Ultraschall Med 2019; 40(01): 76-84
DOI: 10.1055/s-0044-100492
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Interobserver Analysis of CEUS-Derived Perfusion in Fibrotic and Inflammatory Crohn’s Disease

Interobserver-Analyse der CEUS abgeleiteten Perfusion bei fibrotischem und entzündlichem Morbus Crohn
Kim Nylund
1   National Centre of Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
,
Fredrik Sævik
2   Department of Clinical Medicine, University of Bergen, Norway
,
Sabine Leh
3   Department of Clinical Sciences, University of Bergen, Norway
4   Department of Pathology, Haukeland University Hospital, Bergen, Norway
,
Frank Pfeffer
5   Department of Surgery, Haukeland University Hospital, Bergen, Norway
,
Trygve Hausken
2   Department of Clinical Medicine, University of Bergen, Norway
6   Department of Medicine, Haukeland University Hospital, Bergen, Norway
,
Odd Helge Gilja
1   National Centre of Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
2   Department of Clinical Medicine, University of Bergen, Norway
› Author Affiliations
Further Information

Publication History

22 June 2016

15 December 2017

Publication Date:
14 March 2018 (online)

Abstract

Aim To examine if there are perfusion differences in fibrotic versus inflammatory lesions in patients with Crohn’s disease (CD) and to assess the interobserver reliability of the analysis.

Materials and Methods 37 patients with Crohn’s disease were prospectively recruited. 20 were operated and 18 of them had fibrotic disease. 17 received and were mostly responsive to medical treatment (14/17). Each patient underwent clinical scoring and ultrasound (US) examination with high-frequency linear transducers and US contrast. The perfusion analysis was performed using exported DICOM videos with VueBox® (Bracco Suisse SA, Genève, Switzerland). The program fits the time-intensity data to a standardized curve, from which several parameters can be derived, such as amplitude-based peak enhancement (PE), total area under the curve (AUC), area under the curve during wash-in and wash-out (WiAUC and WoAUC), wash-in rate (WiR) and wash-out rate (WoR) and time-based rise time (RT), fall time (FT) and mean transit time (MTT).

Results There was a significant difference between the groups for the parameters PE (p = 0.032), WiAUC (p = 0.035) and WoR (p = 0.038). We found no significant difference for RT, MTT, FT, WiR, AUC and WoAUC. An interobserver analysis showed correlation between two observers for all the parameters (r = 0.66 – 0.92, p < 0.001), except MTT (r = 0.46, p = 0.129). Bland Altman analysis revealed a fixed bias for the parameters PE, WiAUC and RT.

Conclusion The amplitude-based parameters PE, WiAUC and WoR could potentially be used to separate fibrotic and inflammatory lesions in patients suffering from CD due to significant differences and low interobserver variability.

Zusammenfassung

Ziel Untersuchung, inwieweit bei Patienten mit Morbus Crohn (CD) Perfusionsunterschiede zwischen fibrotischen und entzündlichen Läsionen bestehen, sowie die Bewertung der Interobserver-Reliabilität der Analyse.

Material und Methoden Siebenunddreißig Patienten mit CD wurden prospektiv aufgenommen; 20 wurden operiert und 18 davon hatten eine fibrotische Erkrankung. Siebzehn erhielten eine medizinische Behandlung und sprachen mehrheitlich darauf an (14/17). Jeder Patient wurde klinisch bewertet und sonografisch (US) mit hochfrequenten linearen Schallköpfen und CEUS untersucht. Die Perfusionsanalyse erfolgte mit exportierten DICOM-Videos mittels VueBox® (Bracco Suisse SA, Genève, Schweiz). Das Programm passt die Zeitintensitätsdaten an eine Standardkurve an, aus der mehrere Parameter abgeleitet werden können, z. B. amplitudenbasiertes Peak Enhancement (PE), gesamte Area Under Curve (AUC), Area Under Curve während des Wash-in und Wash-outs (WiAUC und WoAUC), Wash-in Rate (WiR) und Wash-out Rate (WoR) und zeitbasierte Rinse Time (RT), Fall Time (FT) und mittlere Durchflusszeit (MTT).

Ergebnis Es gab einen signifikanten Unterschied zwischen den Gruppen für die Parameter PE (p = 0,032), WiAUC (p = 0,035) und WoR (p = 0,038). Wir fanden keinen signifikanten Unterschied für RT, MTT, FT, WiR, AUC und WoAUC. Die Interobserver-Analyse zeigte für alle Parameter eine Korrelation zwischen zwei Beobachtern (r = 0,66 – 0,92, p < 0,001) mit Ausnahme der MTT (r = 0,46; p = 0,129). Die Bland Altman-Analyse ergab einen Bias für die Parameter PE, WiAUC und RT.

Schlussfolgerung Die amplitudenbasierten Parameter PE, WiAUC und WoR sind aufgrund der signifikanten Unterschiede und einer geringen Interobserver-Variabilität möglicherweise dazu geeignet, fibrotische von entzündlichen Läsionen bei Patienten mit CD zu differenzieren.

 
  • Reference

  • 1 Dignass A, Van Assche G, Lindsay JO. et al. The second European evidence-based Consensus on the diagnosis and management of Crohn’s disease: Current management. Journal of Crohn’s & colitis 2010; 4: 28-62
  • 2 Lahat A, Chowers Y. The patient with recurrent (sub) obstruction due to Crohn’s disease. Best practice & research Clinical gastroenterology 2007; 21: 427-444
  • 3 Girlich C, Jung EM, Huber E. et al. Comparison between preoperative quantitative assessment of bowel wall vascularization by contrast-enhanced ultrasound and operative macroscopic findings and results of histopathological scoring in Crohn’s disease. Ultraschall in der Medizin 2011; 32: 154-159
  • 4 Panes J, Bouzas R, Chaparro M. et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn’s disease. Alimentary pharmacology & therapeutics 2011; 34: 125-145
  • 5 Horsthuis K, Bipat S, Bennink RJ. et al. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 2008; 247: 64-79
  • 6 Wang Z, Tang J, An L. et al. Contrast-enhanced ultrasonography for assessment of tumor vascularity in hepatocellular carcinoma. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2007; 26: 757-762
  • 7 Dietrich CF, Averkiou MA, Correas JM. et al. An EFSUMB introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for quantification of tumour perfusion. Ultraschall in der Medizin 2012; 33: 344-351
  • 8 Piscaglia F, Nolsoe C, Dietrich CF. et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall in der Medizin 2012; 33: 33-59
  • 9 Girlich C, Schacherer D, Jung EM. et al. Comparison between a clinical activity index (Harvey-Bradshaw-Index), laboratory inflammation markers and quantitative assessment of bowel wall vascularization by contrast-enhanced ultrasound in Crohn’s disease. European journal of radiology 2012; 81: 1105-1109
  • 10 Ripolles T, Martinez MJ, Paredes JM. et al. Crohn disease: correlation of findings at contrast-enhanced US with severity at endoscopy. Radiology 2009; 253: 241-248
  • 11 Quaia E, Migaleddu V, Baratella E. et al. The diagnostic value of small bowel wall vascularity after sulfur hexafluoride-filled microbubble injection in patients with Crohn’s disease. Correlation with the therapeutic effectiveness of specific anti-inflammatory treatment. European journal of radiology 2009; 69: 438-444
  • 12 Nylund K, Jirik R, Mezl M. et al. Quantitative Contrast-Enhanced Ultrasound Comparison Between Inflammatory and Fibrotic Lesions in Patients With Crohn’s Disease. Ultrasound Med Biol 2013; 39: 1187-1206
  • 13 Quaia E, De Paoli L, Stocca T. et al. The value of small bowel wall contrast enhancement after sulfur hexafluoride-filled microbubble injection to differentiate inflammatory from fibrotic strictures in patients with Crohn’s disease. Ultrasound in medicine & biology 2012; 38: 1324-1332
  • 14 Ripolles T, Rausell N, Paredes JM. et al. Effectiveness of contrast-enhanced ultrasound for characterisation of intestinal inflammation in Crohn’s disease: a comparison with surgical histopathology analysis. Journal of Crohn’s & colitis 2013; 7: 120-128
  • 15 Danese S, Sans M, de la Motte C. et al. Angiogenesis as a novel component of inflammatory bowel disease pathogenesis. Gastroenterology 2006; 130: 2060-2073
  • 16 Nylund K, Hausken T, Gilja OH. Ultrasound and inflammatory bowel disease. Ultrasound quarterly 2010; 26: 3-15
  • 17 Nylund K, Hausken T, Odegaard S. et al. Gastrointestinal Wall Thickness Measured with Transabdominal Ultrasonography and Its Relationship to Demographic Factors in Healthy Subjects. Ultraschall Med 2012; 33: E225-E232
  • 18 Gauthier TP, Chebil M, Peronneau P. et al. In vitro evaluation of the impact of ultrasound scanner settings and contrast bolus volume on time-intensity curves. Ultrasonics 2012; 52: 12-19
  • 19 Tang MX, Mulvana H, Gauthier T. et al. Quantitative contrast-enhanced ultrasound imaging: a review of sources of variability. Interface focus 2011; 1: 520-39
  • 20 Tranquart F, Mercier L, Frinking P. et al. Perfusion quantification in contrast-enhanced ultrasound (CEUS)--ready for research projects and routine clinical use. Ultraschall in der Medizin 2012; 33 (Suppl. 01) S31-S38
  • 21 Rognin NG, Frinking P, Costa M. et al. In-vivo perfusion quantification by contrast ultrasound: Validation of the use of linearized video data vs. raw RF data. Ultrasonics Symposium, 2008 IUS 2008 IEEE 2008; 1690-1693
  • 22 Nylund K, Leh S, Immervoll H. et al. Crohn’s disease: Comparison of in vitro ultrasonographic images and histology. Scandinavian journal of gastroenterology 2008; 43: 719-726
  • 23 Zink F, Kratzer W, Schmidt S. et al. Comparison of Two High-End Ultrasound Systems for Contrast-Enhanced Ultrasound Quantification of Mural Microvascularity in Crohn’s Disease. Ultraschall Med 2015
  • 24 Jirik R, Nylund K, Gilja O. et al. Ultrasound perfusion analysis combining bolus-tracking and burst-replenishment. IEEE Trans Ultrason Ferroelectr Freq Control 2013; 60: 310-319
  • 25 Stangeland M, Engjom T, Mezl M, Jirik R, Gilja OH, Damcevski G, Nylund K. Interobserver Variation of the Bolus-and-Burst Method for Pancreatic Perfusion with Dynamic - Contrast-Enhanced Ultrasound.. Ultrasound Int Open. 2017; 3: E99-E106 . doi:10.1055/s-0043-110475
  • 26 Kimmey MB, Martin RW, Haggitt RC. et al. Histologic correlates of gastrointestinal ultrasound images. Gastroenterology 1989; 96: 433-441
  • 27 Odegaard S, Nesje LB, Laerum OD. et al. High-frequency ultrasonographic imaging of the gastrointestinal wall. Expert review of medical devices 2012; 9: 263-273
  • 28 Maconi G, Carsana L, Fociani P. et al. Small bowel stenosis in Crohn’s disease: clinical, biochemical and ultrasonographic evaluation of histological features. Alimentary pharmacology & therapeutics 2003; 18: 749-756