Z Gastroenterol 2002; 40(3): 171-175
DOI: 10.1055/s-2002-22325
Originalarbeiten
© Karl Demeter Verlag im Georg Thieme Verlag Stuttgart · New York

Non-invasive Evaluation of Activity in Inflammatory Bowel Disease by Power Doppler Sonography[*]

Nichtinvasive Evaluation der Aktivität von chronisch-entzündlichen Darmerkrankungen mit der Power-Doppler-SonographieR. Heyne1 , S. Rickes1 , P. Bock1 , S. Schreiber2 , W. Wermke1 , H. Lochs1
  • 1Dept. of Gastroenterology, Hepatology and Endocrinology, University Hospital Charité (Campus Mitte), 10117 Berlin, Germany
  • 2Dept. of Internal Medicine I, Christian Albrechts University, 24105 Kiel, Germany
Further Information

Publication History

5.9.2001

19.11.2001

Publication Date:
19 March 2002 (online)

Abstract

Background: To study the vascularization in the diseased bowel wall by power Doppler sonography in patients with inflammatory bowel disease.

Patients and methods: The diseased bowel wall was investigated in 99 patients with inflammatory bowel disease (60 patients with Crohn’s disease and 39 patients with ulcerative colitis) either with active disease or in remission by B-mode and power Doppler sonography. Disease activity was determined by clinical indices. Twenty healthy age and sex matched individuals served as controls.

Results: Bowel wall was thickened in active Crohn’s disease (mean 7 mm, range 4-14) and ulcerative colitis (mean 5 mm, range 2-15) as compared to healthy controls (mean 2 mm, range 1-3), p < 0.001. In contrast to healthy controls blood vessels were detected in the bowel wall in 100 % of patients with active Crohn’s disease and 91 % with active ulcerative colitis. Vascularization was significant decreased in patients with quiescent versus active disease in ulcerative colitis (p < 0.05), while in Crohn’s disease there was no significance between active and remission phase.

Conclusions: Thickened and hypervascularized bowel wall are characteristic findings in inflammatory bowel disease. A combination of B-mode and power Doppler sonography offers an additional noninvasive procedure for the determination of activity in patients with inflammatory bowel disease.

Zusammenfassung

Studienziel: Mit der Power-Doppler-Sonographie sollte prospektiv die Vaskularisation in erkrankten Darmabschnitten von Patienten mit chronisch-entzündlichen Darmerkrankungen untersucht werden.

Patienten und Methoden: Erkrankte Darmsegmente von 99 Patienten mit chronisch-entzündlicher Darmerkrankung (60 Patienten mit Morbus Crohn und 39 Patienten mit Colitis ulcerosa) im aktiven Stadium oder in Remission wurden mit der B-Bild-Sonographie und der Power-Doppler-Sonographie untersucht. Die Krankheitsaktivität wurde anhand klinischer Parameter bestimmt. 20 gesunde Personen dienten als Kontrollgruppe.

Ergebnisse: Die Darmwand war verdickt in Patienten mit aktivem Morbus Crohn (Durchschnitt 7 mm, Range 4-14) und aktiver Colitis ulcerosa (Durchschnitt 5 mm, Range 2-15) verglichen mit der Kontrollgruppe (Durchschnitt 2 mm, Range 1-3), p < 0,001. Blutgefäße wurden detektiert in 100 % der Patienten mit aktivem Morbus Crohn und 91 % der Patienten mit aktiver Colitis ulcerosa. Die Vaskularisation war signifikant erniedrigt in Darmabschnitten von Patienten mit inaktiver Colitis ulcerosa gegenüber Patienten mit aktiver Krankheit (p < 0,05). Bei Patienten mit Morbus Crohn war kein Unterschied zwischen inaktiver und aktiver Phase zu beobachten.

Folgerungen: Verdickte und vermehrt durchblutete Darmwände sind charakteristisch für chronisch-entzündliche Darmerkrankungen. Eine Kombination von konventionellem Ultraschall und echosignalverstärkter Power-Doppler-Sonographie ist ein zusätzliches nichtinvasives Verfahren zur Bestimmung der Aktivität bei Patienten mit chronisch-entzündlichen Darmerkrankungen.

1 Paper has been represented at the 1998 Annual Meeting during Digestive Disease Week in New Orleans, LA, May 17-20.

References

  • 1 Kimmey M B, Martin R W, Haggitt R C. et al . Histologic correlates of gastrointestinal ultrasound images.  Gastroenterology. 1989;  96 433-441
  • 2 Hata J, Haruma K, Yamanka H. et al . Ultrasonographic evaluation of the bowel wall in inflammatory bowel disease: Comparison of in vivo and in vitro studies.  Abdom Imaging. 1994;  19 395-399
  • 3 Hata J, Haruma K, Suenaga K. et al . Ultrasonographic assessment of inflammatory bowel disease.  Am J Gastroenterol. 1992;  87 443-447
  • 4 Lim J H, Ko T Y, Lee D H, Lim J W, Kim T H. Sonography of inflammatory bowel disease: findings and value in differential diagnosis.  AJR. 1994;  163 343-347
  • 5 Maconi G, Parente F, Bollani S. et al . Abdominal ultrasound in the assessment of extent and activity of Crohn’s disease: Clinical significance and implication of bowel wall thickening.  Am J Gastroenterol. 1996;  91 1604-1609
  • 6 Lunderquist A, Knutsson A. Angiography in Crohn’s disease of the small bowel and colon.  AJR. 1967;  101 338-344
  • 7 Boijsen E, Reuter S R. Mesenteric angiography in the evaluation of inflammatory and neoplastic disease of the intestine.  Radiology. 1966;  87 1028-1036
  • 8 Van Oostayen J A, Wasser M NJM, Van Hogezand R A, Griffioen G, De Roos A. Activity of Crohn disease assessed by measurement of superior mesenteric artery flow with Doppler US.  Radiology. 1994;  193 551-554
  • 9 Van Oostayen J A, Wasser M NJM, Van Hogezand R A. et al . Doppler sonographic evaluation of superior mesenteric artery flow to assess Crohn’s disease activity: Correlation with clinical evaluation, Crohn’s disease activity index, and α1-antitrypsin clearance in feces.  AJR. 1997;  168 429-433
  • 10 Van Oostayen J A, Wasser M NJM, Griffioen G. et al . Diagnosis of Crohn’s ileitis and monitoring of disease activity: Value of Doppler ultrasound of superior mesenteric artery flow.  Am J Gastroenterol. 1998;  93 88-91
  • 11 Bolondi L, Gaiani S, Brignola C. et al . Changes in splanchnic hemodynamics in inflammatory bowel disease. Non-invasive assessment by Doppler ultrasound flowmetry.  Scand J Gastroenterol. 1992;  27 501-507
  • 12 Ludwig D, Wiener S, Bruning A. et al . Mesenteric blood flow is related to disease activity and risk of relapse in ulcerative colitis: A prospective follow up study.  Gut. 1999;  45 546-52
  • 13 Zoli M, Merkel C, Sabba C. et al . Interobserver and inter-equipment variability of echo-Doppler sonographic evaluation of the superior mesenteric artery.  J Ultrasound Med. 1996;  15 99-106
  • 14 Sturm W, Judmaier G, Propst A, Kathrein H. Clinical paper colour Doppler imaging for examination of bowel wall vessels in inflammatory bowel disease: preliminary results.  Eur J Ultrasound. 1994;  1 229-233
  • 15 Bude R O, Rubin J M. Power Doppler sonography.  Radiology. 1996;  200 21-23
  • 16 Bude R O, Rubin J M, Adler R S. Power versus conventional colour Doppler sonography: Comparison in the depiction of normal intrarenal vasculature.  Radiology. 1994;  192 777-780
  • 17 Sohn C, Krunes U, Becker D. et al . Possibilities and limits of a new colour technique: Ultrasound angiography-results of the ”Heidelberg Round Table Discussion”.  Bildgebung. 1995;  62 53-63
  • 18 Clautice-Engle T, Jeffrey R B Jr, Li K C, Barth R A. Power Doppler imaging of focal lesions of the gastrointestinal tract: Comparison with conventional colour Doppler imaging.  J Ultrasound Med. 1996;  15 63-66
  • 19 Wermke W, Gaßmann B. Tumour diagnostics of the liver with echo enhancers. Berlin, Heidelberg, New York; Springer Verlag 1998: 8-223
  • 20 Rickes S, Unkrodt K, Wermke W. et al . Evaluierung dopplersonographischer Kriterien zur Differentialdiagnostik von Pankreastumoren.  Ultraschall Med. 2000;  21 253-258
  • 21 Malchow H, Ewe K, Brandes J W. et al . European cooperative Crohn’s disease study (ECCDS): Results of drug treatment.  Gastroenterology. 1984;  86 249
  • 22 Rachmilewicz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: A randomised trial.  BMJ. 1989;  298 82-86
  • 23 Best W R, Becktel J M, Singleton J W, Kern jr F. Development of a Crohn’s disease activity index. National cooperative Crohn’s disease study.  Gastroenterology. 1976;  70 439-444
  • 24 Kathrein H, Dzien A, Schuhmayer R, Judmaier G, Braunsteiner H. Diagnosis of changes in blood flow in the inferior mesenteric artery in inflammatory bowel diseases with duplex sonography.  Vasa Suppl. 1990;  30 129-132
  • 25 Mirk P, Palazzoni G, Gimondo P. Doppler sonography of hemodynamic changes of the inferior mesenteric artery in inflammatory bowel disease.  AJR. 1999;  173 381-387
  • 26 Maconi G, Imbesi V, Bianchi P orro B. Doppler ultrasound measurement of intestinal blood flow in inflammatory bowel disease.  Scand J Gastroenterol. 1996;  31 590-593
  • 27 Maconi G, Parente F, Bollani S. et al . Factors affecting splanchnic haemodynamics in Crohn’s disease: A prospective controlled study using Doppler ultrasound.  Gut. 1998;  43 645-650
  • 28 Rubin J M, Bude R O, Carson P L, Bree R L, Adler R S. Power Doppler US: A potentially useful alternative to mean frequency-based colour Doppler sonography.  Radiology. 1994;  190 853-856
  • 29 Limberg B. Diagnosis of chronic inflammatory bowel disease by ultrasonography.  Z Gastroenterol. 1999;  37 495-508
  • 30 Worlicek, Lutz H, Thoma B. Sonography of chronic inflammatory bowel diseases - a prospective study.  Ultraschall Med. 1986;  7 275-280
  • 31 Meckler U, Caspary W F, Clement T. et al . Sonography in Crohn disease - the conclusions of an experts’ group.  Z Gastroenterol. 1991;  29 355-359

1 Paper has been represented at the 1998 Annual Meeting during Digestive Disease Week in New Orleans, LA, May 17-20.

Address for correspondence

Prof. Dr. W. Wermke

Dept. of Gastroenterology, Hepatology and Endocrinology
University Hospital Charité (Campus Mitte)

Schumannstraße 20/21

10117 Berlin

Email: steffen.rickes@charite.de