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P111. The usefulness of intestinal real time virtual sonography in patients with inflammatory bowel disease

S. Kawai, H. Iijima, S. Shinzaki, M. Araki, E. Shiraishi, S. Hiyama, T. Inoue, T. Nishida, M. Tsujii, T. Takehara, Osaka University Graduate School of Medicine, Department of Gastroenterology and Hepatology, 2–2 Yamadaoka, Suita, Osaka, Japan

Background

Intestinal ultrasonography (US) is useful for screening intestinal diseases. However intestinal US sometimes has a difficulty in obtaining accurate images because some parts of the intestine locate deeply in the abdominal cavity and are unfixed in the abdomen. Real time virtual sonography (RVS) synchronizes US images with the computed tomography (CT) or magnetic resonance imaging (MRI) with multi-planar reconstruction of the same section. RVS has been widely used for fixed organs such as liver but not for intestine. However some parts of anatomically fixed intestine, such as ascending and descending colon, and inflamed adherent intestine are suggested to be visualized by using RVS. The aim of this study is to evaluate the usefulness of RVS for detecting intestine especially in inflammatory bowel disease (IBD) patients.

Methods

Intestinal US was performed in 7 healthy volunteers. Each volunteer was examined with conventional US and RVS. Examination time for 3 parts of the large intestine (descending colon, ascending colon, and ileocecum) was compared. Intestinal RVS was also performed in 19 patients with IBD including 17 with Crohn's disease and 2 with ulcerative colitis. Abdominal CT scan within 6 months was used for the reference of RVS.

Results

Compared with conventional US, intestinal RVS for healthy volunteers showed a significant reduction in examination time; 36.7 vs 50 seconds for ascending colon (p = 0.0313), and 35.4 vs 66.4 seconds for ileocecum (p = 0.0156), respectively. In all the IBD patients, good synchronized US images could be obtained in the fixed parts of the large intestine. In ten of the 19 IBD patients, 11 lesions with active inflammation or strictures in the small intestine or sigmoid colon were detected by CT scan. In 8 out of the 11 lesions (72.7%), the inflamed intestinal lesions could be well visualized by intestinal RVS. Although the small intestine and sigmoid colon are usually considered unfixed in the abdomen, well-synchronized images were obtained in the examination of these inflamed lesions. Intestinal gas prevented us from obtaining good US images of other 3 lesions.

Conclusion

RVS significantly reduced the examination time of the large intestine. In addition, US images of the inflamed intestine were well-synchronized by RVS with the images of CT scan in IBD patients. Intestinal RVS can be a useful modality for detecting intestine especially in IBD patients.