A milestone in the diagnosis of chronic inflammatory diseases

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(Image: Uni-Klinikum Erlangen)

Erlangen-based physicians show for the first time how inflammation can be detected sooner and with less stress for patients using an innovative laser technology

Ulcerative colitis and Crohn’s disease are the most common chronic inflammatory bowel diseases – around 400,000 people in Germany suffer from recurring inflammation of the intestinal mucosa. Reliable non-invasive methods of detecting acute episodes of these disorders have to date been unavailable. Researchers working at the Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology) and the Department of Paediatrics and Adolescent Medicine at Universitätsklinikum Erlangen have shown for the first time that multispectral optoacoustic tomography (MSOT) can be used to detect inflammation at an early stage. They have published their results in the New England Journal of Medicine.

Physicians frequently have to rely on invasive endoscopy to assess the status of the intestinal mucosa of patients with chronic inflammatory intestinal disorders. The aim is to prevent the development of related complications and facilitate the best possible treatment. However, the use of less stressful imaging techniques such as ultrasound is becoming more frequent. Physicians can use this to regularly monitor patients with regard to the structure, thickness and blood perfusion of the walls of the intestinal tract. A change in the pattern of blood perfusion can be evidence of an impending acute inflammatory episode.

‘During an MSOT scan, we also use a laser which the patient cannot feel that enables us to detect inflammatory activity earlier than was previously possible,’ explains Prof. Dr. Maximilian Waldner, junior professor at the Department of Medicine 1, Universitätsklinikum Erlangen. ‘The sooner we detect the signs of an impending episode, for instance on the basis of changes to blood perfusion, the sooner we can react and provide the patient with preventive treatment.’ The MSOT technique was developed by iThera Medical GmbH in Munich and used for the first time during intestinal research carried out at Erlangen last year.

The researchers at the Department of Medicine 1 and the Department of Paediatrics and Adolescent Medicine at Universitätsklinikum Erlangen recently announced their findings in the eminent New England Journal of Medicine. ‘We examined a total of 108 patients with Crohn’s disease using MSOT and then compared the results with those of other established techniques used in hospitals and laboratories and for endoscopic and histological examinations,’ clarifies Prof. Waldner. ‘We were able to demonstrate that the haemoglobin levels detected in tissues during MSOT provide very accurate information about inflammatory activity in the intestinal tract. MSOT is very probably superior to other non-invasive techniques as it can detect even low levels of inflammation without having to carry out an endoscopic examination.’

Dr. Ferdinand Knieling, junior physician at the Department of Paediatrics and Adolescent Medicine, adds: ‘We have good reason to hope we can employ this principle in other areas and use it specifically to undertake particularly stress-free examinations of children and young people. In many cases, this new technique may avoid the need to use invasive diagnostic methods.’

MSOT scanning the intestine through the skin with the help of pulsed laser light. The energy of the absorbed light is transformed into an ultrasound signal that is then recorded by highly sensitive ultrasound detectors. Christian Wiest, Managing Director at iThera Medical GmbH, explains: ‘MSOT is a completely new imaging technique that enables highly sensitive diagnosis of various diseases without the need to use contrast agents.’ In a pilot study undertaken in 2016, researchers were already able to detect changes to the red blood pigment, haemoglobin, inside the intestinal wall with the help of MSOT.

The results of the study were published on 30 March 2017 in the specialist publication New England Journal of Medicine (Volume 376, Issue 13, p. 1292–1294).

More information:

Dr. Ferdinand Knieling
Phone: +49 9131 85 33118
E-mail: ferdinand.knieling@uk-erlangen.de

Prof. Dr. Maximilian Waldner
Phone: +49 9131 85 35204
E-mail: maximilian.waldner@uk-erlangen.de