Validity of Contrast-Enhanced Ultrasonography and Dynamic Contrast-Enhanced MR Enterography in the Assessment of Transmural Activity and Fibrosis in Crohn's Disease

Rune Wilkens, Rikke H Hagemann-Madsen, David A Peters, Agnete H Nielsen, Charlotte B Nørager, Henning Glerup, Klaus Krogh

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Resumé

Background and Aims: Increased small intestinal wall thickness correlates with both inflammatory activity and fibrosis in Crohn's disease [CD]. Assessment of perfusion holds promise as an objective marker distinguishing between the two conditions. Our primary aim was to determine if relative bowel wall perfusion measurements correlate with histopathological scores for inflammation or fibrosis in CD. Methods: A total of 25 patients were investigated before elective surgery for small intestinal CD. Unenhanced ultrasonography [US] and magnetic resonance enterography [MRE] were applied to describe bowel wall thickness. Perfusion was assessed with contrast-enhanced US [CEUS] and dynamic contrast-enhanced MRE [DCE-MRE]. Histopathology was used as gold standard. Results: Compared with histopathology, the mean wall thickness was 0.4 mm greater on US [range -0.3 to 1.0, p = 0.24] and 1.4 mm greater on MR [0.4 to 2.3, p = 0.006]. No correlation was found between the severity of inflammation or fibrosis on histopathology, and either DCE-MRE [r = -0.13, p = 0.54 for inflammation and r = 0.41, p = 0.05 for fibrosis] or CEUS [r = 0.16, p = 0.45 for inflammation and r = -0.28, p = 0.19 for fibrosis]. Wall thickness assessed with US was correlated with both histological inflammation [r = 0.611, p = 0.0012] and fibrosis [r = 0.399, p = 0.048]. The same was not true for MR [r = 0.41, p = 0.047 for inflammation and r = 0.29, p = 0.16 for fibrosis] Conclusions: Bowel wall thickness assessed with US is a valid marker of inflammation in small intestinal CD. However, relative contrast enhancement of US or of MRE cannot distinguish between inflammatory activity and fibrosis.

OriginalsprogEngelsk
TidsskriftJournal of Crohn's and Colitis
Vol/bind12
Udgave nummer1
Sider (fra-til)48-56
ISSN1873-9946
DOI
StatusUdgivet - 1. jan. 2018

Fingeraftryk

Crohn Disease
Ultrasonography
Intestinal Diseases
Perfusion

Citer dette

Wilkens, Rune ; Hagemann-Madsen, Rikke H ; Peters, David A ; Nielsen, Agnete H ; Nørager, Charlotte B ; Glerup, Henning ; Krogh, Klaus. / Validity of Contrast-Enhanced Ultrasonography and Dynamic Contrast-Enhanced MR Enterography in the Assessment of Transmural Activity and Fibrosis in Crohn's Disease. I: Journal of Crohn's and Colitis. 2018 ; Bind 12, Nr. 1. s. 48-56.
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title = "Validity of Contrast-Enhanced Ultrasonography and Dynamic Contrast-Enhanced MR Enterography in the Assessment of Transmural Activity and Fibrosis in Crohn's Disease",
abstract = "Background and Aims: Increased small intestinal wall thickness correlates with both inflammatory activity and fibrosis in Crohn's disease [CD]. Assessment of perfusion holds promise as an objective marker distinguishing between the two conditions. Our primary aim was to determine if relative bowel wall perfusion measurements correlate with histopathological scores for inflammation or fibrosis in CD. Methods: A total of 25 patients were investigated before elective surgery for small intestinal CD. Unenhanced ultrasonography [US] and magnetic resonance enterography [MRE] were applied to describe bowel wall thickness. Perfusion was assessed with contrast-enhanced US [CEUS] and dynamic contrast-enhanced MRE [DCE-MRE]. Histopathology was used as gold standard. Results: Compared with histopathology, the mean wall thickness was 0.4 mm greater on US [range -0.3 to 1.0, p = 0.24] and 1.4 mm greater on MR [0.4 to 2.3, p = 0.006]. No correlation was found between the severity of inflammation or fibrosis on histopathology, and either DCE-MRE [r = -0.13, p = 0.54 for inflammation and r = 0.41, p = 0.05 for fibrosis] or CEUS [r = 0.16, p = 0.45 for inflammation and r = -0.28, p = 0.19 for fibrosis]. Wall thickness assessed with US was correlated with both histological inflammation [r = 0.611, p = 0.0012] and fibrosis [r = 0.399, p = 0.048]. The same was not true for MR [r = 0.41, p = 0.047 for inflammation and r = 0.29, p = 0.16 for fibrosis] Conclusions: Bowel wall thickness assessed with US is a valid marker of inflammation in small intestinal CD. However, relative contrast enhancement of US or of MRE cannot distinguish between inflammatory activity and fibrosis.",
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Validity of Contrast-Enhanced Ultrasonography and Dynamic Contrast-Enhanced MR Enterography in the Assessment of Transmural Activity and Fibrosis in Crohn's Disease. / Wilkens, Rune; Hagemann-Madsen, Rikke H; Peters, David A; Nielsen, Agnete H; Nørager, Charlotte B; Glerup, Henning; Krogh, Klaus.

I: Journal of Crohn's and Colitis, Bind 12, Nr. 1, 01.01.2018, s. 48-56.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Validity of Contrast-Enhanced Ultrasonography and Dynamic Contrast-Enhanced MR Enterography in the Assessment of Transmural Activity and Fibrosis in Crohn's Disease

AU - Wilkens, Rune

AU - Hagemann-Madsen, Rikke H

AU - Peters, David A

AU - Nielsen, Agnete H

AU - Nørager, Charlotte B

AU - Glerup, Henning

AU - Krogh, Klaus

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background and Aims: Increased small intestinal wall thickness correlates with both inflammatory activity and fibrosis in Crohn's disease [CD]. Assessment of perfusion holds promise as an objective marker distinguishing between the two conditions. Our primary aim was to determine if relative bowel wall perfusion measurements correlate with histopathological scores for inflammation or fibrosis in CD. Methods: A total of 25 patients were investigated before elective surgery for small intestinal CD. Unenhanced ultrasonography [US] and magnetic resonance enterography [MRE] were applied to describe bowel wall thickness. Perfusion was assessed with contrast-enhanced US [CEUS] and dynamic contrast-enhanced MRE [DCE-MRE]. Histopathology was used as gold standard. Results: Compared with histopathology, the mean wall thickness was 0.4 mm greater on US [range -0.3 to 1.0, p = 0.24] and 1.4 mm greater on MR [0.4 to 2.3, p = 0.006]. No correlation was found between the severity of inflammation or fibrosis on histopathology, and either DCE-MRE [r = -0.13, p = 0.54 for inflammation and r = 0.41, p = 0.05 for fibrosis] or CEUS [r = 0.16, p = 0.45 for inflammation and r = -0.28, p = 0.19 for fibrosis]. Wall thickness assessed with US was correlated with both histological inflammation [r = 0.611, p = 0.0012] and fibrosis [r = 0.399, p = 0.048]. The same was not true for MR [r = 0.41, p = 0.047 for inflammation and r = 0.29, p = 0.16 for fibrosis] Conclusions: Bowel wall thickness assessed with US is a valid marker of inflammation in small intestinal CD. However, relative contrast enhancement of US or of MRE cannot distinguish between inflammatory activity and fibrosis.

AB - Background and Aims: Increased small intestinal wall thickness correlates with both inflammatory activity and fibrosis in Crohn's disease [CD]. Assessment of perfusion holds promise as an objective marker distinguishing between the two conditions. Our primary aim was to determine if relative bowel wall perfusion measurements correlate with histopathological scores for inflammation or fibrosis in CD. Methods: A total of 25 patients were investigated before elective surgery for small intestinal CD. Unenhanced ultrasonography [US] and magnetic resonance enterography [MRE] were applied to describe bowel wall thickness. Perfusion was assessed with contrast-enhanced US [CEUS] and dynamic contrast-enhanced MRE [DCE-MRE]. Histopathology was used as gold standard. Results: Compared with histopathology, the mean wall thickness was 0.4 mm greater on US [range -0.3 to 1.0, p = 0.24] and 1.4 mm greater on MR [0.4 to 2.3, p = 0.006]. No correlation was found between the severity of inflammation or fibrosis on histopathology, and either DCE-MRE [r = -0.13, p = 0.54 for inflammation and r = 0.41, p = 0.05 for fibrosis] or CEUS [r = 0.16, p = 0.45 for inflammation and r = -0.28, p = 0.19 for fibrosis]. Wall thickness assessed with US was correlated with both histological inflammation [r = 0.611, p = 0.0012] and fibrosis [r = 0.399, p = 0.048]. The same was not true for MR [r = 0.41, p = 0.047 for inflammation and r = 0.29, p = 0.16 for fibrosis] Conclusions: Bowel wall thickness assessed with US is a valid marker of inflammation in small intestinal CD. However, relative contrast enhancement of US or of MRE cannot distinguish between inflammatory activity and fibrosis.

KW - Adult

KW - Aged

KW - C-Reactive Protein/metabolism

KW - Contrast Media

KW - Crohn Disease/complications

KW - Feces/chemistry

KW - Female

KW - Fibrosis

KW - Humans

KW - Inflammation/blood

KW - Intestines/pathology

KW - Leukocyte L1 Antigen Complex/analysis

KW - Magnetic Resonance Imaging/methods

KW - Male

KW - Middle Aged

KW - Severity of Illness Index

KW - Ulcer/diagnostic imaging

KW - Ultrasonography

KW - Young Adult

U2 - 10.1093/ecco-jcc/jjx111

DO - 10.1093/ecco-jcc/jjx111

M3 - Journal article

VL - 12

SP - 48

EP - 56

JO - Journal of Crohn's and Colitis

JF - Journal of Crohn's and Colitis

SN - 1873-9946

IS - 1

ER -