Download PDF
Ultraschall Med 2016; 37(01): 74-81
DOI: 10.1055/s-0034-1398746
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Comparison of Two High-End Ultrasound Systems for Contrast-Enhanced Ultrasound Quantification of Mural Microvascularity in Crohn’s Disease

Vergleich von zwei HighEnd-Ultraschallsystemen zur Beurteilung der Mikrovaskularisation bei Morbus Crohn mittels quantitativer kontrastverstärkter Sonografie
F. Zink
1   Department of Internal Medicine I, University Hospital Ulm, Germany
,
W. Kratzer
1   Department of Internal Medicine I, University Hospital Ulm, Germany
,
S. Schmidt
2   Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Germany
,
S. Oeztuerk
1   Department of Internal Medicine I, University Hospital Ulm, Germany
,
R. A. Mason
3   Department of Veterans Affairs, Louis Stokes Cleveland Medical Center, Brecksville, USA
,
M. Porzner
1   Department of Internal Medicine I, University Hospital Ulm, Germany
,
J. Klaus
1   Department of Internal Medicine I, University Hospital Ulm, Germany
,
M. M. Haenle
1   Department of Internal Medicine I, University Hospital Ulm, Germany
,
T. Graeter
2   Department of Interventional and Diagnostic Radiology, University Hospital Ulm, Germany
› Author Affiliations
Further Information

Publication History

27 February 2014

08 November 2014

Publication Date:
07 August 2015 (online)

Also available at
    Permissions and Reprints

Abstract

Purpose: To verify the reproducibility of contrast-enhanced ultrasound (CEUS) quantification results of two different high-end ultrasound systems and to evaluate the clinical utility of the method in patients with Crohn’s disease (CD).

Materials and Methods: 18 patients with histologically confirmed CD (36.8 % women, 63.2 % men; mean age 43.7 ± 14.1 years) and wall segments thicker than 5 mm were recruited. CEUS quantification and conventional ultrasound investigation were performed under standardized settings using Toshiba Aplio500 and Siemens Acuson S3000 high-end ultrasound systems. CEUS was performed at a low mechanical index of 0.1 after bolus application of 4.8 ml of SonoVue® contrast medium. The recorded DICOM clips were quantified using VueBox® (version 4.3) calculating 11 quantitative parameters. Subsequently, CEUS quantification and conventional ultrasound results were analyzed.

Results: Correlation of quantitative parameters between the Aplio500 and AcusonS3000 systems for peak enhancement (PE), rise time (RT), wash-in-rate (WiR) and quality of fit (QOF) yielded significance levels of p < 0.05 and p < 0.0001 for wash-in-wash-out area under the curve (WiWoAUC). Spearman rank test showed moderate levels of correlation for PE, RT, WiR and QOF (r = 0.5, 0.49, 0.49 and 0.5 respectively), and high correlation for WiWoAUC (r = 0.89) between the two ultrasound systems.

Conclusion: Due to multiple uncontrollable affecting factors, the method of CEUS quantification by VueBox in the intestine cannot be recommended for device-independent multicenter studies. Therefore we suggest to use identical ultrasound systems and probes as well as to establish adequate reference ROIS, like a AIF-ROI.

Zusammenfassung

Ziel: Überprüfung der Reproduzierbarkeit quantitativer kontrastverstärkter Ultraschallergebnisse (CEUS) an zwei High-End-Geräten unterschiedlicher Hersteller und Evaluation der klinischen Eignung der Methode bei Patienten mit Morbus Crohn.

Material und Methoden: 18 Patienten (36.8 % Frauen, 63.2 % Männer; mittleres Alter 43.7 ± 14.1 Jahre) mit histologisch nachgewiesenem Morbus Crohn und Darmwandverdickungen > 5 mm wurden für die Studie rekrutiert. Mit zwei High-End Ultraschallgeräte, dem Toshiba Aplio500 und dem Siemens Acuson S3000, wurden unter standardisierten technischen Einstellungen die CEUS Quantifizierung und eine konventionelle Ultraschalluntersuchung durchgeführt. Für den CEUS wurde ein niedriger mechanischer Index von 0.1 unter Applikation von 4.8 ml des Kontrastmittels Sonovue® gewählt. Ausgewertet wurden die aufgenommenen DICOM-clips mittels VueBox-Version 4.3, welche 11 quantitative Parameter kalkuliert. Abschließend wurden die Ergebnisse der konventionellen Ultraschalluntersuchung und die quantitativen CEUS-Ergebnisse ausgewertet.

Ergebnisse: Im Vergleich der quantitativen Ergebnisse beider Ultraschallgeräte ergaben sich für peak enhancement (PE), rise time (RT), Wash-in rate (WiR) und quality of fit (QOF) signifikante (jeweils p < 0.05), für die WiWoAUC hochsignifikante (p < 0.0001) Korrelationen. Im Spearman Rank Test zeigte sich für PE, RT, WiR und QOF eine mäßige (r = 0.5, 0.49, 0.49 und 0.5 respektive), für WiWoAUC eine deutliche (r = 0.89) Korrelation zwischen den Ergebnissen beider Ultraschallgeräten.

Schlussfolgerung: Die in unserer Studie beschriebene Methode der CEUS-Quantifizierung per VueBox am Darm kann aufgrund multipler, nicht zu kontrollierender Einflussfaktoren, nicht für geräteunabhängige multizentrische Studien empfohlen werden. Deshalb legen wir für weitere geräteübergreifende CEUS-Quantifizierungsstudien am Darm die Verwendung identischer Ultraschallsysteme und Schallköpfe sowie die Etablierung adäquater Referenz-ROIs, z. B. im Sinne einer AIF-ROI, nahe.

Key words

Crohn's disease - CEUS quantification - contrast agents - utrasonography
 

  • References

  • 1 Colombel JF, Solem CA, Sandborn WJ et al. Quantitative measurement and visual assessment of ileal crohn's disease activity by computed tomography enterography: Correlation with endoscopic severity and C reactive protein. Gut 2006; 55: 1561-1567
    CrossrefPubMedSearch in Google Scholar
  • 2 Ordas I, Rimola J, Rodriguez S et al. Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with crohn's disease. Gastroenterology 2013; 146: 374-382
    PubMedSearch in Google Scholar
  • 3 Fraquelli M, Colli A, Casazza G et al. Role of US in detection of crohn disease: meta-analysis. Radiology 2005; 236: 95-101
    CrossrefPubMedSearch in Google Scholar
  • 4 Baert F, Moortgat L, Van Assche G et al. Mucosal healing predicts sustained clinical remission in patients with early-stage crohn's disease. Gastroenterology 2010; 138: 463-468 ; quiz e10–e11
    CrossrefPubMedSearch in Google Scholar
  • 5 Drews BH, Barth TF, Haenle MM et al. Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in crohn's disease. Eur Radiol 2009; 19: 1379-1386
    CrossrefPubMedSearch in Google Scholar
  • 6 Ripolles T, Martinez MJ, Barrachina MM. Crohn's disease and color doppler sonography: Response to treatment and its relationship with long-term prognosis. J Clin Ultrasound 2008; 36: 267-272
    CrossrefPubMedSearch in Google Scholar
  • 7 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
    CrossrefPubMedSearch in Google Scholar
  • 8 Girlich C, Schacherer D, Lamby P et al. Innovations in contrast enhanced high resolution ultrasound improve sonographic imaging of the intestine. Clin Hemorheol Microcirc 2010; 45: 207-215
    PubMedSearch in Google Scholar
  • 9 Migaleddu V, Quaia E, Scanu D et al. Inflammatory activity in crohn's disease: CE-US. Abdom Imaging 2011; 36: 142-148
    CrossrefPubMedSearch in Google Scholar
  • 10 Brahme F, Lindstroem C. A comparative radiographic and pathological study of intestinal vaso-architecture in crohn's disease and in ulcerative colitis. Gut 1970; 11: 928-940
    CrossrefPubMedSearch in Google Scholar
  • 11 Wejman J, Pyzlak M, Szukiewicz D et al. Thrombospondin and VEGF-R: Is there a correlation in inflammatory bowel disease?. Mediators Inflamm 2013; 2013: 908259
    PubMedSearch in Google Scholar
  • 12 De Franco A, Marzo M, Felice C et al. Ileal crohn's disease: CEUS determination of activity. Abdom Imaging 2012; 37: 359-368
    CrossrefPubMedSearch in Google Scholar
  • 13 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. Eur J Radiol 2012; 81: 1105-1109
    CrossrefPubMedSearch in Google Scholar
  • 14 Piscaglia F, Nolsøe 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 Med 2012; 33: 33-59
    Thieme ConnectPubMedSearch in Google Scholar
  • 15 Schreyer AG, Finkenzeller T, Gossmann H et al. Microcirculation and perfusion with contrast enhanced ultrasound (CEUS) in crohn's disease: First results with linear contrast harmonic imaging (CHI). Clin Hemorheol Microcirc 2008; 40: 143-155
    PubMedSearch in Google Scholar
  • 16 Paredes JM, Ripolles T, Cortes X et al. Contrast-enhanced ultrasonography: Usefulness in the assessment of postoperative recurrence of crohn's disease. J Crohns Colitis 2013; 7: 192-201
    CrossrefPubMedSearch in Google Scholar
  • 17 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. Eur J Radiol 2009; 69: 438-444
    CrossrefPubMedSearch in Google Scholar
  • 18 Schirin-Sokhan R, Winograd R, Tischendorf S et al. Assessment of inflammatory and fibrotic stenoses in patients with crohn's disease using contrast-enhanced ultrasound and computerized algorithm: A pilot study. Digestion 2011; 83: 263-268
    CrossrefPubMedSearch in Google Scholar
  • 19 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. J Crohns Colitis 2013; 7: 120-128
    CrossrefPubMedSearch in Google Scholar
  • 20 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: 1197-1206
    CrossrefPubMedSearch in Google Scholar
  • 21 Cosgrove D, Piscaglia F, Bamber J et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall in Med 2013; 34: 238-253
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Vogel R, Indermuehle A, Reinhardt J et al. The quantification of absolute myocardial perfusion in humans by contrast echocardiography: Algorithm and validation. J Am Coll Cardiol 2005; 45: 754-762
    CrossrefPubMedSearch in Google Scholar
  • 23 Jirik R, Nylund K, Gilja OH et al. Ultrasound perfusion analysis combining bolus-tracking and burst-replenishment. IEEE Trans Ultrason Ferroelectr Freq Control 2013; 60: 310-319
    CrossrefPubMedSearch in Google Scholar
  • 24 Best WR, Becktel JM, Singleton JW et al. Development of a crohn’s disease activity index. National cooperative crohn's disease study. Gastroenterology 1976; 70: 439-444
    PubMedSearch in Google Scholar
  • 25 Limberg B. Diagnosis of chronic inflammatory bowel disease by ultrasonography. Z Gastroenterol 1999; 37: 495-508
    PubMedSearch in Google Scholar
  • 26 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 Med 2012; 33: 344-351
    Thieme ConnectPubMedSearch in Google Scholar
  • 27 Migaleddu V, Scanu AM, Quaia E et al. Contrast-enhanced ultrasonographic evaluation of inflammatory activity in crohn's disease. Gastroenterology 2009; 137: 43-52
    CrossrefPubMedSearch in Google Scholar
  • 28 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
    CrossrefPubMedSearch in Google Scholar
  • 29 Gauthier M, Leguerney I, Thalmensi J et al. Estimation of intra-operator variability in perfusion parameter measurements using DCE-US. World J Radiol 2011; 3: 70-81
    CrossrefPubMedSearch in Google Scholar
  • 30 Lassau N, Chapotot L, Benatsou B et al. Standardization of dynamic contrast-enhanced ultrasound for the evaluation of antiangiogenic therapies: The french multicenter support for innovative and expensive techniques study. Invest Radiol 2012; 47: 711-716
    CrossrefPubMedSearch in Google Scholar
  • 31 Gauthier M, Pitre-Champagnat S, Tabarout F et al. Impact of the arterial input function on microvascularization parameter measurements using dynamic contrast-enhanced ultrasonography. World J Radiol 2012; 4: 291-301
    CrossrefPubMedSearch in Google Scholar
  • 32 Wong DD, Forbes GM, Zelesco M et al. Crohn’s disease activity: Quantitative contrast-enhanced ultrasound assessment. Abdom Imaging 2012; 37: 369-376
    CrossrefPubMedSearch in Google Scholar