diseases are chronic inflammatory diseases of the bowel that are
of unknown etiology. These diseases either progress with intermittent
flare-ups interrupted by periods of remission or on a chronic
active progressive mode. Inflammatory bowel diseases include Crohn
disease and ulcerative colitis. Clinical and imaging diagnosis
often is challenging, hence explaining the frequent time delay
between onset of disease and initiation of therapy.
Crohn disease usually
presents with pain, diarrhea and weight loss.
The terminal ileum/ileo caecal junction is involved in the
majority of cases, and thickened; hypoechoic bowel wall can often
be demonstrated in this area. Inflammatory thickening of the intestines
is generally diffuse and concentric
In Crohn's lesions there is a well-defined echopoor outer
rim and a bright inner region; transverse scans may demonstrate
a target lesion. The bowel thickening
may be focal or found over long segments, characteristic skip
lesions may be observed. A wall thickness
greater than 3 mm is considered abnormal. Ultrasound may
be used to identify complications of Crohn's disease, screen patients
at risk, and monitor patients for recurrence of disease following
Crohn's disease affects the entire thickness of the bowel
wall, and one of the common complications is that of intramural
abscesses. These can sometimes be seen within the thickened wall
as gas-containing, highly echogenic areas. When large, they may
perforate, resulting in an ill-defined collection of pus, which
may be drained percutaneously.
Fistulae are another complication of Crohn's, and are easier to
demonstrate with contrast radiography.
Inflammatory bowel diseases increase the perfusion of the
intestine, decreasing vascular resistance.
In both Crohn's and ulcerative colitis compared with normal subjects.
Doppler of the SMA reveals an increase in flow velocities : both
peak systolic and end diastolic, and a decrease in resistance
index in numerous types of pathological bowel, including Crohn's.
In patients with active Crohn's disease the flow is 826
± 407ml/min (range 242-1455ml/min). A certain overlap is present. If the threshold value of less than
5OOmL/min is used, a sensitivity of 83 pet cent and specificity
of 87 pet cent can be achieved for active Crohn's disease.
Changes in resistance index have been found to be related
to the activity of Crohn's disease, which could prove valuable
in monitoring patients with known disease.
Intravenous contrast agents may help to differentiate fibrotic
and inflammatory strictures, and to discriminate inflammatory
masses from intra-abdominal abscesses.
The sonographic detection of enlarged regional lymph nodes
is more frequent in young patients, which suggests an earlier
phase of Crohn's disease and the presence of septic complications
such as fistulas and abscesses.
Crohn's disease is associated with fatty liver, hepatic
abscesses, gallstones, cholecystitis, sclerosing cholangitis,
hepatocellular carcinoma, bile duct carcinoma, renal calculi and
Another condition that can produce bowel
thickening is :
* Colitis (Ameobiasis. Pseudomembranous colitis. Necrotising enterocolitis).
* Ileocecal tuberculosis
*Oedema - hypoalbuminaemia, portal hypertension, constrictive
*Ischaemia and intramural haemorrhage.
*Venous congestion including malrotation and chronic volvulus.
*Henoch-Schônlein purpura (this may accentuate the mucosal pattern).
*Pelvic inflammatory disease.
*Gastroenteritis (including eosinophilic enteritis).
*Giardiasis or strongyloidiasis.
*Behçet's syndrome, the appearance is similar to Crohns disease.
*Tumeurs including métastases*.
is helpful in differentiating tubo-ovarian pathology.
* 1 De Pascale A, Garofalo G, Perna M, Priola S, Fava C. Contrast-enhanced
ultrasonography in Crohn's disease. Radiol Med (Torino). 2006
Jun;111(4):539-50. Epub 2006 May 25.
* 2 Maconi G, Radice E, Greco S, Bianchi Porro G. Bowel ultrasound
in Crohn's disease. Best Pract Res Clin Gastroenterol. 2006 Feb;20(1):93-112.
* 3 Maconi G, Di Sabatino A, Ardizzone S, Greco S, Colombo E,
Russo A, Cassinotti A, Casini V, Corazza GR, Bianchi Porro G.
Prevalence and clinical significance of sonographic detection
of enlarged regional lymph nodes in Crohn's disease. Scand J Gastroenterol.
* 4 Fraquelli M, Colli A, Casazza G, Paggi S, Colucci A, Massironi
S, Duca P, Conte D. Role of US in detection of Crohn disease:
meta-analysis. Radiology. 2005 Jul;236(1):95-101.
* 5 Parente F, Greco S, Molteni M, Anderloni A, Maconi G, Bianchi
Porro G. Modern imaging of Crohn's disease using bowel ultrasound.
Inflamm Bowel Dis. 2004 Jul;10(4):452-61.
* 6 Ludwig D. Doppler sonography in inflammatory bowel disease.
Z Gastroenterol. 2004 Sep;42(9):1059-65.
* 7 Neye H, Voderholzer W, Rickes S, Weber J, Wermke W, Lochs
H. Evaluation of criteria for the activity of Crohn's disease
by power Doppler sonography. Dig Dis. 2004;22(1):67-72.
* 8 Di Sabatino A, Armellini E, Corazza GR. Doppler sonography
in the diagnosis of inflammatory bowel disease. Dig Dis. 2004;22(1):63-6.
9 Sturm EJ, Cobben LP, Meijssen MA, van der Werf SD, Puylaert
JB. Detection of ileocecal Crohn's disease using ultrasound as
the primary imaging modality. Eur Radiol. 2004 May;14(5):778-82.
Epub 2004 Feb 4.
* 9 Hirche TO, Russler J, Schroder O, Schuessler G, Kappeser P,
Caspary WF, Dietrich CF. The value of routinely performed ultrasonography
in patients with Crohn disease. Scand J Gastroenterol. 2002 Oct;37(10):1178-83.
* 10 Meckler U. [Ultrasound diagnosis of Crohn disease] Schweiz
Rundsch Med Prax. 2002 Apr 3;91(14):591-6.
* 11 Rubini B, Jaafar S, Gaucher H, Kissel A, Gobertier-Gasparini
G, Fromaget JM, Tabary D, Muller M, Etzel JC. [Value of sonography
in the diagnosis and follow-up of patients with cryptogenic inflammatory
bowel diseases in current practice: review of a 10-year experience
in a community hospital] J Radiol. 2001 Nov;82(11):1601-11.
* 12 Valette PJ, Rioux M, Pilleul F, Saurin JC, Fouque P, Henry
L. Ultrasonography of chronic inflammatory bowel diseases. Eur
* 13 Esteban JM, Maldonado L, Sanchiz V, Minguez M, Benages A.
Activity of Crohn's disease assessed by colour Doppler ultrasound
analysis of the affected loops. Eur Radiol. 2001;11(8):1423-8.
* 14 Spalinger J, Patriquin H, Miron MC, Marx G, Herzog D, Dubois
J, Dubinsky M, Seidman EG. Doppler US in patients with crohn disease:
vessel density in the diseased bowel reflects disease activity.
Radiology. 2000 Dec;217(3):787-91.
* 15 Limberg B. [Diagnosis of chronic inflammatory bowel disease
by ultrasonography] Z Gastroenterol. 1999 Jun;37(6):495-508.
* 16 van Oostayen JA, Wasser MN, Griffioen G, van Hogezand RA,
Lamers CB, de Roos A. Activity of Crohn's disease assessed by
measurement of superior mesenteric artery flow with Doppler ultrasound.
Neth J Med. 1998 Dec;53(6):S3-8.
* 17 Giovagnorio F, Diacinti D, Vernia P. Doppler sonography of
the superior mesenteric artery in Crohn's disease. AJR Am J Roentgenol.
* 18 Maconi G, Bollani S, Bianchi Porro G. Ultrasonographic detection
of intestinal complications in Crohn's disease. Dig Dis Sci. 1996