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CEUS Bowel: Inflammatory Masses
Alexandra Medellin, MD; Stephanie R. Wilson, MD
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KEY FACTS

  • Terminology

    • Clinical Implications

      • Imaging

        TERMINOLOGY

        • Abbreviations

          • Inflammatory bowel disease (IBD)
          • Crohn disease (CD)
        • Definitions

          • Perienteric inflammatory masses
            • Phlegmon: Vascularized, inflammatory mass that is still perfused and cannot be drained
            • Abscess: Localized, suppurative, avascular collection of pus amenable to drainage and encompassed by inflamed tissue
            • CEUS fistulography: Technique in which microbubble contrast agent injected directly into cavity or sinus tract
          • Inflammatory masses within bowel
            • Inflammatory polyp: Nonneoplastic intraluminal vascular mass composed of nonepithelialized granulation tissue admixed with inflammatory cells
            • Intramural abscess: Avascular collection of pus located within bowel wall, shown on grayscale US as asymmetric, hypoechoic mural mass
        • Contributions of US/CEUS

          • CEUS can differentiate nature of inflammatory mass as abscess or phlegmon
          • CEUS offers several advantages to clinical management, all of which lend further support for inclusion of this imaging modality into clinical practice
          • CEUS is
            • Noninvasive
            • Easily repeatable
            • Free of ionizing radiation
            • Well tolerated
          • Flexibility of US/CEUS overall enhanced for this application by addition of
            • Endovaginal scans in women for accurate assessment of pouch of Douglas and deep loops of bowel
            • Transperineal scans in both men and women for confirmation of perianal abscess and fistula
            • CEUS fistulography to potentially replace standard fistulography without requirement of ionizing radiation

        CLINICAL IMPLICATIONS

        • Clinical Importance

          • Clinical Considerations

            CEUS TECHNIQUE

            • CEUS Protocol Advice

              • CEUS Fistulography

                IMAGING

                • Perienteric Inflammatory Masses

                  • Intramural/Intraluminal Inflammatory Masses

                    MANAGEMENT IMPLICATIONS

                    • Clinical Uses of CEUS

                      SUMMARY

                      • CEUS of Inflammatory Bowel Masses

                        Selected References

                        1. Kucharzik T et al: Intestinal ultrasound and management of small bowel Crohn's disease. Therap Adv Gastroenterol. 11:1756284818771367, 2018
                        2. Maconi G et al: EFSUMB Recommendations and clinical guidelines for intestinal ultrasound (GIUS) in inflammatory bowel diseases. Ultraschall Med. 39(3):304-317, 2018
                        3. Medellin A et al: Role of contrast-enhanced ultrasound in evaluation of the bowel. Abdom Radiol (NY). 43(4):918-933, 2018
                        4. Pecere S et al: Usefulness of contrast-enhanced ultrasound (CEUS) in Inflammatory Bowel Disease (IBD). Dig Liver Dis. 50(8):761-767, 2018
                        5. Politis DS et al: Pseudopolyps in inflammatory bowel diseases: Have we learned enough? World J Gastroenterol. 23(9):1541-1551, 2017
                        6. Ripollés T et al: Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn's disease and other abdominal conditions. Eur J Radiol. 82(10):e525-31, 2013
                        7. Ripollés T et al: Contrast-enhanced ultrasound (CEUS) in Crohn's disease: technique, image interpretation and clinical applications. Insights Imaging. 2(6):639-652, 2011
                        8. Esteban JM et al: Contrast-enhanced power Doppler ultrasound in the diagnosis and follow-up of inflammatory abdominal masses in Crohn's disease. Eur J Gastroenterol Hepatol. 15(3):253-9, 2003
                        Related Anatomy
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Clinical Implications

                            • Imaging

                              TERMINOLOGY

                              • Abbreviations

                                • Inflammatory bowel disease (IBD)
                                • Crohn disease (CD)
                              • Definitions

                                • Perienteric inflammatory masses
                                  • Phlegmon: Vascularized, inflammatory mass that is still perfused and cannot be drained
                                  • Abscess: Localized, suppurative, avascular collection of pus amenable to drainage and encompassed by inflamed tissue
                                  • CEUS fistulography: Technique in which microbubble contrast agent injected directly into cavity or sinus tract
                                • Inflammatory masses within bowel
                                  • Inflammatory polyp: Nonneoplastic intraluminal vascular mass composed of nonepithelialized granulation tissue admixed with inflammatory cells
                                  • Intramural abscess: Avascular collection of pus located within bowel wall, shown on grayscale US as asymmetric, hypoechoic mural mass
                              • Contributions of US/CEUS

                                • CEUS can differentiate nature of inflammatory mass as abscess or phlegmon
                                • CEUS offers several advantages to clinical management, all of which lend further support for inclusion of this imaging modality into clinical practice
                                • CEUS is
                                  • Noninvasive
                                  • Easily repeatable
                                  • Free of ionizing radiation
                                  • Well tolerated
                                • Flexibility of US/CEUS overall enhanced for this application by addition of
                                  • Endovaginal scans in women for accurate assessment of pouch of Douglas and deep loops of bowel
                                  • Transperineal scans in both men and women for confirmation of perianal abscess and fistula
                                  • CEUS fistulography to potentially replace standard fistulography without requirement of ionizing radiation

                              CLINICAL IMPLICATIONS

                              • Clinical Importance

                                • Clinical Considerations

                                  CEUS TECHNIQUE

                                  • CEUS Protocol Advice

                                    • CEUS Fistulography

                                      IMAGING

                                      • Perienteric Inflammatory Masses

                                        • Intramural/Intraluminal Inflammatory Masses

                                          MANAGEMENT IMPLICATIONS

                                          • Clinical Uses of CEUS

                                            SUMMARY

                                            • CEUS of Inflammatory Bowel Masses

                                              Selected References

                                              1. Kucharzik T et al: Intestinal ultrasound and management of small bowel Crohn's disease. Therap Adv Gastroenterol. 11:1756284818771367, 2018
                                              2. Maconi G et al: EFSUMB Recommendations and clinical guidelines for intestinal ultrasound (GIUS) in inflammatory bowel diseases. Ultraschall Med. 39(3):304-317, 2018
                                              3. Medellin A et al: Role of contrast-enhanced ultrasound in evaluation of the bowel. Abdom Radiol (NY). 43(4):918-933, 2018
                                              4. Pecere S et al: Usefulness of contrast-enhanced ultrasound (CEUS) in Inflammatory Bowel Disease (IBD). Dig Liver Dis. 50(8):761-767, 2018
                                              5. Politis DS et al: Pseudopolyps in inflammatory bowel diseases: Have we learned enough? World J Gastroenterol. 23(9):1541-1551, 2017
                                              6. Ripollés T et al: Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn's disease and other abdominal conditions. Eur J Radiol. 82(10):e525-31, 2013
                                              7. Ripollés T et al: Contrast-enhanced ultrasound (CEUS) in Crohn's disease: technique, image interpretation and clinical applications. Insights Imaging. 2(6):639-652, 2011
                                              8. Esteban JM et al: Contrast-enhanced power Doppler ultrasound in the diagnosis and follow-up of inflammatory abdominal masses in Crohn's disease. Eur J Gastroenterol Hepatol. 15(3):253-9, 2003