Crohn's disease and color Doppler sonography: response to treatment and its relationship with long-term prognosis.

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.