Emilio Quaia MD, Presenter: Nothing to Disclose

Matteo Coss MD, Abstract Co-Author: Nothing to Disclose

Alexia Rossi MD, Abstract Co-Author: Nothing to Disclose

Marco Doddi, Abstract Co-Author: Nothing to Disclose

Maurizio Grotto, Abstract Co-Author: Nothing to Disclose

Maria Assunta Cova MD, Abstract Co-Author: Nothing to Disclose

To assess the diagnostic value of the small bowel wall vascularity after microbubble contrast agent injection in evaluating the disease activity and the therapeutic effectiveness of specific anti-inflammatory treatment in patients with Crohn’s disease.

Fifteen patients (7 male and 8 female; mean age ± SD, 40 years ± 6) with a biopsy-proven diagnosis of Crohn’s disease involving the terminal loop of the small bowel - Crohn’s disease activity index (CDAI) >150 (n=12 patients) or ≤150 (n=3) - were included. In each patient the terminal loop of the ileum was scanned after sulfur hexafluoride-filled microbubble injection the day before and the day after the end of the first 3 and 6-months of specific anti-inflammatory treatment (mesalamine in 10 patients, corticosteroids in 2 patients, and immunosuppressives including azathioprine or methotrexate in 3 patients). The small bowel vascularity was visually assessed and scored (0= absent, 1= limited to the submucosa, or 2= diffuse transparietal) and correlated with the CDAI by non-parametric correlation analysis. Moreover, the refilling kinetic of the terminal bowel loop by microbubbles after high transmit power insonation was quantified in grey-scale levels (0 – 255) by a dedicated software.

Before the treatment all patients revealed diffuse transparietal enhancement, except for 3 patients who revealed only submucosa enhancement with significant correlation with the CDAI (correlation factor=0.95, P<0.05). In 13 patients the slope of the first ascending tract and the plateau phase of the refilling curve were significantly lower after the first 3 and 6 months of treatment (P<0.05; Wilcoxon test) with correlation with CDAI reduction (correlation factor = 0.85, P<0.05). In 2 patients no significant vascularity change was found even though a low reduction of the CDAI (from 200 to 150) was identified.

The assessment of the small bowel wall vascularity after microbubble injection is reliable to assess the disease activity and the specific effectiveness in patients with Crohn's disease.

Contrast-enhanced US should be included in the diagnostic management of patients with Crohn’s disease.

Quaia, E, Coss, M, Rossi, A, Doddi, M, Grotto, M, Cova, M, The Diagnostic Value of the Small Bowel Wall Vascularity after Microbubble Injection in Patients with Crohn’s Disease: Correlation with the Disease Activity and the Therapeutic Effectiveness of Specific Anti-inflammatory Treatment.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5000285.html