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Hydrocolonic Sonography for Evaluating Inflammatory Bowel Disease

¹ Ultrasonography Unit, Centre de Diagnòstic per la Imatge, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.
² Department of Gastroenterology, Institut de Malalties Digestives, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel 170, 08036 Barcelona, Spain.
³ Department of Nuclear Medicine, Centre de Diagnòstic per la Imatge, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain.

View larger version (30K): [in a new window]   Fig. 1. —Bar chart shows bowel wall thickness measured during hydrocolonic sonography in patients with inflammatory bowel disease (IBD) and in control subjects (p < 0.05 vs. involved segments of active IBD).

View larger version (32K): [in a new window]   Fig. 2. —Bar chart shows mucosal thickness measured during hydrocolonic sonography in patients with inflammatory bowel disease (IBD) and in control subjects (p < 0.05 vs. involved segments of active IBD).

View larger version (71K): [in a new window]   Fig. 3. —Longitudinal split sonogram obtained at ascending colon of 28-year-old female control subject. Fluid-filled lumen is an echo-free structure with haustra (arrows) projected as echogenic lamellae into lumen. Wall (asterisk) consists of five layers. From lumen, first (anechoic) and second (echopoor) layers represent mucosa. Third layer (echogenic) is submucosa, forth layer (echopoor) is muscularis propria, and fifth layer (echogenic) is serosa.

View larger version (108K): [in a new window]   Fig. 4A. —Hydrocolonic sonography in two patients with ulcerative colitis. In 28-year-old woman, sonogram shows thickened bowel wall with mucosal irregularity (asterisks). Five-layer stratification is not well preserved.

View larger version (102K): [in a new window]   Fig. 4B. —Hydrocolonic sonography in two patients with ulcerative colitis. In 35-year-old man with more severe disease, sonogram shows mucosal detachment into bowel lumen (arrows) and loss of haustra.

View larger version (117K): [in a new window]   Fig. 5. —29-year-old man with colonic Crohn's disease. Hydrocolonic sonogram shows thickened hypoechoic colonic wall that has lost five-layer stratification (arrows). Note absence of haustra and irregular mucosal surface (asterisks). Colonic wall distensibility is decreased.

View larger version (143K): [in a new window]   Fig. 6. —42-year-old woman with Crohn's disease. Hydrocolonic sonogram shows wall thickening (arrowheads) of ileal segment adjacent to ileocecal valve. Involved wall is hypoechoic, and distensibility is reduced.

View larger version (14K): [in a new window]   Fig. 7. —Graph shows correlation between hydrocolonic activity index and clinical activity index in patients with Crohn's disease (black boxes) and ulcerative colitis (white boxes). r = 0.66, p < 0.0001.

View larger version (33K): [in a new window]   Fig. 8. —Graph shows relationship between bowel wall thickness, measured by hydrocolonic sonography, and endoscopic activity of individual bowel segments. p < 0.01 for severe and moderate activity versus inactive, p < 0.01 for inactive, mild, and moderate versus severe endoscopic activity.

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