Multimodality ultrasound in Crohn’s disease strictures

Table 2 Summary of studies evaluating contrast-enhanced ultrasound for characterization of Crohn’s disease strictures, with emphasis on fibrosis detection and correlation with histological or imaging reference standards

Ref.	Study design	n (CD strictures)	CEUS modality	Reference standard	Key findings
Goertz et al[25], 2018	Prospective cohort	30	Quantitative CEUS (peak enhancement, AUC, TTP)	Surgery or clinical follow-up	CEUS correlated well with histological fibrosis; peak enhancement and AUC were lower in fibrotic vs inflammatory strictures
Horjus Talabur Horje et al[21], 2015	Prospective observational	30	CEUS with dynamic perfusion analysis	Surgical pathology	CEUS showed correlation with fibrosis; fibrotic strictures had lower contrast uptake
Servais et al[22], 2021	Prospective cohort	34	Qualitative CEUS, quantitative (AUC, TTP, PI)	Histopathology	Combined CEUS + elastography improved diagnostic accuracy for fibrostenotic vs inflammatory
Wilkens et al[20], 2018	Prospective diagnostic accuracy study	25	Quantitative CEUS	Surgery	Moderate accuracy in distinguishing fibrosis; combined CEUS + DCE-MRE showed complementary roles
Lu et al[2], 2022	Prospective study	40	CEUS and SWE	Histology	CEUS parameters and shear wave velocity discriminated fibrosis; AUC and PE were reduced in fibrotic strictures
Ma et al[16], 2020	Prospective study	20	Quantitative CEUS + elastography	CT and endoscopy	CEUS differentiated inflammatory vs fibrotic stenosis; AUC and PE were higher in the inflammatory group
Nylund et al[24], 2013	Pilot feasibility study	15	Quantitative CEUS	Endoscopy	CEUS is feasible and safe; potential for stricture characterization; inflammation showed higher perfusion
Quaia et al[17], 2018	Prospective pilot study	20	Visual CEUS + strain elastography	Histopathology	Combined CEUS + elastography improved accuracy (AUC up to 0.95); good inter-reader agreement
Serra et al[18], 2017	Prospective study	29	CEUS + strain elastography	Histology	No correlation between CEUS parameters and histologic fibrosis; overlap of inflammation and fibrosis
Sidhu et al[19], 2023	Prospective pediatric study	25 (11 surgical)	CEUS + SWE	Surgical pathology	CEUS AUC correlated with fibrosis and muscular hypertrophy; it helped identify candidates for surgery
Ripollés et al[26], 2013	Prospective observational	28	B-mode, CDI, CEUS with PME and TTP analysis	Surgical specimens	PME correlated with inflammatory activity; CEUS showed low PME in fibrotic strictures
Schirin-Sokhan et al[29], 2011	Pilot prospective	18	Quantitative CEUS with QONTRAST software	Endoscopy + histology + follow-up	No significant correlation between quantitative CEUS and histologic fibrosis; Limberg score and CDAI better correlated with inflammation
Wilkens et al[28], 2022	Prospective cohort	18	CEUS + DCE-MRE + elastography	Biomechanical stiffness ex vivo	CEUS perfusion did not correlate with stricture stiffness; DCE-MRE slope correlated better with mechanical stiffness
Ponorac et al[27], 2021	Prospective single-center	24	Quantitative CEUS (PI, TTP, AUC)	Surgical pathology	Lower AUC and TTP values in fibrotic strictures; CEUS is useful in stricture phenotype classification
Quaia et al[23], 2012	Prospective pilot	28	CEUS with PME, wash-in slope	Endoscopy + MRE	PME is significantly lower in fibrostenotic than in inflammatory strictures; good intraobserver reproducibility

CEUS: Contrast-enhanced ultrasound; CD: Crohn’s disease; AUC: Area under the curve; TTP: Time to peak; PI: Peak intensity; PME: Percentage of maximal enhancement; SWE: Shear wave elastography; DCE-MRE: Dynamic contrast-enhanced magnetic resonance enterography; CDI: Color Doppler imaging; CT: Computed tomography; MRE: Magnetic resonance enterography; CDAI: Crohn’s disease activity index; PE: Peak enhancement.