J Korean Med Sci.  2023 Jul;38(29):e219. 10.3346/jkms.2023.38.e219.

Contrast-Enhanced Ultrasonography for the Evaluation of Crohn’s Disease in Pediatric Patients

• Yoon H
• Kim J
• Lim HJ
• Lee MJ
• Lim H
• Noh J
• Park S

• KMID: 2544942
• DOI: http://doi.org/10.3346/jkms.2023.38.e219

Abstract

Background
Contrast-enhanced ultrasonography (CEUS) of the bowel wall has been suggested as an alternative imaging modality for the follow-up of children with Crohn’s disease. To demonstrate the feasibility and clinical usefulness of CEUS in the estimation of Crohn’s disease activity in children with endoscopy as the reference standard. Method: In this prospective study, 30 pediatric patients with Crohn’s disease (24 males and 6 females; median age 14 years) underwent CEUS from December 2020 to August 2021. The simple endoscopic score for Crohn’s disease, pediatric Crohn’s disease activity index, serologic inflammatory markers, fecal calprotectin and CEUS perfusion parameters were assessed and compared between the inactive and active group based on endoscopic findings.
Results
CEUS was performed successfully in all 30 patients. Two patients showed mild adverse side effects such as temporary dysosmia. The active Crohn’s disease group showed higher erythrocyte sedimentation rate (mm/hr) (13.0 vs. 2.0, P = 0.003), C-reactive protein (mg/dL) (4.7 vs. 0.55, P = 0.018) and fecal calprotectin (mcg/g) (1,503 vs. 237.5, P = 0.005). Among the quantitative parameters for CEUS, the mean gradient to the peak value was higher in the active group (1.18 vs. 0.93, P = 0.034). The sensitivity and specificity of the mean gradient to the peak value for predicting active Crohn’s disease was 55.6% and 83.3%, respectively, with a cut-off of 1.09 (P = 0.015).
Conclusion
CEUS can be a safe and specific diagnostic modality for Crohn’s disease activity in children. Among quantitative CEUS parameters, the mean gradient to the peak value could be used to differentiate active and inactive Crohn’s disease.

Keyword

Contrast Enhanced Ultrasound; Crohn’s Disease; Pediatric

Figure

• 

  Fig. 1 CEUS of the terminal ileum in a 15-year-old male with Crohn’s disease. There was bowel wall thickening with intense transmural enhancement. A time intensity curve was automatically generated from the region of interest. The X axis represents time (sec) and the y axis represents signal intensity (arbitrary units). This patient was assigned active disease status with the pediatric Crohn’s disease activity index and simple endoscopic score for Crohn’s disease. The mean gradient to the peak was 1.57 AU/sec, suggesting active disease on CEUS.CEUS = contrast-enhanced ultrasound, AU = arbitrary unit.

• 

  Fig. 2 Contrast-enhanced ultrasound perfusion parameters and time intensity curve.ROI = region of interest, Mgrad = Max gradient, AU = arbitrary unit, MGT = Max gradient time, Grad = mean gradient to the peak, ArT = arrival time, TtoP = time to peak, PI = peak intensity, TWH = time width at half maximum, TWR = time width ratio, AUC = area under the curve, WiAUC = wash in area under the curve, WoAUC = wash out are under the curve.

• 

  Fig. 3 Comparison of receiver operating characteristics curves for peak enhancement in the prediction of active Crohn’s disease. There was no significant difference in diagnostic performance between the parameters.ESR = erythrocyte sedimentation rate, FC = fecal calprotectin, Grad = mean gradient to the peak, CRP = C-reactive protein.

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