CEUS: A useful technique to monitor ulcerative colitis and Crohn’s disease
Contrast-enhanced ultrasonography (CEUS) is a useful technique to monitor patients with chronic inflammatory bowel disease (IBD) during and after treatment. It may provide an alternative to frequent endoscopies performed to evaluate treatment response, according to an article published in the Journal of Gastrointestinal and Liver Disease.
A prospective comparative study of 107 patients treated at the Regional Gastroenterology and Hepatology Institute in Cluj-Napoca, Romania was conducted over a 46 month period starting June 2009. The patients received both an endoscopy and a CEUS exam when they presented for treatment and subsequently during follow-up. The patient cohort included 65 cases of ulcerative colitis and 42 cases of Crohn’s disease.
The primary objective of the study was to determine the usefulness of CEUS quantification parameters measured by time intensity curves (TIC) in the assessment of disease activity by endoscopic standards. They did this by correlating the measured TIC parameters and the endoscopic scores, according to lead author Mihai Socaciu, M.D., and colleagues. Their secondary objective was to assess differences in all parameters that appeared at follow-up after 90 days of treatment and to correlate these differences with changes in endoscopic scores.
The scanning protocol used consisted of an initial systematic survey of the four abdominal quadrants. The most relevant bowel segment that showed changes such as wall thickening, fat stranding, wall feature effacement, strictures, Doppler signal increase, or changes in layer structure was selected for further analysis.
The authors reported that for the initial part of their study, they found good correlations for ulcerative colitis between the Mayo endoscopic scores and the TIC volumes. C reactive protein (CRP) and thickness showed significant correlations, but TIC flow parameters did not. TIC volume parameters were also identified as good independent predictors for the endoscopy score. The best independent predictor was In(AUC), significantly discriminating between the main classes of endoscopic. The best correlations for Crohn’s disease was between the simple endoscopic score for Crohn’s disease and the TIC volume parameters. Thickness and layer also had a significant correlation. The best predictor for endoscopic improvement for both disease conditions was In(AUC) measured in logarithmic form. This parameter correlated better with the endoscopic activity than the clinical scores, CRP and other ultrasound parameters.
While acknowledging limitations of the study, the researchers believe that CEUS could be a useful technique to more frequently monitor patients with ulcerative colitis and Crohn’s disease during treatment. This might reduce the frequency of endoscopic exams, reducing discomfort and the risk of ileocolonoscopy. Recent studies have shown that extended follow-up is recommended for cases in which where clinical remission has not been reached and endoscopic mucosal healing may not have been achieved.
REFERENCE
- Socacio M, Ciobanu L, Diaconu B, et al. Non-Invasive Assessment of Inflammation and Treatment Response in Patients with Crohn’s Disease and Ulcerative Colitis using Contrast-Enhanced Ultrasonography Quanitification. 2015 J Gastrointestin Liver Dis. 24;4:457-465.