Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jan 25:14:100632.
doi: 10.1016/j.ejro.2024.100632. eCollection 2025 Jun.

Real-time shear wave elastography in measuring normal ileocolon intestinal wall stiffness using colonoscopy as reference: A single-center research

Shuo Wang  1 , Shihui Li  1 , Shuling Chen  1 , Manying Li  1 , Xiaoyan Xie  1 , Mao Ren  2 , Yujun Chen  1
Affiliations

Real-time shear wave elastography in measuring normal ileocolon intestinal wall stiffness using colonoscopy as reference: A single-center research

Shuo Wang et al. Eur J Radiol Open. .

Abstract

Purpose: To investigate the feasibility of real-time shear wave elastography (SWE) in evaluating intestinal wall stiffness, and to establish the threshold SWE value of normal intestinal wall and explore the influencing factors of intestinal SWE.

Method: 659 subjects who underwent intestinal SWE and colonoscopy were retrospectively enrolled. The wall elasticity of colonoscopy-confirmed normal/abnormal intestinal segment was measured by transabdominal SWE. Measurement reliability was evaluated by the intraclass correlation coefficient (ICC). The threshold value of SWE in differentiating normal and abnormal intestine was determined using ROC curve analysis with the largest Youden index, and the diagnostic performance of this threshold was evaluated. We explored the effects of gender, age, depth and type of the targeted intestinal segment on the intestinal wall elasticity by t test and logistic linear regression analysis.

Results: The technical success rate of SWE examination is 95.3 % (628/659). The mean SWE value of normal intestinal walls is (5.45 ± 1.34) kPa, which was significantly lower than that of abnormal ones (15.38 kPa±7.22, P < 0.001). Using 8.1 kPa as the threshold， the sensitivity and specificity were 93.5 % and 96.0 % with an AUC of 94.8 %. The overall ICC for SWE measurements was 0.933. Gender (ß=0.278, P = 0.013), depth (ß=0.220, P = 0.043) and type of the targeted segment (ß=0.522, P < 0.001) was associated with the SWE value of intestinal wall, but age was not (ß=0.050, P = 0.484).

Conclusions: SWE is feasible in evaluating the stiffness of intestinal wall with high reliability. The SWE threshold value differentiating normal intestinal wall and abnormal intestinal wall is 8.1 kPa.

Keywords: Elastography; Intestine; Ultrasound.

PubMed Disclaimer

Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Movie S1
Movie S1
Fig. 1
Fig. 1
A, Real-time SWE image of normal intestinal bowel wall of terminal ileum overlaying conventional ultrasound grayscale images in a 24-year-old subject. Circular ROI are depicted. The color scale indicates the distribution of the measured elasticity within the circular ROI. The Q-box includes the full thickness of bowel wall. The mean and standard deviation (SD) of elastic modulus (kPa) displayed on the Q-box were recorded and the measurement was repeated 3 times for average values. B, Normal bowel segment (terminal ileum) under enteroscopy corresponding to Fig. 1.A.
Fig. 2
Fig. 2
A, Real-time SWE image of ascending colon carcinoma with thickening of the colon wall with eccentric mass and increased elasticity under SWE. B, ascending colon carcinoma with huge ulcer under enteroscopy corresponding to Fig. 2.A.
Fig. 3
Fig. 3
A, Real-time SWE image of Crohn’s disease with stenotic intestine and increased elasticity under SWE. B, Stenotic intestine of Crohn’s disease with longitudinal ulcer and cobblestone appearance under enteroscopy corresponding to Fig. 3.A. CD, Crohn’s disease, Min, minimum, Max, maximum, ROI, regions of interest, SD, standard deviation, SWE, shear-wave elastography, and Diam, diameter.
Fig. 4
Fig. 4
Flow diagram of the study.
Fig. 5
Fig. 5
ROC curve for differentiating normal intestinal wall from abnormal intestinal wall.
See this image and copyright information in PMC

References

    1. Bettenworth D., Bokemeyer A., Baker M., Mao R., et al. Assessment of Crohn's disease-associated small bowel strictures and fibrosis on cross-sectional imaging: a systematic review. Gut. 2019;68(6):1115–1126. doi: 10.1136/gutjnl-2018-318081. Epub 2019 Apr 3. PMID: 30944110; PMCID: PMC6580870. - DOI - PMC - PubMed
    1. Higgins P.D., Fletcher J.G. Characterization of inflammation and fibrosis in Crohn's disease lesions by magnetic resonance imaging. Am. J. Gastroenterol. 2015;110(3):441–443. doi: 10.1038/ajg.2015.26. PMID: 25743712. - DOI - PubMed
    1. Kratzer W., von Tirpitz C., Mason R., et al. Contrast-enhanced power Doppler sonography of the intestinal wall in the differentiation of hypervascularized and hypovascularized intestinal obstructions in patients with Crohn's disease. J. Ultrasound Med. 2002;21(2):149–157. doi: 10.7863/jum.2002.21.2.149. PMID: 11833871. - DOI - PubMed
    1. Ripolles T., Rausell N., Paredes J.M., et al. Effectiveness of contrast-enhanced ultrasound for characterisation of intestinal inflammation in Crohn's disease: a comparison with surgical histopathology analysis. J. Crohns Colitis. 2013;7(2):120–128. doi: 10.1016/j.crohns.2012.03.002. Epub 2012 Apr 5. PMID: 22483566. - DOI - PubMed
    1. Quaia E., De Paoli L., Stocca T., et al. The value of small bowel wall contrast enhancement after sulfur hexafluoride-filled microbubble injection to differentiate inflammatory from fibrotic strictures in patients with Crohn's disease. Ultrasound Med Biol. 2012;38(8):1324–1332. doi: 10.1016/j.ultrasmedbio.2012.04.008. Epub 2012 Jun 13. PMID: 22698508. - DOI - PubMed

LinkOut - more resources