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Crohn Disease Activity Evaluated by Doppler Ultrasonography of the Superior Mesenteric Artery and the Affected Small-Bowel Segments

Department of Radiology (E.Y., B.M., S.Y., B.A.) and Division of Gastroenterohepatology (A.D., C.K., S.K.), Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.

Address correspondence and reprint requests to Ensar Yekeler, MD, Department of Radiology, Istanbul University, Istanbul Faculty of Medicine, 34390 Capa, Istanbul, Turkey. E-mail: yekelerensar{at}yahoo.com

Objective. To reveal the disease activity in Crohn disease by gray scale and Doppler ultrasonography of the superior mesenteric artery (SMA) and the affected bowel segments. Methods. Twenty-six patients (12 with active and 14 with inactive disease according to the Crohn disease activity index) were prospectively evaluated with gray scale and Doppler ultrasonography. The control group included 10 healthy subjects. In the SMA evaluation, anteroposterior diameter, resistive index (RI), and flow volume were measured. In the affected small-bowel segments, wall thickness, mural vascularity, RI, and extraintestinal findings were evaluated. Results. Differences between the active and inactive groups but not between the inactive and control groups were statistically significant for mean SMA diameter, RI, and flow volume (P = .019; P < .001; and P < .001, respectively). Superior mesenteric artery flow volume values were higher than 500 mL/min in the active group except 2 patients (sensitivity, 83%; specificity, 100%). Increased gut wall thickness and vascularity were highly significant for patients with active disease (P < .001). The mean SMA RI value of the active group was significantly lower (P < .001). Doppler measures of vascularity were similarly affected in the SMA and the bowel wall in the active subgroup. In 10 patients with active disease and higher SMA flow volume (>500 mL/min), the affected small-bowel segments also had increased wall thickness and vascularity. Conclusion. Evaluation of the SMA and the affected small-bowel segments together by gray scale and Doppler ultrasonography is a reliable quantitative method for determining Crohn disease activity. Findings obtained from both the SMA and the affected small-bowel segments showed parallel results about the disease activity.

Key Words: Crohn disease activity index • Doppler ultrasonography • small bowel • superior mesenteric artery

Abbreviations: CDAI, Crohn disease activity index • RI, resistive index • SMA, superior mesenteric artery

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