Ultrasound elasticity imaging could inform Crohns disease treatment

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Ultrasound elasticity imaging (UEI) could allow physicians to noninvasively make the distinction between inflammation and fibrosis in patients with Crohn's disease, and thus enable more appropriate and timely care, according to a study published in the September edition of Gastroenterology.

Ryan W. Stidham, MD, of the University of Michigan in Ann Arbor, and colleagues wanted to investigate whether UEI could help determine whether patients with Crohn's disease could benefit from medical therapy or undergo surgery.

Intestinal fibrosis is a condition that requires surgery, though inflammation can be treated with medicine that suppresses the patient’s immune system. Crohn's disease patients suffer from chronic inflammation of the intestines, which over time can cause scar tissue to form, resulting in intestinal fibrosis.

CT scans and MRIs are unable to detect the difference between the two conditions, resulting in patients with fibrosis being initially treated with drugs that are expensive, unlikely to help and carry risk.

UEI measures the relative hardness and thickness of tissue inside the body. Inflamed intestinal tissue is softer than fibrotic tissue, which is hard and thick, and the new method potentially allows doctors to differentiate between the two conditions without invasive surgery.

Researchers gave a group of female Lewis rats weekly trinitrobenzene sulfonic acid enemas to yield models of acute inflammation and chronic intestinal fibrosis. UEI scanning was conducted and the resected bowel segments were evaluated showing UEI was able to accurately identify the two different conditions.

"UEI has great potential to provide a clear measurement that helps clinicians judge whether medical or surgical management is best for the individual patient earlier in their disease course," Stidham said in a statement.

The study also conducted UEI scans on seven human patients already scheduled for surgical treatment of fibrosis. UEI was able to differentiate between the fibrotic tissue and unaffected intestine in these patients.

Beginning this winter, the researchers will conduct a long-term human clinical trial. If the diagnostic accuracy of UEI holds up, physicians could have a new tool to more efficiently detect whether a patient with Crohn’s disease is suffering from inflammation or fibrosis.