ABSTRACT
This was a prospective comparison of dynamic MRI (1.5 T) and echo-signal enhanced ultrasound in evaluating vascularization in thickened bowel walls cases of Crohn's disease. Twenty-one patients with histologically confirmed Crohn's disease and bowel wall diameters >5 mm were examined by MRI and ultrasound (US). MR sequences: T1w fl2D, T2w, FLASH T1w post-contrast media (CM) applications with fat saturation were used. Dynamic Turbo-FLASH T1w sequences were acquired in the area of maximal thickening of the ileal wall every 1.5 s post-CM application for a total duration of 1 min. US was performed after the application of 1.2 ml of echo-signal enhancer. Contrast uptake was measured by the semiquantitative score and brightness analysis in regions of interest (ROI). Clinical and laboratory findings including Crohn's disease activity indices were documented; MRI and US parameters were correlated. The length of sonographically documented lesions (122+/-75 mm) correlated significantly with the length of thickened bowel segments in MRI (128+/-76 mm; r=0.466; P=0.033). The maximum percent signal enhancement in the terminal ileum at ultrasound (217.5+/-100.1%) showed a high correlation with the findings of MRI (262+/-108%; r=0.623; P=0.003). With both methods, a plateau phase was observed. US and MRI are capable of evaluating local vascularization in the bowel wall objectively.
Subject(s)
Contrast Media/administration & dosage , Crohn Disease/diagnostic imaging , Crohn Disease/pathology , Image Enhancement , Magnetic Resonance Imaging , Ultrasonography, Interventional , Adult , Artifacts , Contrast Media/metabolism , Female , Humans , Image Processing, Computer-Assisted , Injections, Intravenous , Magnetic Resonance Imaging/methods , Male , Middle Aged , Phospholipids/administration & dosage , Phospholipids/metabolism , Prospective Studies , Severity of Illness Index , Sulfur Hexafluoride/administration & dosage , Sulfur Hexafluoride/metabolismABSTRACT
OBJECTIVE: To assess the possibility of quantitative determination of bowel wall vascularity using contrast-enhanced (SonoVue) wideband harmonic imaging ultrasound and the HDI-Lab software in patients with Crohn's disease. MATERIAL AND METHODS: Twenty-one patients (13 F, 8 M, average age 33.8+/-12.7 years, range 21-60 years) with histologically confirmed Crohn's disease and bowel wall thickness > or -5 mm were recruited for the study. All ultrasound examinations were performed using a Philips HDI 5000 scanner. Bowel wall vascularity was determined at the site of maximum bowel wall thickness at baseline and at 30, 60, 90 and 120 s following application of the contrast enhancer SonoVue (1.2 ml) using the HDI-Lab software. RESULTS: The mean length of bowel segments exhibiting increased wall thickness was 122.3 mm (range: 23-350+/-74.7 mm), with a mean wall thickness of 7.6+/-1.2 mm. Onset of echo enhancement secondary to contrast medium application was observed after an average 13.4 s (range 7-19+/-4.2 s). Echo intensity corresponding to maximum vascularity was measured 30 s after application of contrast medium. Maximum average contrast medium uptake was 217.5% (range 118-466+/-100.1%). CONCLUSIONS: It is possible to quantify bowel wall vascularity accurately in patients with Crohn's disease using contrast-enhanced pulse inversion ultrasound (low-MI).
