Romanini Laura, Passamonti Matteo, Navarria Mario, Lanzarotto Francesco, Villanacci Vincenzo, Grazioli Luigi, Calliada Fabrizio, Maroldi Roberto
Department of Radiology, Spedali Civili di Brescia, P.le Spedali Civili, 1, 25123 Brescia, Italy.
Department of Radiology-AO Provincia di Lodi, Via Fissiraga, 15, 26900 Lodi, Italy.
Eur J Radiol. 2014 Aug;83(8):1317-23. doi: 10.1016/j.ejrad.2014.05.012. Epub 2014 May 16.
To evaluate the accuracy of quantitative analysis of bowel wall enhancement in inflammatory bowel disease (IBD) with contrast enhanced ultrasound (CEUS) by comparing the results with vascular density in a biopsy sample from the same area of the intestinal tract, and to determine the usefulness of this analysis for the prediction of disease activity.
This prospective study was approved by our institute's ethics committee and all patients gave written informed consent. We enrolled 33 consecutive adult patients undergoing colonoscopy and biopsy for IBD. All patients underwent CEUS and the results were quantitatively analyzed. Vessel count per high-power field on biopsy specimens was compared with colonoscopy, baseline ultrasonography, and CEUS findings, and with analysis of peak intensity, time to peak, regional blood volume, mean transit time, and regional blood flow. Results in patients with high and low vascular density were compared using Fisher's test, t-test, Pearson's correlation test, and receiver operating characteristic curve (ROC) analysis. Cutoff values were determined using ROC analysis, and sensitivity and specificity were calculated.
High vascular density (>265 vessels per field) on histological examination was significantly correlated with active disease on colonoscopy, baseline ultrasonography, and CEUS (p<.0001). Quantitative analysis showed a higher enhancement peak, a shorter time to peak enhancement, a higher regional blood flow and regional blood volume in patients with high vascular density than in those with low vascular density. Cutoff values to distinguish between active and inactive disease were identified for peak enhancement (>40.5%), and regional blood flow (>54.8 ml/min).
Quantitative analysis of CEUS data correlates with disease activity as determined by vascular density. Quantitative parameters of CEUS can be used to predict active disease with high sensitivity and specificity.
通过将炎症性肠病（IBD）肠壁强化的定量分析结果与来自肠道同一区域活检样本中的血管密度进行比较，评估对比增强超声（CEUS）在IBD中的准确性，并确定该分析对疾病活动预测的有用性。
本前瞻性研究经我院伦理委员会批准，所有患者均签署了书面知情同意书。我们纳入了33例连续接受结肠镜检查及IBD活检的成年患者。所有患者均接受CEUS检查，并对结果进行定量分析。将活检标本每高倍视野的血管计数与结肠镜检查、基线超声检查及CEUS结果进行比较，并与峰值强度、达峰时间、局部血容量、平均通过时间及局部血流量分析结果进行比较。使用Fisher检验、t检验、Pearson相关检验及受试者工作特征曲线（ROC）分析比较高血管密度和低血管密度患者的结果。通过ROC分析确定临界值，并计算敏感性和特异性。
组织学检查显示高血管密度（每视野>265个血管）与结肠镜检查、基线超声检查及CEUS上的活动性疾病显著相关（p<0.0001）。定量分析显示，高血管密度患者的增强峰值更高、达峰增强时间更短、局部血流量和局部血容量高于低血管密度患者。确定了区分活动期和非活动期疾病的临界值，即增强峰值（>40.5%）和局部血流量（>54.8 ml/min）。
CEUS数据的定量分析与由血管密度确定的疾病活动相关。CEUS的定量参数可用于以高敏感性和特异性预测活动性疾病。
