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P152 Ultrasound elasticity imaging accurately quantifies ileal fibrosis in patients with Crohn's Disease

M. Fraquelli1, F. Branchi1, 2, M. Cribiù3, A. Magarotto1, 2, S. Massironi1, S. Orlando1, 2, F. Botti2, 4, E. Contessini Avesani2, 4, D. Conte1, 2, G. Basilisco1, F. Caprioli*1, 2

1Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, Milan, Italy, 2Università degli Studi di Milano, Department of Pathophysiology and Transplantation, Milan, Italy, 3Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Pathology Unit, Milan, Italy, 4Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, General and Emergency Surgery Unit, Milan, Italy


Bowel wall fibrosis is associated with a complicated disease behavior and a reduced efficacy of anti-inflammatory therapies in patients with Crohn's disease (CD). A quantitative assessment of fibrosis severity in CD-affected areas, and their differentiation from inflammatory lesions, can be of great help in clinical decision-making. We have hereby aimed to evaluate the feasibility, reliability and reproducibility of Ultrasound Elasticity Imaging (UEI) in the assessment of ileal fibrosis in patients with CD.


A group of consecutive patients (n=16) with ileal or ileocolonic CD underwent bowel ultrasound (US) and UEI as well as surgical resection of the terminal ileum. Bowel wall stiffness was evaluated with UEI by means of both a color scale and a quantitative strain ratio measurement. Bowel wall thickness, stratification pattern and vascularization were evaluated at bowel US. The severity of bowel wall fibrosis and that of acute and chronic inflammation were evaluated on histological sections by both semi-quantitative and quantitative image analysis, and used as a reference standard.


Both UEI color scale and strain ratio measurements were characterized by an excellent inter-rater agreement. A highly significant correlation was found between strain ratio values and severity of bowel fibrosis at both semi-quantitative and quantitative histological image analysis. At variance, UEI Results were not influenced by the severity of acute and chronic intestinal inflammation. A degree of mucosal vascularization at bowel US was associated with more severe ileal fibrosis and with higher strain ratio values at UEI.


The Results show that UEI is a reliable highly reproducible technique, which can be complementary to bowel US examination in CD patients, as it can accurately identify small bowel segments affected by advanced fibrosis, without being influenced by the severity of intestinal inflammation.