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Open Access Research article

Doppler ultrasound findings correlate with tissue vascularity and inflammation in surgical pathology specimens from patients with small intestinal Crohn’s disease

Tomohiko Sasaki128, Reiko Kunisaki2*, Hiroto Kinoshita2, Hideaki Kimura2, Teruaki Kodera3, Akinori Nozawa3, Akiho Hanzawa4, Naomi Shibata4, Hiromi Yonezawa4, Eiji Miyajima4, Satoshi Morita5, Shoichi Fujii6, Kazushi Numata1, Katsuaki Tanaka1, Masanori Tanaka7 and Shin Maeda8

Author Affiliations

1 Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan

2 Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan

3 Department of Pathology, Yokohama City University Medical Center, Yokohama, Japan

4 Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Yokohama, Japan

5 Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan

6 Department of Surgery, NTT Medical Center Tokyo, Tokyo, Japan

7 Department of Pathology and Laboratory Medicine, Hirosaki City Hospital, Aomori, Japan

8 Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan

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BMC Research Notes 2014, 7:363  doi:10.1186/1756-0500-7-363

Published: 14 June 2014

Abstract

Background

Crohn’s disease (CD) is routinely evaluated using clinical symptoms, laboratory variables, and the CD activity index (CDAI). However, clinical parameters are often nonspecific and do not precisely reflect the actual activity of CD small-intestinal lesions. The purposes of this prospective study were to compare color Doppler ultrasound (US) findings with histological findings from surgically resected specimens and confirm the hypothesis that color Doppler US can distinguish tissue inflammation and fibrosis.

Methods

Among 1764 consecutive patients who underwent color Doppler US examinations, 10 patients with CD (12 small-intestinal CD lesions) who underwent US examinations before elective small-intestine resection were evaluated in the present study. Areas of thickened intestinal walls were evaluated in terms of blood flow using color Doppler US imaging. The blood flow was semiquantitatively classified as “hyper-flow” and “hypo-flow” according to the Limberg score. Resected lesions were macroscopically and histopathologically processed. Inflammatory cell infiltration, fibrosis and vascularity were evaluated by myeloperoxidase (granulocytes), CD163 (macrophages), CD79a (B cells), CD3 (T cells), Masson’s trichrome (fibrosis), and factor VIII staining (vascular walls). All histopathological images were entered into virtual slide equipment and quantified using a quantitative microscopy integrated system (TissueMorph™).

Results

There were no significant differences in disease features or laboratory findings between “hypo-flow” lesions (n = 4) and “hyper-flow” lesions (n = 8). Histopathologically, “hyper-flow” lesions showed significantly greater bowel wall vascularity (factor VIII) (p = 0.047) and inflammatory cell infiltration, including CD163 macrophages (p = 0.008), CD3 T cells, and CD79a B cells (p = 0.043), than did “hypo-flow” lesions. There was no apparent association between the blood flow and CDAI.

Conclusions

In this study, active CD lesions were macroscopically visible in surgical specimens of patients with increased blood flow on preoperative color Doppler US imaging. Additionally, these CD lesions exhibited significantly greater vascularity and numbers of inflammatory leukocytes microscopically. Color Doppler US may predict tissue inflammation and fibrosis in small-intenstinal CD lesions.

Keywords:
Crohn’s disease; Small intestine; Color doppler ultrasound; Vascularity; Inflammation; Fibrosis