Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia.
Chair of Biomedicine, Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia.
Pediatr Radiol. 2021 Mar;51(3):410-418. doi: 10.1007/s00247-020-04870-3. Epub 2021 Jan 7.
Contrast-enhanced ultrasound (US) of the bowel wall has been suggested as an alternative imaging modality for the follow-up of children with Crohn disease.
To evaluate the diagnostic performance of contrast-enhanced US in the estimation of Crohn disease activity in children with histopathology as the reference standard.
In 24 children with Crohn disease confirmed on histopathology, disease activity was evaluated on 40 bowel segments using US score and subjective and quantitative contrast-enhanced US evaluation. Contrast-enhanced US evaluation included enhancement pattern analysis with a graphic representation of log time-intensity curve and calculation of kinetic parameters with the definition of thresholds for disease activity, as determined by receiver operating characteristics curve analysis. The diagnostic accuracy of US with colour Doppler imaging and subjective and quantitative contrast-enhanced US were calculated.
Moderate or severe inflammation was identified in 18 segments and remission or mild inflammation was identified in 22 segments on histopathology. The quantitative contrast-enhanced US, namely the peak enhancement value, had 72.2% sensitivity (95% confidence interval [CI] 46.5-90.3), 100% specificity (95% CI 84.6-100.0) and 87.5% diagnostic accuracy (95% CI 73.2-95.8) in predicting moderate or severe grade inflammation at histopathology. The sensitivity, specificity and diagnostic accuracy of subjective contrast-enhanced US were 77.8% (95% CI 52.4-93.6), 77.3% (95% CI 54.6-92.2) and 77.5% (95% CI 61.6-89.2), respectively, and of US with colour Doppler imaging were 55.6% (95% CI 30.8-78.5), 86.4% (95% CI 65.1-79.1) and 72.5% (95% CI 56.1-85.4), respectively.
Quantitative contrast-enhanced US has the potential of becoming a complementary method in the evaluation of Crohn disease activity in children. Fibrosis may affect peak enhancement results and underestimate inflammatory activity.
对比增强超声（CEUS）已被提议作为克罗恩病患儿随访的替代成像方式。
评估对比增强超声（CEUS）在以组织病理学为参考标准评估儿童克罗恩病活动度方面的诊断性能。
在 24 例经组织病理学证实为克罗恩病的患儿中，使用超声评分和主观及定量 CEUS 评估对 40 个肠段的疾病活动度进行评估。CEUS 评估包括通过图形表示记录对数时间-强度曲线进行增强模式分析，以及使用接收器操作特性曲线分析确定疾病活动度的阈值来计算动力学参数。计算彩色多普勒成像和主观及定量 CEUS 的诊断准确性。
组织病理学上，18 个肠段显示中度或重度炎症，22 个肠段显示缓解或轻度炎症。定量 CEUS，即峰值增强值，在预测组织病理学上的中度或重度炎症时，具有 72.2%的灵敏度（95%置信区间 [CI] 46.5-90.3）、100%的特异性（95% CI 84.6-100.0）和 87.5%的诊断准确性（95% CI 73.2-95.8）。主观 CEUS 的灵敏度、特异性和诊断准确性分别为 77.8%（95% CI 52.4-93.6）、77.3%（95% CI 54.6-92.2）和 77.5%（95% CI 61.6-89.2），彩色多普勒成像的灵敏度、特异性和诊断准确性分别为 55.6%（95% CI 30.8-78.5）、86.4%（95% CI 65.1-79.1）和 72.5%（95% CI 56.1-85.4）。
定量 CEUS 有可能成为评估儿童克罗恩病活动度的一种补充方法。纤维化可能会影响峰值增强结果并低估炎症活动度。
