Jairath Vipul, Adsul Shashi, Allocca Mariangela, Danese Silvio, Dubinsky Marla C, de Oliveira Marcelo Freire, Ma Christopher, Kucharzik Torsten, Novak Kerri L, Panaccione Remo, Bautista Itzel Romo, Sands Bruce E, Taylor Stuart A, Wilkens Rune, Maaser Christian
Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Alimentiv, London, ON, Canada.
Inflamm Bowel Dis. 2025 Sep 15. doi: 10.1093/ibd/izaf196.
This narrative review summarizes the current knowledge on using intestinal ultrasonography (IUS) to evaluate disease activity in patients with Crohn's disease (CD) and explores its potential role in clinical trials. Current trial endpoints and their limitations are discussed, highlighting the need for more patient-centric approaches, including increased use of magnetic resonance enterography (MRE) and IUS. Intestinal ultrasonography offers several advantages: it is noninvasive, requires no sedation, bowel preparation, or exposure to ionizing radiation, and enables real-time assessment of disease activity. It also demonstrates high sensitivity and specificity for detecting transmural inflammation and complications such as strictures, abscesses, and fistulas. Compared with cross-sectional imaging modalities like MRE and computed tomography, IUS is more patient-friendly, cost-effective, and suitable for point-of-care examination. However, challenges remain, including the lack of a universally accepted disease activity scoring system for MRE or IUS, despite the development and validation of several scoring tools. Key unmet needs include standardization of image acquisition and reporting, adequate training of healthcare professionals, improved access to equipment, and reimbursement pathways. Intestinal ultrasonography is increasingly being integrated into clinical trials to assess transmural inflammatory changes in CD, with IUS-based measures of transmural remission or response showing promise as potential endpoints. Although its advantages are clear, addressing these unmet needs is essential to broaden the adoption of IUS in both clinical trials and routine clinical practice.
本叙述性综述总结了目前关于使用肠道超声（IUS）评估克罗恩病（CD）患者疾病活动度的知识，并探讨了其在临床试验中的潜在作用。讨论了当前的试验终点及其局限性，强调需要采用更多以患者为中心的方法，包括增加磁共振肠造影（MRE）和IUS的使用。肠道超声具有多个优点：它是非侵入性的，无需镇静、肠道准备或暴露于电离辐射，并且能够实时评估疾病活动度。它在检测透壁性炎症和诸如狭窄、脓肿及瘘管等并发症方面也显示出高敏感性和特异性。与MRE和计算机断层扫描等横断面成像方式相比，IUS对患者更友好、性价比更高，且适合床旁检查。然而，挑战依然存在，包括尽管已开发并验证了多种评分工具，但仍缺乏针对MRE或IUS的普遍接受的疾病活动度评分系统。关键的未满足需求包括图像采集和报告的标准化、医疗保健专业人员的充分培训、设备的更好获取以及报销途径。肠道超声越来越多地被纳入临床试验以评估CD中的透壁性炎症变化，基于IUS的透壁缓解或反应测量结果有望作为潜在终点。尽管其优势明显，但满足这些未满足的需求对于在临床试验和常规临床实践中扩大IUS的应用至关重要。
