{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:50:03Z","timestamp":1787313003060,"version":"build-2736575974"},"reference-count":66,"publisher":"SAGE Publications","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CH"],"published-print":{"date-parts":[[2022,12,27]]},"abstract":"<jats:p>The aim was to describe the small bowel morphology with conventional B-mode and elastography and additionally to evaluate dynamic effects of COVID-19 associated small bowel microvascularization using CEUS with color coded perfusion parameters. Thirteen patients with severe COVID-19 acute respiratory distress syndrome (ARDS) were investigated. 13 patients required intensive care treatment with mechanical ventilation. Five patients required extracorporeal membrane oxygenation (ECMO). Contrast-enhanced ultrasound (CEUS) was performed by an experienced investigator as a bolus injection of up to 2.4\u200aml sulfur hexafluoride microbubbles via a central venous catheter. In the parametric analysis of CEUS, the flare of microbubbles over time is visualized with colors. This is the first work using parametric analysis of CEUS to detect perfusion differences in the small bowel. Parametric analysis of CEUS in the intestinal phase was carried out, using DICOM loops for 20 seconds. In 5 patients, parametric analysis revealed intraindividual differences in contrast agent behavior in the small bowel region. Analogous to the computed tomography (CT) images parametric analysis showed regions of simultaneous hyper- and hypoperfusion of the small intestine in a subgroup of patients. In 5 patients, the parametric image of transmural global contrast enhancement was visualized. Our results using CEUS to investigate small bowel affection in COVID-19 suggest that in severe COVID-19 ARDS systemic inflammation and concomitant micro embolisms may lead to disruption of the epithelial barrier of the small intestine. This is the first study using parametric analysis of CEUS to evaluate the extent of small bowel involvement in severe COVID-19 disease and to detect microemboli. In summary, we show that in COVID-19 the small bowel may also be an important interaction site. This is in line with the fact that enterocytes have been shown to a plenitude of angiotensin converting enzyme (ACE)-2 receptors as entry sites of the virus.<\/jats:p>","DOI":"10.3233\/ch-221540","type":"journal-article","created":{"date-parts":[[2022,7,22]],"date-time":"2022-07-22T11:20:41Z","timestamp":1658488841000},"page":"341-360","source":"Crossref","is-referenced-by-count":10,"title":["Multimodal ultrasound imaging with conventional B-mode, elastography, and parametric analysis of contrast-enhanced ultrasound (CEUS): A novel approach to assess small bowel manifestation in severe COVID-19 disease"],"prefix":"10.1177","volume":"82","author":[{"given":"H.C.","family":"Tews","sequence":"first","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Kandulski","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Schmid","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Schlosser","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Schirner","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F.J.","family":"Putz","sequence":"additional","affiliation":[{"name":"Department of Nephrology, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Cosma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"G\u00fclow","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine I, Gastroenterology, Hepatology, Endocrinology, Rheumatology and Infectious diseases, University Hospital, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.M.","family":"Jung","sequence":"additional","affiliation":[{"name":"Department of Radiology, University Hospital Regensburg, Regensburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","reference":[{"issue":"SI-1","key":"10.3233\/CH-221540_ref1","doi-asserted-by":"crossref","first-page":"549","DOI":"10.3906\/sag-2004-127","article-title":"Coronaviruses and SARS-COV-2","volume":"50","author":"Has\u00f6ks\u00fcz","year":"2020","journal-title":"Turk J Med Sci"},{"issue":"2","key":"10.3233\/CH-221540_ref2","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1111\/all.14657","article-title":"Risk factors for severe and critically ill COVID-19 patients: A review","volume":"76","author":"Gao","year":"2021","journal-title":"Allergy"},{"issue":"2","key":"10.3233\/CH-221540_ref3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1152\/physiolgenomics.00087.2020","article-title":"SARS-CoV-2, ACE2 expression, and systemic organ invasion","volume":"53","author":"Ashraf","year":"2021","journal-title":"Physiol Genomics"},{"issue":"2","key":"10.3233\/CH-221540_ref4","first-page":"00133","article-title":"Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): aSystemic Infection","volume":"34","author":"Synowiec","year":"2021","journal-title":"Clin Microbiol Rev. 17. 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