Yaguchi Katsuki, Kunisaki Reiko, Sato Sho, Hirai Kaori, Izumi Misato, Fukuno Yoshimi, Tanaka Mami, Okazaki Mai, Wu Rongrong, Nishikawa Yurika, Matsune Yusuke, Shibui Shunsuke, Nakamori Yoshinori, Nishio Masafumi, Matsubayashi Mao, Ogashiwa Tsuyoshi, Fujii Ayako, Toritani Kenichiro, Kimura Hideaki, Kumagai Eita, Sasahara Yukiko, Inayama Yoshiaki, Fujii Satoshi, Ebina Toshiaki, Numata Kazushi, Maeda Shin
Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan.
Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
Intest Res. 2024 Jul;22(3):297-309. doi: 10.5217/ir.2023.00129. Epub 2024 Jul 16.
BACKGROUND/AIMS: Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease.
We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists.
Bowel wall thickness (P< 0.001), vascularity (P< 0.001), loss of bowel wall stratification (P= 0.015), and white-plague sign (P= 0.013) were significantly exacerbated in the endoscopic active ulcer stage. Receiver operating characteristic curve analysis revealed that a bowel wall thickness of > 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom.
Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease.
背景/目的：肠道白塞病通常与回盲部圆形溃疡相关，且具有较高的发病率和死亡率。肠道超声是一种用于疾病监测的非侵入性成像技术。然而，此前尚无关于肠道白塞病的肠道超声与内镜下溃疡活动度或组织病理学结果进行比较的报道。我们评估了肠道超声在评估肠道白塞病回盲部溃疡活动度方面的实用性。
我们回顾性地将肠道超声检查结果与73例相应的内镜图像和6例切除标本进行了比较。对肠道超声检查结果评估了7项参数（肠壁厚度、血管情况[使用改良林贝格评分和彩色多普勒评估]、肠壁分层、白膜征[强回声线或斑点]、肠系膜淋巴结肿大、壁外脓肿和瘘管），并将内镜下溃疡活动度分为活动期、愈合期和瘢痕期。组织病理学结果由经验丰富的病理学家共同评估。
在内镜下溃疡活动期，肠壁厚度（P<0.001）、血管情况（P<0.001）、肠壁分层消失（P=0.015）和白膜征（P=0.013）均显著加重。受试者操作特征曲线分析显示，肠壁厚度>5.5mm（敏感性89.7%，特异性85.3%）可能有助于检测活动性病变。与组织病理学结果相比，肠壁厚度增加反映溃疡边缘嵴，白膜征反映溃疡底部。
肠道超声有助于监测肠道白塞病的肠道溃疡活动度。
