da Silva Moraes Antonio Carlos, de Freitas Moraes Glycia, de Araújo Antonio Luis Eiras, Luiz Ronir Raggio, Elia Celeste, Carneiro Antonio Jose, de Souza Heitor Siffert Pereira
Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
Cavallieri Medical Diagnostic Imaging Centre, Rio de Janeiro, Brazil.
Intest Res. 2019 Apr;17(2):227-236. doi: 10.5217/ir.2018.00124. Epub 2019 Apr 10.
BACKGROUND/AIMS: Consistently defining disease activity remains a critical challenge in the follow-up of patients with Crohn's disease (CD). We investigated the potential applicability of abdominal ultrasonography with color Doppler (USCD) analysis for the detection of morphological alterations and inflammatory activity in CD.
Forty-three patients with CD ileitis/ileocolitis were evaluated using USCD analysis with measurements obtained on the terminal ileum and right colon. Sonographic parameters included wall thickening, stricture, hyperemia, presence of intra-abdominal mass, and fistulas. Patients were evaluated for the clinical activity (Harvey-Bradshaw Index [HBI]), fecal calprotectin (FC) and C-reactive protein (CRP). The USCD performance was assessed using magnetic resonance enterography (MRE) as a criterion standard.
Most measurements obtained with USCD matched the data generated with MRE; however, the agreement improved in clinically active patients where sensitivity, positive predictive value, and accuracy were >80%, considering wall thickening and hyperemia. Complications such as intestinal wall thickening, stricture formation, and hyperemia, were detected in the USCD analysis with moderate agreement with MRE. The best agreement with the USCD analysis was obtained in regard to FC, where the sensitivity, positive predictive value, and accuracy were >70%. The overall performance of USCD was superior to that of HBI, FC and CRP levels, particularly when considering thickening, stricture, and hyperemia parameters.
USCD represents a practical noninvasive and low-cost tool for evaluating patients with ileal or ileocolonic disease, particularly in clinically active CD. Therefore, USCD might become a useful asset in the follow-up of patients with CD.
背景/目的：在克罗恩病（CD）患者的随访中，持续准确地定义疾病活动度仍然是一项严峻挑战。我们研究了彩色多普勒腹部超声检查（USCD）在检测CD形态学改变和炎症活动方面的潜在适用性。
对43例患有回肠炎/回结肠型CD的患者进行USCD分析，测量末段回肠和右半结肠。超声参数包括肠壁增厚、狭窄、充血、腹内肿块及瘘管的存在情况。对患者进行临床活动度评估（采用哈维-布拉德肖指数[HBI]）、粪便钙卫蛋白（FC）及C反应蛋白（CRP）检测。以磁共振肠造影（MRE）作为标准对照评估USCD的性能。
USCD获得的大多数测量结果与MRE得出的数据相符；然而，在临床活动期患者中，考虑肠壁增厚和充血情况时，二者的一致性有所提高，此时敏感性、阳性预测值及准确性均>80%。在USCD分析中检测到诸如肠壁增厚、狭窄形成及充血等并发症，与MRE的一致性为中等。在FC方面，USCD分析与之的一致性最佳，其敏感性、阳性预测值及准确性均>70%。USCD的整体性能优于HBI、FC及CRP水平，尤其是在考虑增厚、狭窄及充血参数时。
USCD是评估回肠或回结肠疾病患者的一种实用、非侵入性且低成本的工具，尤其是在临床活动期CD患者中。因此，USCD可能会成为CD患者随访中的一项有用手段。
