Usefulness of Strain Elastography, ARFI Imaging, and Point Shear Wave Elastography for the Assessment of Crohn Disease Strictures

• Published in: Journal of ultrasound in medicine Vol. 38; no. 11; pp. 2861 - 2870
• Main Authors: Ding, Shi‐si, Fang, Yan, Wan, Jing, Zhao, Chong‐Ke, Xiang, Li‐Hua, Liu, Hui, Pu, Huan, Xu, Guang, Zhang, Kun, Xu, Xiao‐Rong, Sun, Xiao‐Min, Liu, Chang, Wu, Rong
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.11.2019
• Subjects: acoustic radiation force impulse imaging; Adult; Constriction, Pathologic; Crohn disease; Crohn Disease - diagnostic imaging; Crohn Disease - pathology; Elasticity Imaging Techniques - methods; Female; Gastrointestinal Tract - diagnostic imaging; Gastrointestinal Tract - pathology; Humans; Male; Middle Aged; point shear wave elastography; Reproducibility of Results; Sensitivity and Specificity; stenosis; strain elastography; Crohn disease; point shear wave elastography; strain elastography; acoustic radiation force impulse imaging; stenosis
• ISSN: 0278-4297; 1550-9613
• DOI: 10.1002/jum.14989

Objectives The aim of this study was to evaluate the diagnostic performance of strain elastography, acoustic radiation force impulse (ARFI) imaging and point shear wave elastography (p‐SWE) for assessment of the predominant types of intestinal stenosis in Crohn disease. Methods Twenty‐five patients were enrolled in this study, among whom 25 suspicious stenoses in 25 intestinal segments were studied using gray scale ultrasonography. All 3 elastography methods were performed, and all patients underwent endoscopy within 24 hours with pathologic biopsy. The sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), Youden index, and area under the receiver operating characteristic curve (AUROC) were calculated. Pathologic findings were regarded as the gold standard. Results For SE, the optimal cutoff value was a score of 4 or greater (sensitivity, 75%; specificity, 66.7%; accuracy, 68%; PPV, 30%; NPV, 93.3%; AUROC, 0.708; however, P > .05). The results of ARFI imaging were similar: the optimal cutoff value was a score of 4 or greater (sensitivity, 50%; specificity, 81%; accuracy, 76%; PPV, 33.3%; NPV, 89.4%; AUROC, 0.669; P < .05). However, for p‐SWE, the optimal cutoff value was reached when the shear wave velocity exceeded 2.73 m/s (sensitivity, 75%; specificity, 100%; accuracy, 96%; PPV, 100%; NPV, 95.5%; AUROC, 0.833; P < .05). Conclusions p‐SWE had the best performance for evaluating and differentiating intestinal stenosis in Crohn disease, while neither SE nor ARFI imaging achieved satisfactory outcomes for evaluating inflammatory stenosis and fibrotic stenosis of Crohn disease.