Dragoni Gabriele, Gottin Matteo, Innocenti Tommaso, Lynch Erica Nicola, Bagnoli Siro, Macrì Giuseppe, Bonanomi Andrea Giovanni, Orlandini Beatrice, Rogai Francesca, Milani Stefano, Galli Andrea, Milla Monica, Biagini Maria Rosa
Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy.
IBD Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
J Crohns Colitis. 2023 Oct 20;17(9):1387-1394. doi: 10.1093/ecco-jcc/jjad068.
Intestinal ultrasound [IUS] is widely accepted as a reliable tool to monitor Crohn's disease [CD]. Several IUS scores have been proposed, but none has been formally accepted by international organizations. Our aim here was to compare the available scores regarding their correlation with endoscopic activity.
Consenting CD patients undergoing ileocolonoscopy at our Unit between September 2021 and February 2023 were included. Endoscopic activity was defined as SES-CD ≥ 3 or Rutgeerts score ≥ i2b for operated patients. IUS was performed within 6 weeks of endoscopy and scored with IBUS-SAS, BUSS, Simple-US and SUS-CD scores. All correlations were performed using Spearman's rank coefficient [rho = ρ]. Receiver operating characteristic [ROC] curves were compared with the Hanley and McNeil method.
Of 73 CD patients, 45 [61.6%] presented endoscopic activity, of whom 22 were severe [30.1%]. All IUS scores showed a significant positive correlation with endoscopy [p < 0.0001], with IBUS-SAS ranking the highest [ρ = 0.87]. Similarly, IBUS-SAS was the most highly correlated with clinical activity [ρ = 0.58]. ROC analysis of IBUS-SAS for any endoscopic activity showed the highest area under the curve (0.95 [95% confidence interval 0.87-0.99]), with sensitivity of 82.2% and specificity of 100% for a cut-off value of 25.2. IBUS-SAS was statistically superior to all the other scores in detecting severe endoscopic activity [SES-CD ≥ 9 or Rutgeerts i4].
All IUS scores provided solid correlation with endoscopy and clinical symptoms. IBUS-SAS outperformed the others due to a more granular description that might help in stratifying different levels of disease activity. Therefore, the use of IBUS-SAS in centres with well-founded expertise in IUS can be suggested.
肠道超声（IUS）被广泛认为是监测克罗恩病（CD）的可靠工具。已经提出了几种IUS评分，但尚无一种被国际组织正式认可。我们在此的目的是比较现有评分与内镜活动度的相关性。
纳入2021年9月至2023年2月期间在我们科室接受回结肠镜检查且同意参与的CD患者。内镜活动度定义为手术患者的SES-CD≥3或 Rutgeerts评分≥i2b。IUS在结肠镜检查后6周内进行，并采用IBUS-SAS、BUSS、Simple-US和SUS-CD评分。所有相关性分析均使用Spearman等级系数（rho = ρ）。采用Hanley和McNeil方法比较受试者工作特征（ROC）曲线。
73例CD患者中，45例（61.6%）存在内镜活动度，其中22例为重度（30.1%）。所有IUS评分均与内镜检查呈显著正相关（p < 0.0001），其中IBUS-SAS相关性最高（ρ = 0.87）。同样，IBUS-SAS与临床活动度相关性也最高（ρ = 0.58）。对任何内镜活动度的IBUS-SAS进行ROC分析，曲线下面积最高（0.95 [95%置信区间0.87 - 0.99]），截断值为25.2时，灵敏度为82.2%，特异性为100%。在检测重度内镜活动度（SES-CD≥9或Rutgeerts i4）方面，IBUS-SAS在统计学上优于所有其他评分。
所有IUS评分均与内镜检查及临床症状有良好的相关性。IBUS-SAS表现优于其他评分，因其描述更细致，可能有助于区分不同程度的疾病活动度。因此，建议在具备IUS专业知识的中心使用IBUS-SAS。
