P161 Ultrasound as a primary imaging modality for follow-up of Crohn’s disease in pregnant women: initial results
A. Shitrit*1, A. Keinan2, B. Koslowsky3, E. Goldin3, K. R. Cytter4
1Shaare Zedek Medical Centre, Digestive Diseases Institute, Jerusalem, Israel, 2Shaare Zedek Medical Centre, Surgery Department, Jerusalem, Israel, 3Shaare Zedek Medical Centre, Digestive diseases institute, Jerusalem, Israel, 4Shaare Zedek Medical Centre, Radiology Department, Jerusalem, Israel
Imaging pregnant women with Crohn’s disease is very challenging. The use of computed tomography (CT) and magnetic resonance imaging (MRI) is restricted because of radiation or the inability to inject gadolinium. Lack of radiation makes the ultrasound (US) imaging the study of choice for many medical conditions in pregnancy. However, especially in advanced stages of pregnancy, the bowel is pushed by the uterus, and the normal anatomy is altered, which makes the scanning more difficult.
Our study purpose was to evaluate the accuracy and the reliability of ultrasound in the assessment of Crohn’s disease in pregnant women with comparison to post-partum MRI/CT enterography.
In this prospective study (still ongoing), pregnant women with known or suspected Crohn’s disease were referred from the IBD-MOM clinic (a multidisciplinary clinic for follow-up of pregnant IBD patients) for sonographic assessment of abdominal symptoms (pain, bloating, etc.). The study was approved by the institutional review board with waiver of informed consent.
Patients’ demographics, clinical information, and imaging findings were collected for all cases. Radiologic findings included abdomen wall thickness, bowel wall thickness, mucosal irregularity, bowel wall hyperaemia, and strictures. Mesenteric changes and extra-luminal findings were evaluated as well. US studies were compared with post-partum MRI/CT enterography.
Enrolled in the study were 19 patient; 3 of them were scanned more than once. Mean age was 30 y ± 5.8 (range 20–39 y). Pregnancy week ranged from 8–32 weeks. Further, 14 patients had known CD disease (in 5 there was a suspicion of CD). Bowel wall changes were noted in 15 patients, and changes in the mesentery in 6 patients. The terminal ileum was detected in 15 patients. No correlation was found between the abdomen wall thickness and the week of pregnancy with the quality of imaging of the terminal ileum (TI) (p = 0.23 and p = 0.93, respectively). Moreover, 7 women had post-partum CT/magnetic resonance (MR) enterography. In 6 women, findings were correlated with the US findings. In 1 case, an entero-enteric fistula was missed by the US, and 5 women will have their MRI enterography in the next 2 months.
These initial results are indicative of the potential of US as a primary tool for follow-up of CD in pregnancy. Meticulous scanning is informative in most women throughout the whole pregnancy period.