Scientific Abstract

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

Crohn’s disease (CD) is characterized by remitting and relapsing episodes.  Abdominal symptoms may be nonspecific and can result from active inflammation or from fibrotic scarring and stricture formation.  Activity assessment is important to identify patients with active inflammation so that optimal therapy may be prescribed.  Clinical scoring (such as the Crohn’s disease activity index), serologic inflammatory markers (C-reactive protein and orosomucoids), endoscopy and imaging studies have all been used to monitor activity, but no established gold standard exists yet.  Assessment of activity in clinical practice is usually made using a combination of subjective symptoms and laboratory parameters; these index scores, however, are not universally accepted because they are derived predominantly from subjective scoring of clinical symptoms, and the perception of the severity of these complaints can vary considerably among individuals.  Assessment of biological activity based on imaging studies such as endoscopy, leukocyte scintigraphy, X-ray studies and positron emission tomography has been proposed with some success.  All these modalities, however, are invasive or use ionizing radiation, and therefore cannot be easily repeated during the course of disease.

Preliminary data suggest that the measurement of blood perfusion and elasticity of affected bowel walls, as determined by contrast enhanced ultrasound (US) and US-elastography, respectively, may be an accurate index of intestinal inflammation.  Our purpose is to evaluate the accuracy of a new US-based activity index by studying over time a large cohort of CD patients, with various degrees of clinical/biochemical activity, as well as a group of healthy controls, by serial US-perfusion and US-elastography studies.  If perfusion rate/elasticity score accurately reflects intestinal inflammation, then future patient management may be significantly affected thanks to an earlier diagnosis and a 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 strictures still amenable to medical therapy could potentially be avoided.