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Alimentary Tract| Volume 53, ISSUE 6, P729-737, June 2021

Bowel contrast-enhanced ultrasound perfusion imaging in the evaluation of Crohn's disease patients undergoing anti-TNFα therapy

Published:September 05, 2020DOI:https://doi.org/10.1016/j.dld.2020.08.005
Bowel contrast-enhanced ultrasound perfusion imaging in the evaluation of Crohn's disease patients undergoing anti-TNFα therapy
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      Abstract

      Aim

      To evaluate whether changes in bowel perfusion parameters measured by dynamic-CEUS (D-CEUS) can be used for monitoring response to therapy in active Crohn disease (CD).

      Methods

      Fifty-four CD patients were evaluated with d-CEUS before (T0) and after 2 (T1), 6 (T2) and 12 weeks (T3) of anti-TNFα therapy. Variations from baseline were calculated for: peak intensity, PI; area under the curve, AUC; slope of wash in, Pw; time to peak, TP; mean transit time, MTT (median percentage values) and were correlated with combined endoscopic/clinical response after 12 weeks and clinical relapse within 6 months.

      Results

      70% of patients achieved combined endoscopic/clinical response (responders). The reduction in PI, AUC, Pw and MTT between T1 and T0 was higher in responders. Relapsers (21%) showed significantly lower reduction in delta PI and Pw at T1 and T2. At T3 they showed a new increase in PI and lower reduction in delta Pw. In relapsers, AUC showed a significantly lower decrease at T2 and T3, TP showed a significant reduction at T3 and MTT showed a progressive increase at the different time-points, reaching the statistical significance at T3.

      Conclusions

      d-CEUS might become a reliable predictor of combined endoscopic/clinical response and clinical relapse in CD.

      Keywords

      Abbreviations:

      CD (Crohn's disease), US (Ultrasonography), d-CEUS (Dynamic contrast-enhanced ultrasound), CDAI (Crohn's disease activity index), ROI (Region of interest), PI (Peak intensity), TP (Time to peak intensity), AUC (Area under the time-intensity curve), Pw (Slope coefficient of wash in), MTT (Mean transit time), SES-CD (Simplified endoscopic activity score for CD), ICC (Intraclass Correlation Coefficient)
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      Article info

      Publication history

      Published online: September 05, 2020
      Accepted: August 2, 2020
      Received: March 16, 2020

      Identification

      DOI: https://doi.org/10.1016/j.dld.2020.08.005

      Copyright

      © 2020 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

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