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Bowel Wall Thickness (bowel + wall_thickness)
Selected AbstractsOral contrast-enhanced sonography for the diagnosis and grading of postsurgical recurrence of Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 9 2008Fabiana Castiglione MD Abstract Background: Postsurgical recurrence (PSR) is very common in patients with Crohn's disease (CD) and previous surgery. Endoscopy is crucial for the diagnosis of PSR, also showing high prognostic value. Bowel sonography (BS) with or without oral contrast enhancement (OCBS) is accurate for CD diagnosis but its role in PSR detection and grading is poorly investigated. The aim was to evaluate the diagnostic accuracy of BS and OCBS for PSR compared to the endoscopical Rutgeerts's grading system. Methods: We prospectively performed endoscopy, BS, and OCBS in 40 CD patients with previous bowel resection to provide evidence of possible PSR. Endoscopy, BS, and OCBS were executed 1 year after surgery, with PSR diagnosis and grading made in accordance with Rutgeerts. BS and OCBS were considered suggestive for PSR in the presence of bowel wall thickness (BWT) >3 mm. OCBS was performed after ingestion of 750 mL of polyethylene glycol (PEG). Also, a receiver operating characteristic (ROC) curve was constructed in order to define the best cutoff of BWT to discriminate mild from severe PSR (grade 0,2 versus 3,4 of Rutgeerts) for both BS and OCBS. Results: In all, 22 out of the 40 CD showed an endoscopic evidence of PSR (55%). A severe PSR was present in 14 patients (64%). Sensitivity, specificity, and positive and negative predictive values were 77%, 94%, 93%, and 80% for BS, and 82%, 94%, 93%, and 84% for OCBS. On the ROC curve a BWT >5 mm showed sensitivity, specificity, and positive and negative predictive values of 93%, 96%, 88%, and 97% for the diagnosis of severe PSR at BS, while a BWT >4 mm was the best cutoff differentiating the mild from the severe CD recurrence for OCBS, with a sensitivity, specificity, and positive and negative predictive values of 86%, 96%, 97%, and 79%, respectively. Conclusions: Both BS and OCBS show good sensitivity and high specificity for the diagnosis of PSR in CD, with a BWT >5 mm for BS and BWT >4 mm for OCBS strongly indicative of severe endoscopic PSR. Accordingly, these techniques could replace endoscopy for the diagnosis and grading of PSR in many cases. (Inflamm Bowel Dis 2008) [source] Serum bFGF and VEGF correlate respectively with bowel wall thickness and intramural blood flow in Crohn's diseaseINFLAMMATORY BOWEL DISEASES, Issue 5 2004Dr. Antonio Di Sabatino MD Abstract Serum levels of basic fibroblast growth factor (bFGF) and vascular endothelial growth factor (VEGF),two factors known to promote tissue repair, fibroblast proliferation, and angiogenesis,were measured in Crohn's disease patients and correlated with bowel wall thickness (BWT), measured by conventional grey scale ultrasonography, and with the ileal intramural vessel flow, measured by contrast-enhanced color Doppler imaging. Serum samples were obtained from 25 patients with active Crohn's disease and 22 healthy volunteers, all sex- and age-matched. Serum bFGF and VEGF levels were measured by ELISA assay. All the patients were examined with conventional transabdominal bowel sonography. Color Doppler of the intramural enteric vessels was then performed after the intravenous injection of Levovist, a galactose-based sonographic contrast agent. In Crohn's disease patients, serum bFGF and VEGF were significantly higher compared with healthy volunteers. A positive correlation between serum bFGF and BWT and between serum VEGF and color Doppler signal intensity was found. The raised serum bFGF levels in Crohn's disease patients with intestinal strictures compared with patients with other phenotypes (fistulizing, inflammatory), together with the correlation observed between serum bFGF and BWT, suggests a possible involvement of bFGF in the process of transmural fibrogenesis in Crohn's disease. The higher levels of VEGF in those patients with increased intramural blood flow suggests that VEGF may be considered a marker of angiogenesis in this condition. [source] Crohn's disease and color Doppler sonography: Response to treatment and its relationship with long-term prognosisJOURNAL OF CLINICAL ULTRASOUND, Issue 5 2008Tomás Ripollés Abstract Purpose To evaluate the ability of sonography to detect changes in patients undergoing treatment for Crohn's disease and whether these findings are related to the patient's long-term outcome. Methods Twenty-eight patients with Crohn's disease were examined prospectively using gray-scale and color Doppler sonography before and during treatment. Three sonographic examinations were made: on the first day of treatment, between 3 and 8 days later, and approximately 4 weeks after starting the treatment. Sonographic examination included an evaluation of maximum bowel wall thickness and vascularity pattern. The sonographic data were compared with clinical and laboratory data, and possible relation with the patient's long-term outcome was considered. Results Initial baseline sonograms revealed at least 1 thickened segment of the bowel wall in all of the patients. In this initial examination, 18 of 22 patients (81%) with clinically active disease had moderate or marked parietal vascularity. A statistically significant reduction in the vascularity of the affected bowel was observed on the third sonographic examination (p < 0.05). Seventeen patients who were in clinical remission had relapses and were treated with immunosuppressive therapy or surgery during the follow-up. Eighty-six percent of the patients with residual hyperemia on sonographic examination after treatment had an unfavorable clinical course compared with only 30% of the patients with no, or barely visible, residual hyperemia (p < 0.01). Conclusion Sonography can identify bowel inflammation and its changes during treatment. In patients with Crohn's disease, hyperemia on color Doppler sonography during clinical remission after treatment may reflect an increased risk of relapse. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source] | ||||||||||