确定4种超声评分在克罗恩病评估中的准确性及观察者间一致性：与内镜检查的相关性

Determining the Accuracy and Interobserver Agreement of 4 Ultrasound Scores in Crohn's Disease Assessment: Correlations With Endoscopy.

作者信息

Qin Jing, Ma Li, Zhou Meng-Yuan, Li Wen-Bo, Xiao Meng-Su, Niu Zi-Han, Yang Hong, Zhu Qing-Li

机构信息

Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Department of Gastroenterology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China .

出版信息

Clin Transl Gastroenterol. 2025 Apr 1;16(4):e00812. doi: 10.14309/ctg.0000000000000812.

DOI:10.14309/ctg.0000000000000812

PMID:39791555

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12020696/

Abstract

INTRODUCTION

Gastrointestinal ultrasound (GIUS) is recommended for monitoring Crohn's disease (CD). GIUS scores are used to quantify CD activity. Among them, International Bowel Ultrasound Segmental Activity Score (IBUS-SAS), Bowel Ultrasound Score (BUSS), Simple Ultrasound Score, and Simple Ultrasound Score for Crohn's Disease are most commonly used. The aim of this study was to compare and correlate the performance of such indicators with endoscopic activity and to calculate interobserver agreement.

METHODS

Consecutive patients with CD at our hospital between June 2015 and July 2021 were retrospectively enrolled. All patients underwent ileocolonoscopy after medical treatment. GIUS was performed within 2 weeks, and 4 GIUS scores were independently calculated. Receiver operating characteristic curve analyses were used to determine a cutoff value. Cohen kappa (κ) coefficient was calculated to estimate the agreement between GIUS findings.

RESULTS

A total of 106 patients with CD were enrolled. 80.2% (85/106) were endoscopic active (Simple Endoscopic Score for Crohn's disease ≥3), and 8.49% (9/106) were severe cases (Simple Endoscopic Score for Crohn's disease ≥9). All GIUS features (bowel wall thickness, color Doppler signs, bowel wall stratification, inflammatory signals at the mesentery) were statistically significant in assessing CD activity ( P < 0.05). IBUS-SAS showed the highest area under the curve (0.98; 95% CI: 0.96-1.00) and specificity (95.2%) for a cutoff value of 46.50. However, IBUS-SAS had only moderate agreement (Cohen κ = 0.427; P < 0.001). BUSS had substantial interobserver agreement (Cohen κ = 0.947; P < 0.001), with a similar diagnostic value (sensitivity, 100.0%; accuracy, 95.3%; area under the curve of 0.96 [95% CI: 0.91-1.00] for a cutoff value of 4.58).

DISCUSSION

GIUS score is an efficient and reliable method to assess CD activity. BUSS achieved a high accuracy and excellent interobserver agreement, which is more suitable for treatment assessment.

摘要

引言

推荐使用胃肠道超声（GIUS）监测克罗恩病（CD）。GIUS评分用于量化CD活动度。其中，国际肠道超声节段活动评分（IBUS-SAS）、肠道超声评分（BUSS）、简易超声评分以及克罗恩病简易超声评分最为常用。本研究旨在比较这些指标与内镜活动度的表现并进行相关性分析，同时计算观察者间的一致性。

方法

回顾性纳入2015年6月至2021年7月在我院连续就诊的CD患者。所有患者经药物治疗后接受回结肠镜检查。在2周内进行GIUS检查，并独立计算4种GIUS评分。采用受试者工作特征曲线分析确定临界值。计算Cohen kappa（κ）系数以评估GIUS检查结果之间的一致性。

结果

共纳入106例CD患者。80.2%（85/106）为内镜活动期（克罗恩病简易内镜评分≥3），8.49%（9/106）为重症病例（克罗恩病简易内镜评分≥9）。所有GIUS特征（肠壁厚度、彩色多普勒信号、肠壁分层、肠系膜炎症信号）在评估CD活动度方面均具有统计学意义（P<0.05）。对于临界值46.50，IBUS-SAS曲线下面积最高（0.98；95%CI：0.96 - 1.00），特异性为95.2%。然而，IBUS-SAS观察者间一致性仅为中等（Cohen κ = 0.427；P<0.001）。BUSS观察者间一致性良好（Cohen κ = 0.947；P<0.001），诊断价值相似（敏感性100.0%；准确性95.3%；对于临界值4.58，曲线下面积为0.96 [95%CI：0.91 - 1.00]）。