High-Resolution Sonography (HR-US) in Patients with Small Bowel Crohn´s Disease in Comparison with MD-CT-Enterography

  • Prof Norbert Boerner, Medical Practice for Gastroenterology, Germany
  • S Uenker, Medical Practice for Gastroenterology, Germany
  • S Bitschnau, University Mainz, Germany
  • P Mildenberger, University Mainz, Germany
  • Dr Eckhart Froehlich, Karl-Olga Hospital Stuttgart, Germany

    • INTRODUCTION : Imaging of pathologic processes occuring in the small bowel has traditionally been performed with barium small-bowel follow-through
    examinations, single- or double-contrast intubated enteroclysis, MRI and CT. Ultrasonography with highresolution probes (HR-US) have been shown an easy procedure with high diagnostic accuracy.
    In this study outpatients with Crohn´s disease were studied with HR-small bowel ultrasound in comparison with MD-CT-enterography (low radiation mode) on behalf of disease location and extension, activity and complications (fistula and/or abscess).

    MATERIAL and METHODS:
    Small bowel involvement of 43 patients with Crohn´s disease (mean age 35 y +/- 13; mean disease duration 7.9 y; mean CDAI 200 +/- 128) was followed prospectively by HR-ultrasound (GE Logiq 7). Ultrasound investigations were performed during routine ambulatory appointments without any bowel preparation using high resolution ultrasound probes (6-12 MHz-Matrix). Pathologic findings were documented as small bowel thickness (mm), length of involvement (cm) and disease activity measuring the intensity of colour flow signals in the inflamed segments (Grad I-III). MDCT-Enterography (Philips MX 8000 IDT) was performed within 1 week after US using oral bowel preparation with 2l Mannitol, i.v. scopolaminbutylbromid and iv iodinaded contrast material (100 ml, 3 ml/sec).

    US-Results were compared with CT-examinations by quadrant to quadrant analysis.

    RESULTS:
    1) HR-US detected 46 bowel segments with significant wall-thickening in 43 pts. (MD-CT = 58 segments; r=0.646. Best agreement in the right lower quadrant (neo-/terminal ileum). MD-CT was superior to US detecting abnormal segments of shorter length (Skip lesions <5 cm).
    2) Length of bowel wall involvement, mesenterial thickening and lymph node enlargement were comparable.
    3) Bowel wall blood flow as a marker of inflammation was comparable.
    4) Fistulas were detected by both methods were as localized abscess formation (n=4) was only detected by HR-US.

    CONCLUSION: in the clinical setting routine HR-US is suitable for monitoring small bowel Crohn´s disease comparable to radiologic imaging procedures like MD-CT-enterography.