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© 2002 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 21:149-157 • 0278-4297

Article

Contrast-Enhanced Power Doppler Sonography of the Intestinal Wall in the Differentiation of Hypervascularized and Hypovascularized Intestinal Obstructions in Patients With Crohn's Disease

Wolfgang Kratzer, MD, Christian von Tirpitz, MD, Richard Mason, MD, Max Reinshagen, MD, Guido Adler, MD, Peter Möller, MD, Andrea Rieber, MD and Volker Kächele, MD

Departments of Internal Medicine I (W.K., C.v.T., R.M., M.R., G.A., V.K.), Pathology (P.M.), and Radiology I (A.R.), University of Ulm, Ulm, Germany

Address correspondence and reprint requests to Wolfgang Kratzer, MD, Department of Internal Medicine I, University of Ulm, Robert-Koch-Strasse 8, 89081 Ulm, Germany.

Objective. To use power Doppler sonography to quantify the vascularization in the area of stenosed bowel segments in patients with Crohn's disease and to draw conclusions from these findings with regard to the development of these stenoses. Methods. The study collective included 11 patients with confirmed Crohn's disease and sonographically visualized stenoses of the small bowel together with intermittent abdominal cramping as a clinical correlate. Power mode examination was repeated after application of a sonographic signal-enhancing agent. Semiquantitative evaluation based on the sonographically indicated degree of vascularization led to the presumptive diagnosis of either inflammatory or cicatricial intestinal obstruction. Sonographic diagnoses were compared with the findings of surgery and subsequent histologic examination or with patients' clinical responses to conservative therapy. Results. Nine of 11 patients underwent surgery within 1 year of examination. All 3 cases in which sonography had facilitated the diagnosis of cicatricial stenosis were confirmed at postoperative histologic examination; similarly, the surgical and histologic findings in the other 6 patients confirmed the sonographic diagnosis of inflammatory stenosis. Conclusions. Power Doppler sonography in combination with the use of a signal-enhancing agent appears to be effective in the recognition of predominantly cicatricial stenoses in patients with Crohn's disease.

Key Words: sonography • Crohn's disease • stenosis • Levovist • signal enhancer • contrast-enhanced Doppler sonography

Abbreviations: CD, Crohn's disease




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