A novel super-resolution contrast-enhanced ultrasound approach for evaluating inflammatory activity in Crohn’s disease

OBJECTIVES: To investigate the role of super-resolution contrast-enhanced ultrasound (SR-CEUS) in evaluating inflammatory activity in Crohn's disease (CD). MATERIALS AND METHODS: In this prospective study, we consecutively enrolled CD patients confirmed by clinical and ileocolonoscopic findings. All patients underwent B-mode ultrasound (BMUS), color Doppler flow imaging (CDFI), CEUS, and SR-CEUS within 1 week of ileocolonoscopy. SR-CEUS quantitative parameters were recorded, with simple endoscopic score for Crohn's disease (SES-CD) as the reference standard. Diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis. RESULTS: 52 consecutive CD patients were categorized into active (SES-CD ≥ 3, n = 30) and inactive (SES-CD < 3, n = 22) groups. SR-CEUS clearly visualized the intramural microvascular architecture of the bowel wall. SR-CEUS yielded an AUC of 0.903 with 86.4% sensitivity (95% CI: 66.7-95.3%), and 86.7% specificity (95% CI: 70.3-94.5%) for assessing inflammatory activity, significantly outperforming both CDFI (p = 0.014) and CEUS (p = 0.045), while showing no statistically significant difference in comparison with BMUS (p = 0.988). Furthermore, the combination of BMUS and SR-CEUS achieved an AUC of 0.967 for diagnosing active CD, with 100% sensitivity (95% CI: 85.1-100%) and 86.7% specificity (95% CI: 70.3-94.7%), which was significantly superior to BMUS alone (p = 0.038). CONCLUSIONS: SR-CEUS provides quantitative microvascular perfusion maps that display vascular density, flow velocity, and direction, offering a non-invasive tool for evaluating inflammatory activity in CD. CRITICAL RELEVANCE STATEMENT: This study demonstrates that super-resolution contrast-enhanced ultrasound (SR-CEUS) provides a novel, non-invasive approach for quantitative evaluation of inflammatory activity in Crohn's disease (CD), which serves as a valuable supplement or alternative to endoscopy in routine monitoring. KEY POINTS: An unmet need remains for accurate, non-invasive tools to assess CD activity. SR-CEUS outperforms conventional CDFI and CEUS in distinguishing active from inactive CD. Combining SR-CEUS with standard BMUS yields excellent diagnostic accuracy, establishing this combined approach as a promising non-invasive alternative for monitoring inflammatory activity in CD patients.