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Patients affected by inflammatory bowel diseases (IBD) such as Crohn’s disease go through cycles of active disease and remission. Knowing the status of inflammation of the colon wall is of utmost importance to choose appropriate treatment options and avoid serious complications in the long run.
To save patients from discomfort and be able to increase the monitoring frequency, a non-invasive alternative to the current diagnostic gold standard – endoscopy and biopsy – is needed. However, current imaging modalities such as X-ray CT induce a radiation risk or are not able to distinguish patients with intermediate disease activity such as Doppler ultrasound.
A recent clinical pilot study conducted at the University Hospital in Erlangen demonstrates the potential of MSOT to assess disease activity non-invasively through the abdominal wall. Higher histologically confirmed disease activity is associated with higher perfusion and oxygenation determined by MSOT.
The figures below explain the principle of MSOT measurements and showcase examples of MSOT perfusion imaging in a patient in remission compared to a patient with active disease.
Panel A shows total hemoglobin measured by MSOT in the intestinal wall in 44 patients with Crohn’s Disease grouped in terms of severity of intestinal inflammation using the Simplified Endoscopic Score for Crohn’s Disease (SES-CD). MSOT is able to discriminate low and medium levels of inflammation from remission. Panel B shows in the upper row two representative MSOT total hemoglobin images cropped to the region of interest and pseudocoloured (remission and high degree of inflammation). In the background corresponding B-Mode ultrasound images are presented. The lower row depicts corresponding endoscopic images.
Knieling F., Waldner M.J., Neurath M.F., et al., Multispectral Optoacoustic Tomography for Assessment of Crohn’s Disease Activity, N Engl J Med. 2017 Mar 30;376(13):1294-6. DOI: 10.1056/NEJMc1612455.
Waldner, M. J., Knieling, F., Egger, C., Morscher, S., Claussen, J., Vetter, M., Kielisch, C., Fischer, S., Pfeifer, L., Hagel, A., Görtz, R., Wildner, D., Atreya, R., Strobel, D., Neurath, MF. Multispectral optoacoustic tomography in Crohn's disease: Non-invasive imaging of disease activity,
Gastroenterology. 2016 Jun 3. DOI: 10.1053/j.gastro.2016.05.047.
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