Amsterdam University Medical Center, Department of Gastroenterology and Hepatology, Amsterdam, The Netherlands.
Gastrounit, Division of Medicine, Hvidovre Hospital, Copenhagen, Denmark.
J Crohns Colitis. 2021 Aug 2;15(8):1284-1290. doi: 10.1093/ecco-jcc/jjaa267.
Intestinal ultrasound [IUS] is a promising and non-invasive cross-sectional imaging modality in the diagnosis and monitoring of ulcerative colitis [UC]. Unlike endoscopy, where standardized scoring for evaluation of disease activity is widely used, scoring for UC with IUS is currently unavailable. Therefore, we conducted a study to assess the reliability of IUS in UC among expert sonographists in order to identify robust parameters.
Thirty patients with both clinically active [25] and quiescent [five] UC were included. Six expert sonographers first agreed upon key IUS parameters and grading, including bowel wall thickness [BWT], colour Doppler signal [CDS], inflammatory fat [i-fat], loss of bowel wall stratification [BWS], loss of haustrations and presence of lymph nodes. Thirty video-recorded cases were blindly reviewed.
Inter-observer agreement was almost perfect for BWT (intra-class correlation coefficient [ICC]: 0.96) and substantial for CDS [κ = 0.63]. Agreement was moderate for presence of lymph nodes [κ = 0.41] and fair for presence of i-fat [κ = 0.36], BWS [κ = 0.24] and loss of haustrations [κ = 0.26]. Furthermore, there was substantial agreement for presence of disease activity on IUS [κ = 0.77] and almost perfect agreement for disease severity [ICC: 0.93]. Most individual parameters showed a strong association with IUS disease activity as measured by the six readers.
IUS is a reliable imaging modality to assess disease activity and severity in UC. Important individual parameters such as BWT and CDS are reliable and could be incorporated in a future UC scoring index. Standardized acquisition and assessment of UC utilizing IUS with established reliability is important to expand the use of IUS globally.
肠超声[IUS]是一种有前途的非侵入性横断面成像方式，可用于溃疡性结肠炎[UC]的诊断和监测。与内镜不同，内镜广泛使用标准化评分来评估疾病活动度，但目前还没有用于 IUS 评估 UC 的评分。因此，我们进行了一项研究，以评估专家超声医师在 UC 中的 IUS 可靠性，以便确定可靠的参数。
纳入 30 例具有临床活动性[25 例]和静止性[5 例]UC 的患者。六名专家超声医师首先就 IUS 的关键参数和分级达成一致，包括肠壁厚度[BWT]、彩色多普勒信号[CDS]、炎症性脂肪[i-fat]、肠壁分层丢失[BWS]、失去蠕动和存在淋巴结。对 30 个视频记录的病例进行盲法审查。
BWT 的观察者间一致性几乎为完美（组内相关系数[ICC]：0.96），CDS 的一致性为显著（κ=0.63）。淋巴结的存在具有中度一致性（κ=0.41），i-fat 的存在具有适度一致性（κ=0.36），BWS 的存在和蠕动的丧失具有公平一致性（κ=0.24 和κ=0.26）。此外，IUS 上疾病活动的存在具有显著的一致性（κ=0.77），疾病严重程度具有几乎完美的一致性（ICC：0.93）。大多数单个参数与六名读者测量的 IUS 疾病活动具有很强的相关性。
IUS 是一种可靠的成像方式，可用于评估 UC 的疾病活动度和严重程度。BWT 和 CDS 等重要的单个参数是可靠的，可以纳入未来的 UC 评分指数中。使用具有可靠信度的 IUS 对 UC 进行标准化采集和评估，对于在全球范围内扩大 IUS 的应用非常重要。
