Comparison of Two High-End Ultrasound Systems for Contrast-Enhanced Ultrasound Quantification of Mural Microvascularity in Crohn’s Disease

Abstract

Purpose: To verify the reproducibility of contrast-enhanced ultrasound (CEUS) quantification results of two different high-end ultrasound systems and to evaluate the clinical utility of the method in patients with Crohn’s disease (CD).

Materials and Methods: 18 patients with histologically confirmed CD (36.8 % women, 63.2 % men; mean age 43.7 ± 14.1 years) and wall segments thicker than 5 mm were recruited. CEUS quantification and conventional ultrasound investigation were performed under standardized settings using Toshiba Aplio500 and Siemens Acuson S3000 high-end ultrasound systems. CEUS was performed at a low mechanical index of 0.1 after bolus application of 4.8 ml of SonoVue^® contrast medium. The recorded DICOM clips were quantified using VueBox^® (version 4.3) calculating 11 quantitative parameters. Subsequently, CEUS quantification and conventional ultrasound results were analyzed.

Results: Correlation of quantitative parameters between the Aplio500 and AcusonS3000 systems for peak enhancement (PE), rise time (RT), wash-in-rate (WiR) and quality of fit (QOF) yielded significance levels of p < 0.05 and p < 0.0001 for wash-in-wash-out area under the curve (WiWoAUC). Spearman rank test showed moderate levels of correlation for PE, RT, WiR and QOF (r = 0.5, 0.49, 0.49 and 0.5 respectively), and high correlation for WiWoAUC (r = 0.89) between the two ultrasound systems.

Conclusion: Due to multiple uncontrollable affecting factors, the method of CEUS quantification by VueBox in the intestine cannot be recommended for device-independent multicenter studies. Therefore we suggest to use identical ultrasound systems and probes as well as to establish adequate reference ROIS, like a AIF-ROI.

Zusammenfassung

Ziel: Überprüfung der Reproduzierbarkeit quantitativer kontrastverstärkter Ultraschallergebnisse (CEUS) an zwei High-End-Geräten unterschiedlicher Hersteller und Evaluation der klinischen Eignung der Methode bei Patienten mit Morbus Crohn.

Material und Methoden: 18 Patienten (36.8 % Frauen, 63.2 % Männer; mittleres Alter 43.7 ± 14.1 Jahre) mit histologisch nachgewiesenem Morbus Crohn und Darmwandverdickungen > 5 mm wurden für die Studie rekrutiert. Mit zwei High-End Ultraschallgeräte, dem Toshiba Aplio500 und dem Siemens Acuson S3000, wurden unter standardisierten technischen Einstellungen die CEUS Quantifizierung und eine konventionelle Ultraschalluntersuchung durchgeführt. Für den CEUS wurde ein niedriger mechanischer Index von 0.1 unter Applikation von 4.8 ml des Kontrastmittels Sonovue^® gewählt. Ausgewertet wurden die aufgenommenen DICOM-clips mittels VueBox-Version 4.3, welche 11 quantitative Parameter kalkuliert. Abschließend wurden die Ergebnisse der konventionellen Ultraschalluntersuchung und die quantitativen CEUS-Ergebnisse ausgewertet.

Ergebnisse: Im Vergleich der quantitativen Ergebnisse beider Ultraschallgeräte ergaben sich für peak enhancement (PE), rise time (RT), Wash-in rate (WiR) und quality of fit (QOF) signifikante (jeweils p < 0.05), für die WiWoAUC hochsignifikante (p < 0.0001) Korrelationen. Im Spearman Rank Test zeigte sich für PE, RT, WiR und QOF eine mäßige (r = 0.5, 0.49, 0.49 und 0.5 respektive), für WiWoAUC eine deutliche (r = 0.89) Korrelation zwischen den Ergebnissen beider Ultraschallgeräten.

Schlussfolgerung: Die in unserer Studie beschriebene Methode der CEUS-Quantifizierung per VueBox am Darm kann aufgrund multipler, nicht zu kontrollierender Einflussfaktoren, nicht für geräteunabhängige multizentrische Studien empfohlen werden. Deshalb legen wir für weitere geräteübergreifende CEUS-Quantifizierungsstudien am Darm die Verwendung identischer Ultraschallsysteme und Schallköpfe sowie die Etablierung adäquater Referenz-ROIs, z. B. im Sinne einer AIF-ROI, nahe.

Key words

Crohn's disease - CEUS quantification - contrast agents - utrasonography

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