Antonio DeFranco MD, Presenter: Nothing to Disclose

Alessandra di Veronica, Abstract Co-Author: Nothing to Disclose

Luisa Guidi, Abstract Co-Author: Nothing to Disclose

Alessandro Armuzzi MD, Abstract Co-Author: Nothing to Disclose

Enrico Bock MD, Abstract Co-Author: Nothing to Disclose

Lorenzo Bonomo MD, Abstract Co-Author: Nothing to Disclose

Our previous study suggested the possibility to correlate data obtained by HDI-QLab software elaboration applied to CEUS and clinical/laboratory activity indexes in ileal Crohn’s Disease (CD). Aim of the present perspective study was to evaluate if Time To Peak (TTP), Maximum Peak Intensity (MPI) and Slope are able to predict and quantify inflammatory activity in ileal CD.

After informed consent, in the past 2007, thirty-six consecutive patients (M:26, F:10, age range 20-60 years) affected by ileal CD without colonic disease or with inactive colonic disease, were studied by CEUS using digital US scanner Philips iU22 with 4-8 MHz linear-array probe after i.v. administration of 4,8 ml of a blood pool contrast agent (sulphur hexafluoride, SonoVue® - SV). According to Montreal classification 12 patients had inflammatory, 10 stricturing and 14 penetrating disease. As gold standard to determine active disease we choose Biological Activity (BA), scored as positive when 3/4 of next criteria were present: clinical index (CDAI), laboratory indexes (CRP, WBC, fibrinogen, alpha1 acid glycoprotein), Imaging (small bowel enema, entero-CT, entero-MRI or follow through) and retrograde ileoscopy; ten patients had inactive and 26 active disease. US data obtained allow to draw-up time-intensity curves through software-assisted HDI-QLab and to correlate Time To Peak (TTP), Maximum Peak Intensity (MPI) and Slope (β value: coefficient of the wash-in slope) with BA through ROC curve analysis.

In distinguish active disease, TTP (seconds) with a cut-off >0 showed sensitivity 100% specificity 60% (p0.0003, AUC 0.785); MPI (Db), cut-off >24, sensitivity 100%, specificity 80% (p0.0001, AUC 0.946); Slope (Db/sec), cut-off >4.49, sensitivity 84.06%, specificity 90%, (p0.0001, AUC 0.923).

TTP, MPI and Slope are able to predict and quantify inflammatory activity in ileal CD. Quantitative CEUS and definite cut-off could improve the reliability of conventional US to detect active bowel wall inflammation in CD. Quantitative data could objectify the response to the therapies. The sensitivity values found must be verify by including a major number of patients.  

Microvascular activation/angiogenesis in CD could be demonstrate and measured by software assisted-CEUS. It could distinguish active and inactive disease and objectify the response to the therapies.

DeFranco, A, di Veronica, A, Guidi, L, Armuzzi, A, Bock, E, Bonomo, L, Contrast-enhanced Ultrasound and Quantification of Microvascular Activation in Ileal Crohn’s Disease by Means of Software Elaboration Data: Time to Peak, Maximum Peak Intensity, and Slope as Possible Indexes of Active Disease.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6014827.html