Contrast-enhanced ultrasonography with SonoVue after infliximab therapy in Crohn's disease.

The introduction of biological treatments like monoclonal anti TNF-α antibod- ies (infliximab ® ), is changing the clinical history of Crohn's disease (CD). The effects of these therapies are monitored emplying clinical index- es of active disease, laboratory parameters, en- doscopy and histology, and also with imaging techniques. A new ultrasound contrast agent, SonoVue ® (Bracco SpA, Milano, Italy), is opening new perspectives in the study of microvasculature of several organs. Aim of this study is to eval- uate by SonoVue enhanced ultrasonography (US) the occurrence of modifications in bowel wall microvasculature of CD patients and to correlate them with parameters of disease ac- tivity and to follow up the findings during in- fliximab therapy. After performing a basal color-doppler ultra- sonography, the study of the affected bowel loop is performed after i.v. injection of SonoVue and the enhancement is evaluated on a qualita- tive basis. We report on the preliminary results obtained in twenty patients, eight of which have been treated with three infusions of infliximab (induc- tion cycle) and evaluated at baseline and after the treatment. While at baseline we describe a positive correlation of SonoVue enhancement of the affected bowel loop with CRP, α1-glycopro- tein and white blood cell number, after infliximab treatment in 6/8 cases a definite improvement was detected. Ultrasonographic evaluation of the changes of bowel wall enhancement after i.v. SonoVue during infliximab therapy might represent an useful, not invasive and relatively low cost imag- ing modality for the clinical monitoring of activi- ty of small bowel Crohn's disease.