This white paper by Prof. Giovanni Maconi presents a comprehensive overview of intestinal ultrasound in IBD using a multiparametric approach.
The document describes how multiparametric intestinal ultrasound integrates structural, vascular, and stiffness assessment to improve the diagnosis, monitoring, and phenotyping of Crohn’s disease and ulcerative colitis. Conventional bowel wall thickness measurement is first reviewed, highlighting intra- and inter-observer variability due to segment heterogeneity. To address this limitation, the white paper introduces BowelAssist, an AI-based tool that automatically segments the bowel wall layers and provides average BWT measurements within a defined ROI, improving reproducibility and efficiency.
For vascular assessment, the paper compares color Doppler with advanced microvascular imaging techniques such as MV-Flow and contrast-enhanced ultrasound. MV-Flow detects smaller vessels and quantifies vascular pixels within a defined ROI to generate a perfusion index, enhancing activity assessment. CEUS is described as particularly valuable for differentiating abscesses from inflammatory masses and evaluating perianal disease.
The evaluation of bowel stiffness is discussed using strain elastography and shear wave elastography. Strain elastography provides semi-quantitative stiffness ratios, while 2D shear wave elastography offers real-time quantitative stiffness measurements in kilopascals with reliability mapping to guide ROI placement.
The conclusion emphasizes that combining AI-based structural analysis, vascular imaging, and elastography allows for a more precise estimation of inflammation and fibrosis, supporting personalized therapy and disease monitoring in IBD patients.
