Assessment of Crohn's disease activity by doppler ultrasound of superior mesenteric artery and mural arteries in thickened bowel wall: cross-sectional study

Sjekavica, Ivica and Barbarić-Babić, Vinka and Krznarić, Željko and Molnar, Melita and Čuković-Čavka, Silvija and Štern-Padovan, Ranka (2007) Assessment of Crohn's disease activity by doppler ultrasound of superior mesenteric artery and mural arteries in thickened bowel wall: cross-sectional study. Croatian Medical Journal, 48 (6). pp. 822-830. ISSN 0353-9504

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Abstract

AIM: To define sensitive and reliable Doppler parameters for measurements in the superior mesenteric artery and mural arteries of affected bowel loops used in the assessment of Crohn disease activity. ----- METHODS: We performed cross-sectional study at a tertiary care setting in Zagreb, Croatia, between January 2001 and March 2005. We measured arterial flow in the superior mesenteric artery and affected bowel wall in 138 patients with Crohn disease (74 with active, 64 with inactive disease) and 67 healthy volunteers. The disease activity was determined by the clinical examination, Crohn disease activity index, and standard laboratory tests. Superior mesenteric artery color and pulsed Doppler parameters were peak systolic velocity, end-diastolic velocity, resistance index, mean velocity flow, cross-sectional area, and flow volume. When gut mural vessels were identified, we performed spectral analysis of mural arteries by pulsed Doppler, with a measurement of resistance index. ----- RESULTS: The measurements in the superior mesenteric artery showed statistically and clinically significant difference in flow volume in active group, compared with inactive and control groups (C+/-Q=564+/-263 mL/min for active, 421+/-157 for inactive and 416+/-248 for control group). Affected bowel loops analysis showed significant difference between inactive and active Crohn disease group in wall thickness (3.1+/-1.4 vs 5.0+/-1.8 mm, P<0.001, Mann-Whitney test) while all participants from control group had thickness below 2mm. Intensity of color Doppler signals was different for all groups (P<0.001, chi(2) test) with the highest level of hyperemia in the active group. Resistance index measurements of mural arteries in bowel wall revealed differences between all three groups (0.61+/-0.05 in active group, 0.71+/-0.05 in the inactive group and 0.80+/-0.11 in the control group, P<0.001, Kruskal-Wallis test). ----- CONCLUSION: Intensity of color Doppler signals and resistance index measurements of mural arteries in the thickened bowel wall can be used as quantitative diagnostic tool in the assessment of Crohn disease activity.

Abstract in Croatian

Cilj: Odrediti osjetljive i pouzdane Dopplerske parametre za mjerenja u gornjoj mezenterijskoj arteriji i arterijama stijenke zahvaćenih crijevnih vijuga pri procjeni aktivnosti Crohnove bolesti. ----- Postupci: U ustanovi tercijarne zdravstvene skrbi u Zagrebu, Hrvatska, proveli smo presječno istraživanje između siječnja 2001 i ožujka 2005. U 138 bolesnika s Crohnovom bolešću (74 s aktivnim i 64 s ne-aktivnim oblikom bolesti), te u 67 zdravih dragovoljaca, mjerili smo arterijski krvni protok u gornjoj mezenteriskoj arteriji i arterijama zahvaćene crijevne stijenke. Bolest je dijagnosticirana kliničkim pregledom , indeksom aktivnosti Crohnove bolesti i standardnim laboratorijskim testovima. Mjereni parametri za gornju mezenterijsku arteriju određeni su Dopplerom u boji i pulsnim Dopplerom, kao vršna sistolička brzina krvi, brzina krvi na kraju dijastole, indeks otpora, srednja brzina protoka, površina presjeka žile i veličina protoka. U slučajevima kada smo uspjeli identificirati žile u crijevnoj stijenci, napravili smo spektralnu analizu arterija u stijenci s pomoću pulsnoga Dopplera, a mjerenjem indeksa otpora protoku krvi. ----- Rezultati: Mjerenja u gornjoj mezenterijskoj arteriji pokazala su statistički i klinički značajnu razliku veličine protoka krvi u skupini bolesnika s aktivnom bolešću u usporedbi s bolesnicima bez aktivne bolesti i kontrolnim sudionicima (C±Q=564±263 mL/min za aktivni oblik bolesti, 421±157 za ne-aktivni, te 416±248 za kontrolnu skupinu). Analiza zahvaćenih crijevnih vijuga pokazala je značajnu razliku između skupina bolesnika s ne-aktivnim i aktivnim oblikom Crohnove bolesti u debljini crijevne stijenke (3,1±1,4 vs 5,0±1,8 mm, P<0,001, test Mann Whitney), dok je u svih pripadnika kontrolne skupine debljina stijenke bila manja od 2 mm. Intenzitet Dopplerskog signala u boji razlikovala se u svim skupinama (P<0,001, χ2 test), s najvećom hiperemijom u skupini bolesnika s aktivnom bolešću. Mjerenje indeksa otpora protoku u arterijama iz crijevne stijenke također je otkrilo razlike među trima skupinama (0,61±0,05 u skupini s aktivnom bolešću, 0,71±0,05 u skupini s ne-aktivnom bolešću i 0,80±0,11 u kontrolnoj skupini, P<0,001, test Kruskal-Wallis). ----- Zaključak: Intenzitet Dopplerskih signala i mjerenja indeksa otpora protoku krvi u arterijama zadebljane crijevne stijenke mogu poslužiti kao kvantitativna dijagnostička mjera u procjeni aktivnosti Crohnove bolesti.

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