Super-resolution CEUS is an emerging ultrasound technique that can accurately assess Crohn's disease activity by visualizing microstructural changes and blood flow patterns at the micrometer scale, achieving 94% sensitivity and 95% specificity in distinguishing disease severity levels.
- Super-resolution CEUS achieved an AUC of 0.92 with 94.1% sensitivity and 95.0% specificity in differentiating Crohn's disease activity stages
- The technique outperformed conventional CEUS (AUC 0.78) by visualizing microvasculature and hemodynamic microflow at the micrometer scale
- Key findings showed higher vascular parameters in moderate/severe activity groups, including maximum density (63.4 vs 51.1) and mean velocity (40.2 vs 23.0 mm/sec)
- A combined model incorporating super-resolution CEUS parameters achieved an AUC of 0.94, providing even stronger diagnostic performance
- The study included 54 Crohn's disease patients evaluated with intestinal super-resolution CEUS imaging alongside conventional ultrasound methods
An emerging contrast-enhanced ultrasound (CEUS) technique can accurately measure Crohn’s disease patterns in patients, according to research published September 8 in Radiology.
Super-resolution CEUS successfully differentiated Crohn’s disease activity by visualizing microstructural changes and outperformed conventional CEUS in a study led by Yujun Chen, MD from The First Affiliated Hospital of Sun Yat-sen University in Guangzhou, China and colleagues.
“These findings support [super-resolution] CEUS as a promising noninvasive tool for quantitative assessment of Crohn’s disease inflammatory activity,” Chen and co-authors wrote.
Intestinal US is widely used to evaluate Crohn’s disease, but color Doppler flow imaging and CEUS can struggle in visualizing microstructural and hemodynamic details.
Super-resolution CEUS can address these issues by visualizing microvasculature and hemodynamic microflow at the micrometer scale. Prior research has outlined this technique’s success in imaging the kidneys and intestinal fistulas.
The Chen team led a prospective study on super-resolution CEUS’ performance in differentiating disease activity stages of Crohn’s disease.
The study included 54 patients with Crohn’s disease involving the terminal ileum or colon. The patients underwent intestinal super-resolution CEUS imaging in 2025. The researchers classified the patients into remission/mild or moderate/severe activity groups based on the Simple Endoscopic Score for Crohn’s Disease.
Representative multimodal ultrasound and endoscopic images in participants with Crohn's disease. Top row depicts findings in a 26-year-old male participant with Crohn's disease in remission. Bottom row illustrates findings in a 25-year-old male participant with severe active Crohn's disease. The terminal ileum was the most prominently thickened bowel segment in both participants. Paired images comparing imaging modalities are shown. (A, F) Grayscale US images of the longitudinal section; arrows in A indicate the intestinal wall. (B, G) Color Doppler flow images of the longitudinal section; the box outlines the region of interest. In these two images, blue represents venous flow, while red represents arterial flow. (C, H) Conventional CEUS images of the longitudinal section. (D, I) Vascular density maps derived from super-resolution CEUS of the longitudinal section; arrows in D indicate the intestinal wall, and the outline in I indicates the measurement area for quantitative analysis. (E, J) Corresponding endoscopic images in the participants.RSNA
Along with super-resolution CEUS, the team also performed B-mode ultrasound, color Doppler flow imaging, and conventional CEUS.
The team observed higher super-resolution CEUS vascular parameters in the moderate/severe activity group than the remission/mild activity group.
Super-resolution CEUS parameters between patient groups | |||
Measure | Remission/mild activity | Moderate/severe activity | P value |
Maximum density | 51.1 | 63.4 | 0.003 |
Mean density | 21.1 | 26.9 | 0.007 |
Mean velocity | 23.0 mm/sec | 40.2 mm/sec | 0.01 |
Vascular density ratio | 38.5% | 73.2% | < 0.001 |
Fractal dimension | 1.5 | 1.7 | < 0.001 |
Super-resolution CEUS also performed well in distinguishing patients with remission/mild activity from those with moderate/severe activity. It achieved an area under the receiver operating characteristic curve (AUC) of 0.92; 94.1% sensitivity and 95.0% specificity. It also outperformed conventional CEUS (AUC, 0.78; p = 0.03).
The researchers also included parameters from clinical features and all ultrasound approaches in a combined model. They identified the International Bowel Ultrasound Segmental Activity Score and vascular density ratio as influential factors.
The combined model achieved an AUC of 0.94, superior to both color Doppler flow imaging (AUC, 0.82; p = 0.04) and conventional CEUS (p = 0.002) and similar to super-resolution CEUS (p = 0.51).
The study authors noted that the observed differences between the moderate/severe and remission/mild activity groups are biologically consistent with the known effects of inflammation on the intestinal microvasculature.
“Higher activity is associated with increased vascular density, perfusion, blood flow distribution, and structural complexity,” they wrote.
The authors also called for future large multicenter cohorts with external validation datasets to confirm their findings.
The results provide “compelling” early evidence about the potential of super-resolution CEUS in this area, according to an accompanying editorial written by Shailendra Katwal, MD, from the Beth Israel Deaconess Medical Center in Boston, and Victoria Chernyak, MD, from the Columbia University Irving Medical Center in New York.
“The advance is not limited to improved diagnostic performance but also reflects an expansion of what ultrasound is able to depict,” Katwal and Chernyak wrote.
Read the full study here.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
