Potential Role of Thermography in Evaluation of

Disease Activity in Inflammatory Bowel Disease - a

Case Report
Marko Bani1*, Darko Kolari2, Svetlana Antonini3, Željko Fereni4, Sanja Pleško5, Lidija Petriuši1
1
University Hospital Dubrava Division of Gastroenterology, Zagreb, Croatia
2
Ruer Boškovi Institute, Centre for Informatics and Computing, Zagreb, Croatia
3
Primary Health Care Zagreb - Center, Department of Radiology, Zagreb, Croatia
4
Children's Hospital Srebrnjak, Department of Pathology, Zagreb, Croatia
5
University Hospital Rebro, Department of Clinical and molecular Microbiology, Zagreb, Croatia
* mbanic@kbd.hr

Abstract - There is a need for simple, noninvasive and reproducible
test that could accurately reflect the inflammatory activity, and that
could be used safely and repeatedly, during biological course of
inflammatory bowel disease, such as ulcerative colitis. The aim of
this study was to present the possibility of thermal imaging in
assessing the inflammatory disease activity of ulcerative colitis. The
authors presented the case of female patient with newly diagnosed,
severe ulcerative pancolitis. The thermographic patterns, taken before
starting the antiinflammatory treatment, and upon reaching the
remission of the disease correlated with clinical and laboratory, and
endoscopic findings, as well. This case report pointed out to
diagnostic potential of infrared thermographs as a feasible and
noninvasive method in evaluation of disease activity, in the patient
with severe inflammatory bowel disease, such as acute pancolitis.
Keywords - inflammatory bowel disease; ulcerative colitis; Crohn's
disease; thermography
I. INTRODUCTION
Inflammatory bowel diseases (IBD), Crohn's disease and
ulcerative colitis delineate idiopathic chronic inflammation of
the small and large intestines. IBD represent relapsing and
remitting condition characterized by chronic inflammation at
various sites in gastrointestinal tract that result in diarrhea and
abdominal pain [1].
Inflammation results as a loss of tolerance to normal intestinal
flora, provoking the immune response that includes the release
of inflammatory mediators, such as cytokines, interleukins and
tumour necrosis factor, as well [2-3]. The etiopathogenetic
factors for loss of tolerance to normal host microbiota and
subsequent chronic inflammatory cascade include multifactor
genetic predisposition that can lead to abnormal epithelial
barrier and altered mucosal immune defences [4-6].
Diagnostic evaluation of inflammatory bowel diseases
includes clinical examination, laboratory tests, activity indices
and imaging methods, such as endoscopy and methods of
radiology. However, there is a need for simple, noninvasive
and reproducible test that could accurately reflect the disease
activity, and that could be used safely and repeatedly, during
biological course of inflammatory bowel disease. The aim of
this study was to present the possibility of thermal imaging in
the female patient with newly diagnosed ulcerative pancolitis.
II. METHODS
In this case report, for the purpose to evaluate the extent
of intestinal inflammation the female patient underwent the
standard diagnostic workup that included physical exam,
laboratory tests, including C-reactive protein (CRP),
esophagogastroduodenoscopy and total colonoscopy with
terminal iloescopy, as well. The microbiology testing of stool
samples, including A / B Cl. difficile toxin was performed in
order to detect a potential intestinal pathogen. The magnetic
resonance (MR) imaging of the abdomen and MR
enterocolography was done in order to exclude the diagnosis
of Crohn's disease. The patient also underwent the thermal
imaging, provided in real time using infrared camera Thermo
Tracer TH7102WL (NEC, Japan), during all the
measurements [7]. The measurements were done before the
preparations for endoscopy, to exclude the potential influence
of bowel cleansing and endoscopic procedure itself, as well.
The thermographic measurements were done in two interval
times: before initiating the therapy and after the patient had
reached the remission of colitis, according to clinical,
laboratory and endoscopic evaluation [8].
III. CASE REPORT
We present a 53-year old female patient with newly
diagnosed severe ulcerative pancolitis. The patient presented
with fever, fatigue, loss of appetite and loss of body weight, in
duration of 6 weeks before admittance to University Hospital
Dubrava. The disease was characterized with abdominal
cramps and diarrhea (5 – 10 stools / day, mixed with mucus
and blood). The laboratory tests revealed anemia with elevated
erythrocyte sedimentation rate and levels of CRP above
normal values. The upper gastrointestinal (GI) endoscopy
documented mild chronic gastritis and histopathology testing
did not document the presence of H. pylori infection in the
stomach. The MR enterography documented no signs of
Crohn's disease in the small intestines and no signs of fistulas.

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 Figure 1. Image of a patient with areas of thermal abnormalities.
The terminal ileoscopy showed no signs of inflammatory
involvement of the mucosa in terminal ileum. However, total
colonoscopy revealed acute severe pancolitis with Mayo
endoscopic subscore of 3 (ranging 0-3), in each colonic
segment. The initial findings of pancolitis and severe
inflammatory activity of the disease correlated with pattern of
thermographic infrared pictures, taken before treatment. On
initial findings, the pattern of thermographic infrared pictures
identified thermal abnormalities that were shown in increased
temperature of abdominal surface of the patient's body (Figure
1). After four weeks of intensive treatment with
antiinflammatory drugs (methylprednisolone and azathioprine,
in combination with mesalamine), the patient entered the
remission of the disease, documented with significant clinical,
laboratory and imaging improvement in disease activity [9-
10]. The laboratory tests detected no anemia with normal
values of CRP. Control examination by the means of total
colonoscopy, performed 4 weeks after initial examination
documented healing in each segment of colonic mucosa,
expressed with Mayo endoscopic subscore of 1. This finding,
indicating the remission of active colitis correlated with taken
termographic pictures showing only mild abnormalities with
the significant decrease in abdominal surface temperature
pattern, compared to initial thermographic examination
(Figure 2).
IV. DISCUSSION
Ulcerative colitis represents a chronic inflammatory and
ulcerative disease of colonic mucosa. Clinically, ulcerative
colitis is characterized by bloody diarrhea, and the diagnosis
most often relies on colonoscopy and macroscopically scoring
of visualized inflammatory and ulcerative mucosal pattern
[11-13]. Taking into account the standard imaging procedures
for evaluating the activity and extent of inflammatory disease,
the thermal imaging, also known as clinical thermography, is
capable of providing non-contact, in vivo diagnostic
information in regard to body temperature. Infrared imaging
also has the possibility to map small variations of the body
surface temperature and identify thermal abnormalities that
accompany various physiological conditions.
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Figure 2. Examination of the same patient after 4 weeks.
Being a passive technique, (i.e. without external sources of
radiation) thermography is non-invasive and therefore
intrinsically harmless. The findings in this case report indicate
the correlation of standard laboratory and imaging tests and
infrared imaging in evaluating the initial activity of acute
severe pancolitis, in this particular patient. In addition, after
four weeks of intensive treatment with antiinflammatory drugs
(methylprednisolone and azatioprine, in combination with
mesalamine), the documented clinical, laboratory and imaging
improvement in disease activity correlated with pattern of
taken thermographic pictures. We believe that blood vessel
activity during the process of active inflammation induces the
increase in body surface temperature that would be higher than
in normal tissue [8]. Our findings point out to diagnostic
potential of infrared thermography as a feasible and
noninvasive method in evaluation of disease activity, in the
patient with severe inflammatory bowel disease, such as acute
pancolitis [14-15]. There is a need for further basic and
clinical studies, in order to evaluate and validate the method of
thermal imaging by the means of infrared thermography in
assessing the activity and extent of intestinal inflammation, and
other intraabdominal inflammatory conditions, as well.
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