Lay Summary

Proposal No. IBD-0152
Principal Investigator:   Gabriele Bianchi Porro, M.D.
Applicant Organization:  L. Sacco University Hospital (Milan, Italy)
Project Title:  A new sonographic Crohn’s disease activity index based on perfusion rate and elasticity score of the affected bowel walls. Validation through repeated bowel ultrasound measurements.
Period of Award:  September 1, 2006 – August 31, 2007

Assessment of disease activity in Crohn’s disease (CD) is of paramount importance in order to differentiate patients with active inflammation still amenable to medical therapy from those with fixed scar-like strictures who require surgery.  Unfortunately, no single test is available to date that can reliably detect inflammation in the affected bowel loops. The imaging studies currently used to assess inflammation, such as endoscopy, leukocyte scintigraphy, X-ray studies and positron emission tomography, are invasive or use ionizing radiation, and therefore cannot be easily repeated during the course of disease.  Preliminary experience suggests that the measurement of blood perfusion and elasticity of affected bowel walls, as determined by contrast enhanced ultrasound (US) and US-elastography, respectively, may well be used to localize intestinal inflammation and therefore could assess the activity of CD.

Our study will examine the accuracy of contrast-enhanced US and US-elastography in measuring intestinal inflammation of affected bowel loops in a large population of CD patients over time, as well as in a group of healthy controls, by comparing the results of US-perfusion and US-elastography studies with those of conventional clinical/biochemical indices.  If perfusion rate/ elasticity score accurately reflects intestinal inflammation, then future patient management may be significantly affected thanks to an earlier diagnosis and more accurate CD staging.  In particular, subclinical forms of disease, more prone to relapse within a short period of time and therefore deserving more potent medical therapy, may be identified earlier. Similarly, surgery for predominantly inflammatory narrowings still amenable to medical therapy could potentially be avoided.