Problemstellung: Inflammatory hyperperfusion is a mainstay of diagnosis and the main therapeutic target
in chronic inflammatory bowel diseases. It's exact measurement at the local site of
it's development inside the bowel wall is therefore very important. We present a quite
novel approach to sonographic inflammation grading in inflammatory bowel diseases
via dynamic quantification of color Doppler signals along a complete heart cycle inside
the bowel wall. The aim was to describe bowel wall perfusion in Crohn disease patients
in comparison with healthy probands and to compare a conventional activity index (Pediatric
Crohn Disease Activity Index) with perfusion measurements as an indicator of inflammatory
activity.
Methoden: Color Doppler sonographic videos of bowel wall perfusion from 34 healthy children
(aged 5 to 18 years) and from 14 patients with Crohn disease (aged 8.2 to 15.9 years)
were recorded under defined conditions. Perfusion signals (color hue, color area)
were automatically measured inside the bowel wall. Specific tissue perfusion was calculated
as mean flow velocity of a region of interest during one full heart cycle. Bowel wall
perfusion was compared using the Pediatric Crohn Disease Activity Index in 12 patients.
Ergebnisse: Specific bowel wall perfusion was significantly elevated in bowel segments of Crohn
disease patients compared with healthy subjects (p<0.001). Specific flow in small
bowel was 0.025cm/s in healthy probands and 0.095cm/s in patients with Crohn disease,
whereas large bowel wall perfusion of 0.012cm/s in healthy probands clearly differed
from 0.082cm/s in patients with Crohn disease. No differences of perfusion between
moderate and high Pediatric Crohn Disease Activity Index levels could be demonstrated
despite a weak significant overall correlation.
Schlussfolgerungen: The new method of dynamic, automatic noninvasive perfusion quantification is useful
to describe local inflammatory activity in bowel segments affected by Crohn disease
and adds new information to activity evaluation by Pediatric Crohn Disease Activity
Index. Specific wall perfusion in intestines of Crohn patients is significantly elevated
and reaches up to sevenfold intensity compared with healthy subjects.
