Comparison between Preoperative Quantitative Assessment of Bowel Wall Vascularization by Contrast-Enhanced Ultrasound and Operative Macroscopic Findings and Results of Histopathological Scoring in Crohn’s Disease

Zusammenfassung

Ziel: Um Patienten mit Morbus Crohn Untersuchungen zu ersparen, bei denen sie ionisierender Strahlung ausgesetzt werden, wird angestrebt, das Ausmaß der Darmwandentzündung mittels Ultraschall einzuschätzen. Wir versuchten, das Perfusionsmuster entzündeter Darmabschnitte mittels Kontrastmittelsonografie und spezifischer Quantifizierungssoftware zu beschreiben und dann mit dem intraoperativen makroskopischen Befund und den Ergebnissen eines histopathologischen Aktivitätsscores zu vergleichen. Material und Methoden: Wir untersuchten prospektiv 20 Patienten mit nachgewiesenem Morbus Crohn, die sich konsekutiv wenige Tage vor geplanter Darmresektion vorstellten. Zunächst erfolgte präoperativ eine Kontrastmittelsonografie. An den digitalisierten gespeicherten Daten der Kontrastmittelsonografie wurde die Quantifizierungs-Software Qontrast® angewandt. Das Krankheitsverhalten wurde entsprechend dem intraoperativen Befund nach der Vienna-Klassifikation, das histopathologische Ausmaß der Entzündung anhand eines histopathologischen Scoringsystems definiert. Ergebnisse: Wir fanden eine enge negative Korrelation zwischen TTP (s) – entsprechend der Anflutungszeit des Kontrastmittels bis zum Erreichen der maximalen Signalintensität – und dem histopathologischen Gesamtscore (r = – 0,677; p < 0,01). Außerdem zeigten sich enge Korrelationen zwischen TTP (s) und einzelnen histologischen Parametern aus diesem Score. Schlussfolgerung: Es besteht ein enger Zusammenhang zwischen der TTP (s) und dem histologischen Ausmaß der Entzündung, sodass die quantifizierte kontrastmittelgestützte Sonografie zur nicht invasiven, strahlungsfreien Einschätzung der Darmwandentzündung geeignet ist.

Abstract

Purpose: Patients with Crohn’s disease (CD) often undergo several radiological imaging studies, which – with the exception of MRI and US – subject patients to ionizing radiation. Thus, efforts have been made to identify the inflammation activity using ultrasound techniques. The aim of our study was to describe the perfusion pattern of the inflamed bowel wall in CD using contrast-enhanced ultrasound (CEUS) and specific quantification software for perfusion assessment. Moreover, we compared these findings with the operative macroscopic findings as well as with the transparietal histopathological findings of surgical specimens applying an advanced histopathological scoring system. Materials and Methods: We prospectively performed CEUS in 20 consecutive patients with proven CD and planned bowel surgery due to CD within the next 15 days. We then applied the quantification software Qontrast® to obtain contrast-enhanced sonographic perfusion maps. The surgeon defined the clinical behavior of CD according to the Vienna classification. The resected segments were then assessed by a pathologist using an advanced scoring system. We compared the results of CEUS, macroscopic findings and histopathological scoring. Results: We found a strong negative correlation (r = – 0.677, p < 0.01) between the histopathological score and the time-to-peak (TTP). Moreover, we detected a strong correlation between TTP and single parameters of the histopathological scoring system. Conclusion: Ultrasound as a widely available radiation-free imaging method would be preferable for assessing inflammatory activity of CD, particularly since the ultrasound findings correlate significantly with a histopathological scoring system.

Key words

ultrasound - inflammation - abdomen

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