Pediatr Gastroenterol Hepatol Nutr.  2019 May;22(3):282-290. 10.5223/pghn.2019.22.3.282.

Contrast-Enhanced Ultrasound and Shear Wave Elastography Evaluation of Crohn's Disease Activity in Three Adolescent Patients

• Thimm MA
• Cuffari C
• Garcia A
• Sidhu S
• Hwang M

• KMID: 2444854
• DOI: http://doi.org/10.5223/pghn.2019.22.3.282

Abstract

Characterizing inflammation and fibrosis in Crohn's disease (CD) is necessary to guide clinical management, but distinguishing the two remains challenging. Novel ultrasound (US) techniques: contrast-enhanced US (CEUS) and shear wave elastography (SWE) offer great potential in evaluating disease activity in pediatric patients. Three patients ages 16 to 20 with known CD underwent CEUS and SWE to characterize bowel wall inflammation and fibrosis. Magnetic resonance enterography, endoscopy, or surgical pathology findings are also described when available. The patients' disease activity included acute inflammation, chronic inflammation with stricture formation, and a fibrotic surgical anastomosis without inflammation. CEUS was useful in determining the degree of inflammation, and SWE identified bowel wall fibrosis. Used together these techniques allow for better characterization of the degree of fibrosis and inflammation in bowel strictures. With further validation CEUS and SWE may allow for improved characterization of bowel strictures and disease flares in pediatric patients suffering from CD.

Keyword

Ultrasound; Contrast agents; Elastography; Crohn's disease; Inflammatory bowel disease; Pediatrics

MeSH Terms

Adolescent*
Anastomosis, Surgical
Constriction, Pathologic
Contrast Media
Crohn Disease*
Elasticity Imaging Techniques*
Endoscopy
Fibrosis
Humans
Inflammation
Inflammatory Bowel Diseases
Pathology, Surgical
Pediatrics
Ultrasonography*
Contrast Media

Figure

• 

  Fig. 1 A case of acute inflammation in a child with Crohn's disease. (A) Contrast-enhanced ultrasound demonstrates avid contrast enhancement in the narrowed terminal ileum. (B) Transverse contrast magnetic resonance imaging of the abdomen demonstrating bowel wall thickening and inflammation in the terminal ileum. (C) Contrast enhancement curve and quantitative parameters generated from the time-intensity curves based on the drawn region of interest in the terminal ileum. LDRW: local density random walk, WIWO: wash-in, wash-out, AUC: area under the curve.

• 

  Fig. 2 A case of a fibrotic stricture in a child with Crohn's disease. (A) Contrast-enhanced ultrasound demonstrates minimal contrast enhancement in the surgical anastomosis. (B) Transverse magnetic resonance imaging of the abdomen demonstrates mild hyperenhancement of the small bowel loops without definite wall thickening or mesenteric inflammation. (C) Contrast enhancement curve and quantitative parameters generated from the time-intensity curves based on the drawn region of interest in the surgical anastomosis. LDRW: local density random walk, WIWO: wash-in, wash-out, AUC: area under the curve.

• 

  Fig. 3 A case of chronic inflammation and stricture formation in a child with Crohn's disease. (A) Intraoperative picture from ileocecectomy demonstrating the stretched-out stricture. The surgical instrument on the top indicates the area of the worst disease activity. (B) Contrast enhancement curve and quantitative parameters generated from the time-intensity curves based on the drawn region of interest in the terminal ileum. LDRW: local density random walk, WIWO: wash-in, wash-out, AUC: area under the curve.

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