Multimodality ultrasound in Crohn’s disease strictures

Table 3 Table summarizing key prospective, ex vivo, and pilot studies evaluating various ultrasound elastography modalities for characterizing Crohn’s disease strictures, with comparison to histological, surgical, or clinical reference standards

Ref.	Study design	n (CD strictures)	Elastography modality	Reference standard	Key findings
Abu-Ata et al[37], 2023	Prospective	33	SWE	Histology	SWE cut-off > 2.5 m/second had 80% sensitivity, 85% specificity; good fibrosis correlation
Baumgart et al[30], 2015	Ex vivo study	16	Strain elastography	Histology, tensiometry	Strain 1.56 (fibrotic) vs 3.74 (non-fibrotic), P < 0.0001; correlated with collagen
Chen et al[31], 2023	Prospective	52	SWE	Histology	ρ = 0.74 with fibrosis; SWE differentiated fibrosis with high accuracy
Dillman et al[41], 2014	Ex vivo	12	Strain elastography	Histology	Inverse correlation with fibrosis grade (ρ = -0.66), hydroxyproline (ρ = -0.72)
Ding et al[39], 2019	Prospective	25	SE, ARFI, pSWE	Histology	pSWE AUC = 0.833; SWE superior to SE/ARFI in fibrosis detection
Fraquelli et al[33], 2015	Prospective	47	Strain elastography	Histology	SR: 2.64 (severe) vs 1.16 (mild/no fibrosis), AUC = 0.91
Fufezan et al[38], 2015	Pilot pediatric	24	SWE	Clinical indices	Higher SWE values with more active disease; a scoring system proposed
Lu et al[2], 2022	Prospective	40	SWE + CEUS	Histology	SWE + CEUS showed distinct profiles for fibrosis vs inflammation
Ma et al[16], 2020	Prospective	20	SWE + CEUS	CT/endoscopy	SWE and CEUS parameters significantly differed in fibrotic vs inflammatory groups
Matsumoto et al[36], 2023	Prospective	21	SWE	IUS + clinical	SWE decreased only in ustekinumab group (P = 0.028); tracked stiffness after biologics
Mazza et al[34], 2022	Prospective	31	RTE	Histology + MRE	SR AUC = 0.88 for fibrosis; RTE outperformed MRE delayed enhancement (AUC = 0.61)
Orlando et al[35], 2018	Prospective	34	Strain elastography	Histology	SR > 2.52 predicted fibrosis with 90% sensitivity, 88% specificity
Sconfienza et al[32], 2016	Prospective	18	Axial strain sonoelastography	Histology	Improved fibrosis detection vs MRE; better visual pattern recognition
Serra et al[18], 2017	Prospective	29	Strain elastography	Histology	No correlation between SR and fibrosis; overlapping inflammation/fibrosis
Sidhu et al[19], 2023	Prospective pediatric	25	SWE + CEUS	Surgery	SWE + CEUS identified fibrosis/muscular hypertrophy; helpful for surgical planning
Stidham et al[40], 2011	Animal + ex vivo	31	Strain UEI	Histology, tensiometry	UEI strain -2.07 (inflamed) vs -1.10 (fibrotic), Young’s modulus 2.75 kPa vs 0.3 kPa
Zhang et al[42], 2023	Retrospective	37	SWE	Histology	Emean > 21.3 kPa AUC = 0.877 for fibrosis; SWE stronger fibrosis correlation vs CTE

CD: Crohn’s disease; SWE: Shear wave elastography; CEUS: Contrast-enhanced ultrasound; SR: Strain ratio; RTE: Real-time elastography; ARFI: Acoustic radiation force impulse; pSWE: Point shear wave elastography; UEI: Ultrasound elasticity imaging; CT: Computed tomography; MRE: Magnetic resonance enterography; IUS: Intestinal ultrasound; AUC: Area under the curve; ρ: Spearman correlation coefficient.