Ren Mao1,2, Yu-Jun Chen3, Bai-Li Chen1, Xiao-Hua Xie3, Yao He1, Shu-Ling Chen3, Ming Xu3, Xue-Hua Li4, Jian Zhang5, Xin-Ming Song6, Zhi-Rong Zeng1, Jordi Rimola7, Florian Rieder2, Shomron Ben-Horin1,8, Min-Hu Chen1, Xiao-Yan Xie3. 1. Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 2. Department of Gastroenterology, Hepatology and Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, USA. 3. Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 4. Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China. 5. State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China. 6. Department of General Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 7. Department of Radiology, Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain. 8. Department of Gastroenterology, Sheba Medical Center & Sackler School of Medicine, Tel-Aviv University, Israel.
Abstract
BACKGROUND AND AIM: Penetrating disease is a common condition complicating Crohn's disease [CD]. Establishing the presence of a fistula and the anatomical definition of the fistulous tracts are essential for deciding on appropriate treatment strategies. We aimed to assess the diagnostic accuracy of intra-cavitary contrast-enhanced ultrasound [IC-CEUS] for the detection of a fistulous tract associated with abscesses in CD patients. METHODS: In this prospective cohort study, consecutive CD patients suspected of having an intra-abdominal abscess, who were referred for US-guided aspiration were recruited. IC-CEUS was performed by injecting diluted contrast agent [SonoVue] into the abscess cavity immediately following the ultrasound-guided needle abscess aspiration and drainage. The diagnostic accuracy of IC-CEUS in demonstrating the presence of fistulous tracts was compared with that of computed tomography enterography/magnetic resonance enterography [CTE/MRE], using surgical and gross pathological findings as the reference standard. RESULTS: Thirty-one patients who underwent IC-CEUS and subsequent surgery were included in the final analysis. IC-CEUS demonstrated fistulous/sinus tracts in 26 of 31 participants with a sensitivity and specificity of 86.7 % (95% confidence interval [CI], 68.4-95.6%) and 100% [95% CI, 5.5-100.0%], respectively. Moreover, IC-CEUS correctly demonstrated fistulous/sinus tracts in 13 participants without delineation of fistulous/sinus tracts on CTE/MRE. Combining IC-CEUS and CTE/MRE, the fistula/sinus tract was clearly demonstrated in 29 patients [93.5%, 29/31]. The mean duration of the IC-CEUS procedure was 8.6 min [range 5.0-12.0]. No severe adverse events occurred during the IC-CEUS procedure. CONCLUSION: In this pilot study, IC-CEUS accurately delineated the anatomical definition of fistulous/sinus tracts associated with intra-abdominal abscesses in CD patients. As a radiation-free and safe technique, IC-CEUS may be used as an alternative/adjunctive method to CTE/MRE for detecting penetrating disease in patients with CD.
BACKGROUND AND AIM: Penetrating disease is a common condition complicating Crohn's disease [CD]. Establishing the presence of a fistula and the anatomical definition of the fistulous tracts are essential for deciding on appropriate treatment strategies. We aimed to assess the diagnostic accuracy of intra-cavitary contrast-enhanced ultrasound [IC-CEUS] for the detection of a fistulous tract associated with abscesses in CDpatients. METHODS: In this prospective cohort study, consecutive CDpatients suspected of having an intra-abdominal abscess, who were referred for US-guided aspiration were recruited. IC-CEUS was performed by injecting diluted contrast agent [SonoVue] into the abscess cavity immediately following the ultrasound-guided needle abscess aspiration and drainage. The diagnostic accuracy of IC-CEUS in demonstrating the presence of fistulous tracts was compared with that of computed tomography enterography/magnetic resonance enterography [CTE/MRE], using surgical and gross pathological findings as the reference standard. RESULTS: Thirty-one patients who underwent IC-CEUS and subsequent surgery were included in the final analysis. IC-CEUS demonstrated fistulous/sinus tracts in 26 of 31 participants with a sensitivity and specificity of 86.7 % (95% confidence interval [CI], 68.4-95.6%) and 100% [95% CI, 5.5-100.0%], respectively. Moreover, IC-CEUS correctly demonstrated fistulous/sinus tracts in 13 participants without delineation of fistulous/sinus tracts on CTE/MRE. Combining IC-CEUS and CTE/MRE, the fistula/sinus tract was clearly demonstrated in 29 patients [93.5%, 29/31]. The mean duration of the IC-CEUS procedure was 8.6 min [range 5.0-12.0]. No severe adverse events occurred during the IC-CEUS procedure. CONCLUSION: In this pilot study, IC-CEUS accurately delineated the anatomical definition of fistulous/sinus tracts associated with intra-abdominal abscesses in CDpatients. As a radiation-free and safe technique, IC-CEUS may be used as an alternative/adjunctive method to CTE/MRE for detecting penetrating disease in patients with CD.
Authors: Ami Gokli; Jonathan R Dillman; Paul D Humphries; Damjana Ključevšek; Hans-Joachim Mentzel; Erika Rubesova; Marcelo S Takahashi; Sudha A Anupindi Journal: Pediatr Radiol Date: 2021-05-12