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Ultrasound Elastography of the Bowel

  • Jonathan R. DillmanEmail author
  • Jonathan M. Rubin
  • Laura A. Johnson
  • Peter D. R. Higgins
Chapter

Abstract

Over the past decade, there has been increasing evidence that ultrasound elastography may aid in the imaging evaluation and management of pediatric and adult Crohn’s disease patients. Multiple studies have shown that ultrasound-derived intestinal stiffness measurements can suggest the presence of bowel wall fibrosis in areas of stricturing disease, even in the setting of superimposed inflammation. Such knowledge can help guide the appropriate medical and surgical management of these patients. Furthermore, semiquantitative and quantitative elastographic methods may predict response to medical therapy, show evidence of progressive bowel damage over time, and potentially predict ensuing complications, such as impending bowel obstruction or penetrating complications. This chapter will review the different ultrasound elastography techniques for assessing the bowel, published evidence supporting the use of these techniques in Crohn’s disease patients, potential roles in clinical practice, and likely challenges and obstacles to future clinical use.

Keywords

Crohn’s disease Ultrasound Elastography Strain Shear wave speed Fibrosis Stricture Bowel damage 

References

  1. 1.
    Dillman JR, Smith EA, Sanchez RJ, et al. Pediatric small bowel Crohn disease: correlation of US and MR enterography. Radiographics. 2015;35(3):835–48.CrossRefGoogle Scholar
  2. 2.
    Biko DM, Rosenbaum DG, Anupindi SA. Ultrasound features of pediatric Crohn disease: a guide for case interpretation. Pediatr Radiol. 2015;45(10):1557–66.CrossRefGoogle Scholar
  3. 3.
    Dillman JR, Dehkordy SF, Smith EA, 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. 2017;47(8):924–34.CrossRefGoogle Scholar
  4. 4.
    Maconi G, Sampietro GM, Parente F, et al. Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn's disease: a prospective comparative study. Am J Gastroenterol. 2003;98(7):1545–55.CrossRefGoogle Scholar
  5. 5.
    Bruining D, Zimmermann EM, Loftus EV Jr, et al. Consensus recommendations for evaluation, interpretation and utilization of CT and MR enterography in patients with small bowel Crohn’s disease. Radiology. 2018;286(3):776–99.CrossRefGoogle Scholar
  6. 6.
    Lu C, Gui X, Chen W, Fung T, Novak K, Wilson SR. Ultrasound shear wave elastography and contrast enhancement: effective biomarkers in Crohn's disease strictures. Inflamm Bowel Dis. 2017;23(3):421–30.CrossRefGoogle Scholar
  7. 7.
    Adler J, Punglia DR, Dillman JR, et al. Computed tomography enterography findings correlate with tissue inflammation, not fibrosis in resected small bowel Crohn's disease. Inflamm Bowel Dis. 2012;18(5):849–56.CrossRefGoogle Scholar
  8. 8.
    Barkmeier DT, Dillman JR, Al-Hawary M, et al. MR enterography-histology comparison in resected pediatric small bowel Crohn disease strictures: can imaging predict fibrosis? Pediatr Radiol. 2016;46(4):498–507.CrossRefGoogle Scholar
  9. 9.
    Rimola J, Planell N, Rodríguez S, et al. Characterization of inflammation and fibrosis in Crohn's disease lesions by magnetic resonance imaging. Am J Gastroenterol. 2015;110(3):432–40.CrossRefGoogle Scholar
  10. 10.
    Bettenworth D, Rieder F. Reversibility of stricturing Crohn's disease-fact or fiction? Inflamm Bowel Dis. 2016;22(1):241–7.CrossRefGoogle Scholar
  11. 11.
    Malgras B, Pautrat K, Dray X, et al. Multidisciplinary management of gastrointestinal fibrotic stenosis in Crohn's disease. Dig Dis Sci. 2015;60(5):1152–68.CrossRefGoogle Scholar
  12. 12.
    Ophir J, Céspedes I, Ponnekanti H, Yazdi Y, Li X. Elastography: a quantitative method for imaging the elasticity of biological tissues. Ultrason Imaging. 1991;13(2):111–34.CrossRefGoogle Scholar
  13. 13.
    Sigrist RMS, Liau J, Kaffas AE, Chammas MC, Willmann JK. Ultrasound elastography: review of techniques and clinical applications. Theranostics. 2017;7(5):1303–29.CrossRefGoogle Scholar
  14. 14.
    Sarvazyan AP, Rudenko OV, Swanson SD, Fowlkes JB, Emelianov SY. Shear wave elasticity imaging: a new ultrasonic technology of medical diagnostics. Ultrasound Med Biol. 1998;24(9):1419–35.CrossRefGoogle Scholar
  15. 15.
    Nightingale K. Acoustic radiation force impulse (ARFI) imaging: a review. Curr Med Imaging Rev. 2011;7(4):328–39.CrossRefGoogle Scholar
  16. 16.
    Kim K, Johnson LA, Jia C, et al. Noninvasive ultrasound elasticity imaging (UEI) of Crohn’s disease: animal model. Ultrasound Med Biol. 2008;34(6):902–12.CrossRefGoogle Scholar
  17. 17.
    Xu J, Tripathy S, Rubin JM, et al. A new nonlinear parameter in the developed strain-to-applied strain of the soft tissues and its application in ultrasound elasticity imaging. Ultrasound Med Biol. 2012;38(3):511–23.CrossRefGoogle Scholar
  18. 18.
    Havre RF, Leh S, Gilja OH, et al. Strain assessment in surgically resected inflammatory and neoplastic bowel lesions. Ultraschall Med. 2014;35(2):149–58.PubMedGoogle Scholar
  19. 19.
    Baumgart DC, Müller HP, Grittner U, et al. US-based real-time elastography for the detection of fibrotic gut tissue in patients with stricturing Crohn disease. Radiology. 2015;275(3):889–99.CrossRefGoogle Scholar
  20. 20.
    Fraquelli M, Branchi F, Cribiù FM, et al. The role of ultrasound elasticity imaging in predicting ileal fibrosis in Crohn's disease patients. Inflamm Bowel Dis. 2015;21(11):2605–12.CrossRefGoogle Scholar
  21. 21.
    Pescatori LC, Mauri G, Savarino E, Pastorelli L, Vecchi M, Sconfienza LM. Bowel sonoelastography in patients with Crohn's disease: a systematic review. Ultrasound Med Biol. 2018;44(2):297–302.CrossRefGoogle Scholar
  22. 22.
    Orlando S, Fraquelli M, Coletta M, et al. Ultrasound elasticity imaging predicts therapeutic outcomes of patients with Crohn's disease treated with anti-tumor necrosis factor antibodies. J Crohns Colitis. 2018;12(1):63–70.CrossRefGoogle Scholar
  23. 23.
    Dillman JR, Stidham RW, Higgins PD, Moons DS, Johnson LA, Rubin JM. US elastography-derived shear wave velocity helps distinguish acutely inflamed from fibrotic bowel in a Crohn disease animal model. Radiology. 2013;267(3):757–66.CrossRefGoogle Scholar
  24. 24.
    Dillman JR, Stidham RW, Higgins PD, et al. Ultrasound shear wave elastography helps discriminate low-grade from high-grade bowel wall fibrosis in ex vivo human intestinal specimens. J Ultrasound Med. 2014;33(12):2115–23.CrossRefGoogle Scholar
  25. 25.
    Hall TJ, Milkowski A, Garra B, et al. RSNA/QIBA: shear wave speed as a biomarker for liver fibrosis staging. In: Ultrasonics symposium (IUS) IEEE international. New York: IEEE; 2013. p. 397–400.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jonathan R. Dillman
    • 1
    Email author
  • Jonathan M. Rubin
    • 2
  • Laura A. Johnson
    • 3
  • Peter D. R. Higgins
    • 3
  1. 1.Department of RadiologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of RadiologyUniversity of Michigan/Michigan MedicineAnn ArborUSA
  3. 3.Department of Internal Medicine, Division of Gastroenterology and HepatologyUniversity of Michigan/Michigan MedicineAnn ArborUSA

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