Problemstellung: Inflammatory hyperperfusion is a mainstay of diagnosis and the main therapeutic target in chronic inflammatory bowel diseases. It's exact measurement at the local site of it's development inside the bowel wall is therefore very important. We present a quite novel approach to sonographic inflammation grading in inflammatory bowel diseases via dynamic quantification of color Doppler signals along a complete heart cycle inside the bowel wall. The aim was to describe bowel wall perfusion in Crohn disease patients in comparison with healthy probands and to compare a conventional activity index (Pediatric Crohn Disease Activity Index) with perfusion measurements as an indicator of inflammatory activity.
Methoden: Color Doppler sonographic videos of bowel wall perfusion from 34 healthy children (aged 5 to 18 years) and from 14 patients with Crohn disease (aged 8.2 to 15.9 years) were recorded under defined conditions. Perfusion signals (color hue, color area) were automatically measured inside the bowel wall. Specific tissue perfusion was calculated as mean flow velocity of a region of interest during one full heart cycle. Bowel wall perfusion was compared using the Pediatric Crohn Disease Activity Index in 12 patients.
Ergebnisse: Specific bowel wall perfusion was significantly elevated in bowel segments of Crohn disease patients compared with healthy subjects (p<0.001). Specific flow in small bowel was 0.025cm/s in healthy probands and 0.095cm/s in patients with Crohn disease, whereas large bowel wall perfusion of 0.012cm/s in healthy probands clearly differed from 0.082cm/s in patients with Crohn disease. No differences of perfusion between moderate and high Pediatric Crohn Disease Activity Index levels could be demonstrated despite a weak significant overall correlation.
Schlussfolgerungen: The new method of dynamic, automatic noninvasive perfusion quantification is useful to describe local inflammatory activity in bowel segments affected by Crohn disease and adds new information to activity evaluation by Pediatric Crohn Disease Activity Index. Specific wall perfusion in intestines of Crohn patients is significantly elevated and reaches up to sevenfold intensity compared with healthy subjects.
