Puca Pierluigi, Del Vecchio Livio Enrico, Ainora Maria Elena, Gasbarrini Antonio, Scaldaferri Franco, Zocco Maria Assunta
IBD Unit-UOS Malattie Infiammatorie Croniche Intestinali, CEMAD, Digestive Diseases Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, L. Go A. Gemelli 8, 00168 Rome, Italy.
Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, L. Go F. Vito 1, 00168 Rome, Italy.
Diagnostics (Basel). 2022 Aug 17;12(8):1991. doi: 10.3390/diagnostics12081991.
Crohn's disease is one of the two most common types of inflammatory bowel disease. Current medical therapies are based on the use of glucocorticoids, exclusive enteral nutrition, immunosuppressors such as azathioprine and methotrexate, and biological agents such as infliximab, adalimumab, vedolizumab, or ustekinumab. International guidelines suggest regular disease assessment and surveillance through objective instruments to adjust and personalize the therapy, reducing the overall rates of hospitalization and surgery. Although endoscopy represents the gold-standard for surveillance, its frequent use is strongly bordered by associated risks and costs. Consequently, alternative non-invasive tools to objectify disease activity and rule active inflammation out are emerging. Alongside laboratory exams and computed tomography or magnetic resonance enterography, intestinal ultrasonography (IUS) shows to be a valid choice to assess transmural inflammation and to detect transmural healing, defined as bowel wall thickness normalization, no hypervascularization, normal stratification, and no creeping fat. Compared to magnetic resonance imaging (MRI) or computed tomography, CT scan, IUS is cheaper and more widespread, with very similar accuracy. Furthermore, share wave elastography, color Doppler, and contrast-enhanced ultrasonography (CEUS) succeed in amplifying the capacity to determine the disease location, disease activity, and complications. This review aimed to discuss the role of standard and novel ultrasound techniques such as CEUS, SICUS, or share wave elastography in adults with Crohn's disease, mainly for therapeutic monitoring and follow-up.
克罗恩病是两种最常见的炎症性肠病之一。目前的药物治疗基于使用糖皮质激素、全肠内营养、硫唑嘌呤和甲氨蝶呤等免疫抑制剂以及英夫利昔单抗、阿达木单抗、维多珠单抗或乌司奴单抗等生物制剂。国际指南建议通过客观工具进行定期疾病评估和监测，以调整治疗方案并使其个性化，从而降低总体住院率和手术率。尽管内镜检查是监测的金标准，但其频繁使用受到相关风险和成本的强烈限制。因此，用于客观评估疾病活动并排除活动性炎症的替代性非侵入性工具正在兴起。除了实验室检查以及计算机断层扫描或磁共振肠造影外，肠道超声检查（IUS）被证明是评估透壁炎症和检测透壁愈合的有效选择，透壁愈合定义为肠壁厚度正常化、无血管增生、分层正常且无爬行脂肪。与磁共振成像（MRI）或计算机断层扫描（CT扫描）相比，IUS成本更低且应用更广泛，准确性非常相似。此外，剪切波弹性成像、彩色多普勒和对比增强超声检查（CEUS）成功增强了确定疾病位置、疾病活动和并发症的能力。本综述旨在讨论标准和新型超声技术，如CEUS、SICUS或剪切波弹性成像在成人克罗恩病中的作用，主要用于治疗监测和随访。
