dis. 2017;23(1):23–34.

    Article  Google Scholar 

  46. Silva AC, Pimenta M, Guimarães LS. Small bowel obstruction: what to look for. Radiographics. 2009;29(2):423–39.

    Article  Google Scholar 

  47. Medellin A, Merrill C, Wilson SR. Role of contrast-enhanced ultrasound in evaluation of the bowel. Abdom Radiol (NY). 2018;43(4):918–33.

    Article  Google Scholar 

  48. Quaia E, De Paoli L, Stocca T, Cabibbo B, Casagrande F, Cova MA. The value of small bowel wall contrast enhancement after sulfur hexafluoride-filled microbubble injection to differentiate inflammatory from fibrotic strictures in patients with Crohn’s disease. Ultrasound Med Biol. 2012;38(8):1324–32.

    Article  Google Scholar 

  49. Quaia E, Gennari AG, Cova MA, van Beek EJR. Differentiation of inflammatory from fibrotic ileal strictures among patients with Crohn’s disease based on visual analysis: feasibility study combining conventional B-mode ultrasound, contrast-enhanced ultrasound and strain elastography. Ultrasound Med Biol. 2018;44(4):762–70.

    Article  Google Scholar 

  50. Wilkens R, Hagemann-Madsen RH, Peters DA, Nielsen AH, Nørager CB, Glerup H, et al. Validity of contrast enhanced ultrasonography and dynamic contrast enhanced MR Enterography in the assessment of transmural activity and fibrosis in Crohn’s disease. J Crohns Colitis. 2018;12(1):48–56.

    Article  Google Scholar 

  51. Pallotta N, Vincoli G, Montesani C, Chirletti P, Pronio A, Caronna R, et al. Small intestine contrast ultrasonography (SICUS) for the detection of small bowel complications in crohn’s disease: a prospective comparative study versus intraoperative findings. Inflamm Bowel Dis. 2012;18(1):74–84.

    Article  Google Scholar 

  52. Onali S, Calabrese E, Petruzziello C, Zorzi F, Sica G, Fiori R, et al. Small intestine contrast ultrasonography vs computed tomography enteroclysis for assessing ileal Crohn’s disease. World J Gastroenterol. 2012;18(42):6088–95.

    Article  Google Scholar 

  53. Calabrese E, Zorzi F, Onali S, Petruzziello C, Condino G, Lolli E, et al. Small intestine contrast ultrasonography for detecting asymptomatic small bowel Crohn’s disease lesions: a family study. Dig Liver Dis. 2011;43:S210–1.

    Article  Google Scholar 

  54. Havre R, Gilja OH. Elastography and strain rate imaging of the gastrointestinal tract. Eur J Radiol. 2014;83(3):438–41.

    Article  CAS  Google Scholar 

  55. Wildman-tobriner B, Allen BC, Bashir MR, Camp M, Miller C, Fiorillo LE, et al. Structured reporting of CT enterography for inflammatory bowel disease : effect on key feature reporting, accuracy across training levels, and subjective assessment of disease by referring physicians. Abdom Radiol (NY). 2017;42(9):2243–50.

    Article  Google Scholar 

  56. Bruining DH, Zimmermann EM, Loftus EV, Sandborn WJ, Sauer CG, Strong SA. Consensus recommendations for evaluation, interpretation, and utilization of computed tomography and magnetic resonance enterography in patients with small bowel Crohn’s disease. Gastroenterology. 2018;154(4):1172–94.

    Article  Google Scholar 

  57. Kucharzik T, Wittig BM, Helwig U, Börner N, Rössler A, Rath S, et al. Use of intestinal ultrasound to monitor Crohn’s disease activity. Clin Gastroenterol Hepatol. 2017;15(4):535–542.e2.

    Article  Google Scholar 

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Authors and Affiliations

  1. Liverpool Hospital, University of New South Wales, Sydney, NSW, Australia

    Astrid-Jane Greenup

  2. University of Calgary, Calgary, AB, Canada

    Kerri L. Novak

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Correspondence to Kerri L. Novak .

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  1. Department of Radiology, Hospital Clínic of Barcelona, CIBEREHD, University of Barcelona, Barcelona, Spain

    Jordi Rimola

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Greenup, AJ., Novak, K.L. (2019). Bowel Ultrasound Imaging, Protocol and Findings. In: Rimola, J. (eds) Cross-Sectional Imaging in Crohn’s Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-96586-4_2

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  • DOI: https://doi.org/10.1007/978-3-319-96586-4_2

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