Blanca Pellicer, Presenter: Nothing to Disclose

Elena Roma PhD, Abstract Co-Author: Nothing to Disclose

Tomas Ripolles MD, Abstract Co-Author: Nothing to Disclose

Maria Jesus Martinez Perez, Abstract Co-Author: Nothing to Disclose

Jose María Paredes, Abstract Co-Author: Nothing to Disclose

Nuria Rausell, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to evaluate the accuracy of several US parameters, especially of contrast-enhanced US, for characterization of intestinal strictures in CD, with histopathology as the reference.

Preoperative ultrasonographic exam, including color Doppler and contrast-enhanced ultrasound (CEUS) with a second generation agent contrast, was performed in 25 consecutive patients with Crohn´s disease undergoing elective bowel resection. Sonographic variables, such as wall thickness, color Doppler grade and quantitative analysis of the enhancement, were prospectively evaluated and compared with the histopathologic results. Using the sonographic image of the ex vivo surgical specimens, pathologist and radiologist in consensus, identified the location of the precise histologic sampling. Histopathologic grading of acute inflammation with the acute inflammatory score and the degree of fibrostenosis was performed in each segment, and results were compared with every US imaging variable and a previously defined sonographic score system for inflammatory and fibrostenotic changes.

28 segments were analyzed. In pathology analysis there were 12 predominantly inflammatory stenosis, 8 predominantly fibrostenotic and 8 compound lesions. When the stenosis were classified into three groups the agreement between sonography and pathology scores was 64%. When the pathology score was dichotomized into two groups (inflammatory and fibrostenotic) the agreement was 82% (kappa=0.632). Color Doppler grade and percentage of increase in contrast enhancement were significantly associated with the pathology inflammatory score (p=0,036 and p=0,005). Percentage of increase in contrast enhancement of the bowel wall in patients with inflammatory strictures (82,07) was significantly greater in comparison with patients with fibrotic strictures (63,08) p=0,03. With a threshold value of 65% CEUS had a sensitivity of 93,3% and specificity of 69,2% for differentiating between inflammatory and fibrostenotic stenosis.

Color Doppler grade and percentage of increase in contrast enhancement correlate with histologic features of inflammation in Crohn´s disease. Sonography, including CEUS, can be a useful tool for distinguish inflammatory from fibrostenotic stenosis.

 Stenosis treatment in CD is based on the differentiation between inflammatory versus fibrous-predominant strictures.

Pellicer, B, Roma, E, Ripolles, T, Martinez Perez, M, Paredes, J, Rausell, N, Effectiveness of Contrast-enhanced Ultrasonography for Characterization of Bowel Strictures in Crohn’s Disease.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9011373.html