Non-invasive Ultrasound Elasticity Imaging (UEI) in Crohn's Disease

无创超声弹性成像 (UEI) 在克罗恩病中的应用

• 批准号: 7589017
• 负责人: KANG KIM
• 金额: $ 24.08万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-05-15 至 2011-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7589017
• 关键词: Abdominal Pain; Acute; Adverse effects; Algorithms; Blood Vessels; Breast Cancer Detection; Caliber; Chronic; Cicatrix; Clinical; Collagen; Colon; Crohn' s disease; Data; Deep Vein Thrombosis; Deposition; Development; Diagnosis; Diagnostic; Diagnostic tests; Disease; Elastic Tissue; Elasticity; Epithelium; Fibrosis; Flare; Genus Cola; Healed; Histopathology; Human; Image; Imaging Device; Imaging technology; Inflammation; Inflammatory Bowel Diseases; Intestinal Fibrosis; Intestines; Kidney; Kidney Transplantation; Lead; Length; Measurement; Measures; Mechanics; Medical; Methods; Modeling; Nature; Operative Surgical Procedures; Patients; Phase; Procedures; Process; Property; Quality of life; Rattus; Resected; Resolution; Right colon; Rodent; Sampling; Scanning; Sensitivity and Specificity; Severities; Sigmoid colon; Small Intestines; Stenosis; Steroids; System; Techniques; Thick; Tissues; Translating; Trichrome stain; Trinitrobenzenesulfonic Acid; Ultrasonography; Vomiting; Waxes; X-Ray Computed Tomography; base; clinical practice; clinically significant; cost; enema administration; healing; improved; in vivo; novel; pressure; public health relevance; radiofrequency; reconstitution; submicron; tool; two-dimensional

DESCRIPTION (provided by applicant): Non-invasive Ultrasound Elasticity Imaging (UEI) in Crohn's Disease While current imaging systems such as computed tomography (CT) scanning can identify inflammation in Crohn's disease, there are no imaging tools to identify which patients have significant intestinal fibrosis. Healing between flares of inflammation allows the intestine to reconstitute its epithelium, but this healing process results in the deposition of fibrotic scar tissue. Repeated cycles of flares and healing often lead to clinically significant fibrosis and stenosis of the intestine, requiring surgery in 20% of patients within 3 years of diagnosis, and in 57% of patients after 10 years of disease. This has a substantial impact on quality of life and medical costs. When Crohn's patients have abdominal pain and vomiting, this indicates severe narrowing of the small intestine. This can be due to inflammation, which can be treated with medical therapy, or due to chronic fibrosis, which requires surgery. Patients are treated empirically with steroids with their many side effects. Many patients would be better treated with surgery if we could identify which patients truly have severe intestinal fibrosis causing their intestinal strictures. Local ultrasound elasticity imaging (UEI) offers the potential to radically improve the diagnosis and timely management of intestinal fibrosis in Crohn's disease. This method allows complete characterization of the altered local tissue elastic properties and local intestine mechanics. Furthermore, it does so with high spatial resolution, offering excellent sensitivity, specificity, accuracy and precision. The mechanical properties of the intestine are estimated directly from intramural strain rather than inferred from intestine thickness and/or diameter changes. The direct nature of the measurement procedure is ideal for local assessment of tissue mechanical changes that occur with the development of fibrosis in the course of inflammatory bowel disease. If our hypotheses are correct, this method can be rapidly translated into clinical practice since it is based upon novel processing of ultrasound data that can be obtained with commercially available scanners. The fundamental hypotheses of this proposal are: 1.UEI can measure local changes in the elastic properties of the intestinal wall associated with the progression of fibrosis. 2. Local mechanical changes of the intestine wall as measured by UEI can predict the severity and extent of local fibrosis of the intestine resulting from previous inflammation. 3. UEI with speckle tracking can be used to non-invasively measure highly localized intestinal compliance changes in rodents, and is readily translatable into a clinical diagnostic tool in humans. A wide range of technical and scientific issues must be investigated to fully exploit the capabilities of the techniques proposed. Therefore, the two specific aims of this application are: 1. to determine whether noninvasive UEI can distinguish between the mechanical properties of fibrotic colon and normal colon in rats treated chronically with TNBS (trinitrobenzenesulfonic acid) enemas; and 2. To determine whether UEI is able to detect and measure the severity and extent of fibrosis in patients with Crohn's disease. PUBLIC HEALTH RELEVANCE: Repeated cycles of inflammation often lead to clinically significant fibrosis and stenosis of the intestine, requiring surgery in 20% of patients within 3 years of diagnosis, and in 57% of patients after 10 years of disease. This has a substantial impact on quality of life and medical costs. When Crohn's patients have abdominal pain and vomiting, this indicates severe narrowing of the small intestine. This can be due to inflammation, which can be treated with medical therapy, or due to chronic fibrosis, which requires surgery. Patients are treated empirically with steroids with their many side effects. Many patients would be better treated with surgery if we could identify which patients truly have severe intestinal fibrosis causing their intestinal strictures. While current imaging systems such as computed tomography (CT) scanning can identify inflammation in Crohn's disease, there are no imaging tools to identify which patients have significant intestinal fibrosis. The proposed local ultrasound elasticity imaging (UEI) offers the potential to radically improve the diagnosis and timely management of intestinal fibrosis in Crohn's disease. This method allows complete characterization of the altered local tissue elastic properties and local intestine mechanics. This method also can be rapidly translated into clinical practice since it is based upon novel processing of ultrasound data that can be obtained with commercially available scanners.

描述（由申请人提供）：克罗恩病的非侵入性超声弹性成像（UEI）虽然当前的成像系统（例如计算机断层扫描（CT）扫描）可以识别克罗恩病的炎症，但没有成像工具可以识别哪些患者患有明显的肠道炎症纤维化。炎症发作之间的愈合使肠道能够重建其上皮，但这种愈合过程会导致纤维化疤痕组织的沉积。反复的发作和愈合周期通常会导致临床上显着的肠道纤维化和狭窄，20% 的患者在诊断后 3 年内需要手术，57% 的患者在患病 10 年后需要手术。这对生活质量和医疗费用产生重大影响。当克罗恩病患者出现腹痛和呕吐时，这表明小肠严重狭窄。这可能是由于炎症引起的，可以通过药物治疗来治疗，也可能是由于慢性纤维化引起的，需要手术治疗。患者根据经验使用类固醇进行治疗，但类固醇有许多副作用。如果我们能够确定哪些患者确实患有导致肠道狭窄的严重肠道纤维化，那么许多患者会通过手术得到更好的治疗。局部超声弹性成像（UEI）有可能从根本上改善克罗恩病肠道纤维化的诊断和及时治疗。该方法可以完整表征改变的局部组织弹性特性和局部肠道力学。此外，它还具有高空间分辨率，具有出色的灵敏度、特异性、准确性和精密度。肠道的机械特性是直接根据壁内应变估计的，而不是根据肠道厚度和/或直径变化推断的。测量过程的直接性质非常适合局部评估炎症性肠病过程中纤维化发展所发生的组织机械变化。如果我们的假设正确，该方法可以快速转化为临床实践，因为它基于对可通过商用扫描仪获得的超声数据的新颖处理。该提案的基本假设是： 1.UEI可以测量与纤维化进展相关的肠壁弹性特性的局部变化。 2. UEI测量的肠壁局部机械变化可以预测先前炎症引起的肠道局部纤维化的严重程度和程度。 3.具有斑点追踪功能的UEI可用于非侵入性测量啮齿动物高度局部化的肠道顺应性变化，并且很容易转化为人类的临床诊断工具。必须研究广泛的技术和科学问题，以充分利用所提出技术的能力。因此，本申请的两个具体目的是： 1.确定非侵入性UEI是否可以区分长期接受TNBS（三硝基苯磺酸）灌肠治疗的大鼠的纤维化结肠和正常结肠的机械特性； 2. 确定UEI是否能够检测和测量克罗恩病患者纤维化的严重程度和程度。公共卫生相关性：炎症的反复循环通常会导致临床上显着的肠道纤维化和狭窄，20% 的患者在诊断后 3 年内需要手术，57% 的患者在患病 10 年后需要手术。这对生活质量和医疗费用产生重大影响。当克罗恩病患者出现腹痛和呕吐时，这表明小肠严重狭窄。这可能是由于炎症引起的，可以通过药物治疗来治疗，也可能是由于慢性纤维化引起的，需要手术治疗。患者根据经验使用类固醇进行治疗，但类固醇有许多副作用。如果我们能够确定哪些患者确实患有导致肠道狭窄的严重肠道纤维化，那么许多患者会通过手术得到更好的治疗。虽然当前的成像系统（例如计算机断层扫描（CT）扫描）可以识别克罗恩病的炎症，但没有成像工具可以识别哪些患者患有严重的肠道纤维化。所提出的局部超声弹性成像（UEI）有望从根本上改善克罗恩病肠道纤维化的诊断和及时治疗。该方法可以完整表征改变的局部组织弹性特性和局部肠道力学。该方法还可以快速转化为临床实践，因为它基于对可通过市售扫描仪获得的超声数据的新颖处理。