Gastroenterology Department, Hospital da Senhora da Oliveira, Guimarães, Portugal.
Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.
BMC Gastroenterol. 2022 May 18;22(1):252. doi: 10.1186/s12876-022-02326-6.
Intestinal ultrasound (IUS) is an increasingly used non-invasive tool to evaluate Crohn's disease (CD) activity. Recently, two IUS scores that evaluate inflammatory activity have emerged: the Simple Ultrasound Activity Score for CD (SUS-CD) and the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS). We aimed to compare the accuracy of SUS-CD, IBUS-SAS and contrast-enhanced ultrasound (CEUS) in predicting inflammatory activity in the terminal ileum in ileocolonoscopy in CD patients.
Retrospective study including all consecutive CD patients submitted to IUS with CEUS directed to the terminal ileum performed by a single operator between April 2016 and March 2020. Segmental SUS-CD and IBUS-SAS were calculated. A time-intensity curve of the contrast bowel wall enhancement was created with measurement of peak intensity using CEUS. The CD endoscopic activity in ileocolonoscopy was graded by Simple Endoscopic Score for CD (SES-CD) as inactive (SES-CD < 7) or active (SES-CD ≥ 7).
Fifty patients were included, 54.0% were female, with mean age of 34 ± 12 years, and most had isolated ileal disease (60.0%), and a nonstricturing, nonpenetrating behaviour (44.0%). Most of the patients (60.0%) had active endoscopic disease (SES-CD ≥ 7). SUS-CD and IBUS-SAS were not different between patients with active or inactive endoscopic disease (p = 0.15; 0.57, respectively), having a poor accuracy to correlate endoscopic activity (area under de curve (AUC) 0.62; 0.55, respectively). Peak intensity in CEUS was significantly different in patients with active or inactive endoscopic disease (p = 0.004), having a good accuracy to correlate endoscopic activity (AUC 0.80).
Unlike CEUS, SUS-CD and IBUS-SAS were not able to accurately correlate endoscopic activity in terminal ileum in CD. Therefore, CEUS is a non-invasive emerging method that should be increasingly integrated in the ultrasonographic evaluation of CD patients.
肠道超声（IUS）是一种越来越常用的非侵入性工具，用于评估克罗恩病（CD）的活动度。最近，出现了两种评估炎症活动度的 IUS 评分：简单超声活动评分（SUS-CD）和国际肠道超声节段活动评分（IBUS-SAS）。我们旨在比较 SUS-CD、IBUS-SAS 和对比增强超声（CEUS）在预测 CD 患者回肠末端炎症活动度方面的准确性。
回顾性研究纳入了 2016 年 4 月至 2020 年 3 月期间由同一位操作者进行的针对回肠末端的 IUS 与 CEUS 引导的所有连续 CD 患者。计算节段性 SUS-CD 和 IBUS-SAS。使用 CEUS 测量峰值强度，创建对比肠壁增强的时间-强度曲线。回结肠镜下 CD 活动度根据简单内镜评分（SES-CD）分为无活动（SES-CD＜7）或有活动（SES-CD≥7）。
共纳入 50 例患者，54.0%为女性，平均年龄 34±12 岁，大多数为孤立性回肠疾病（60.0%）和非狭窄性、非穿透性行为（44.0%）。大多数患者（60.0%）有活动性内镜疾病（SES-CD≥7）。有或无内镜活动的患者 SUS-CD 和 IBUS-SAS 无差异（p=0.15；0.57），对内镜活动的准确性较差（曲线下面积（AUC）0.62；0.55）。CEUS 中的峰值强度在有或无内镜活动的患者中存在显著差异（p=0.004），对内镜活动的准确性较高（AUC 0.80）。
与 CEUS 不同，SUS-CD 和 IBUS-SAS 不能准确地反映 CD 患者回肠末端的内镜活动度。因此，CEUS 是一种新兴的非侵入性方法，应越来越多地整合到 CD 患者的超声评估中。
