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

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.

Key words

perfusion - contrast agents - Crohn’s disease - fibrosis - CEUS

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