Case of the Day: CEUS of the bowel.

Teaching Point: This is a thickened bowel loop showing fixed acute angulation. Ultrasound of the bowel shows excellent transmural resolution.

Teaching Point:
Color Doppler imaging is an important tool in the evaluation for blood flow in the Bowel wall. Here, we see artifact but no obvious color Doppler within the bowel wall. Color Doppler can have limitations including lack of sensitivity due to increased penetration, and possibility of image artifact from probe motion as seen here, resulting in an indeterminate scan. CEUS is to the rescue!!

Teaching Point:
With the addition of an ultrasound contrast agent, bowel perfusion is easily noted, showing excellent transmural enhancement. This movie indicates that there is at least moderate blood flow in the bowel wall which is directly related to the amount inflammation. CEUS is invaluable in the subjective assessment of blood flow. However, CEUS can be measured objectively.

Teaching Point:

This image shows a unique advantage of CEUS; the ability to quantify blood flow. Generated time intensity curves from 4 Regions of Interest placed on the bowel wall can graphically record the observation of wash-in and decline of contrast agent in the bowel wall, which is reflective of disease status. Bowel with a high peak enhancement in dB and high area under the curve in linear/secs represents severe disease, and mild peak enhancement with a mild Area under the curve represents moderate disease. The Peak enhancement here of 19 and the area under the curve is 3,400 linear seconds representing moderate disease activity. CEUS offers the capability to objectively measure blood flow. Disease progress can be monitored over time. CEUS is invaluable to assess the burden of disease, in Inflammatory Bowel Disease.