Evaluation of Crohn’s Disease Activity: Development of an Ultrasound Score in a Multicenter Study

Abstract

Objective Our goal in this multicentric prospective study was 2-fold: first, to test the diagnostic accuracy of ultrasound, color Doppler imaging (CDI), and contrast-enhanced ultrasound (CEUS) in identifying disease activity in patients with Crohn’s disease (CD) compared with endoscopy as the reference standard; and, second, to construct a sonographic score that allows disease activity to be detected. Materials and methods Seventy-two patients with CD from 3 hospitals underwent within a 30-day period both colonoscopy and ultrasound (US), including mural thickness, CDI, and CEUS, prospectively as part of clinical care. A multivariate analysis was carried out to assess the influence of each of the ultrasound variables in predicting endoscopic activity. We then developed a predictive ultrasound score for disease activity, and a receiver operating characteristic (ROC) curve was constructed to determine the area under the ROC curve (AUC) and the best cut-off score value to discriminate between active and inactive disease. Results Sonographic findings that were independent predictors of the presence of active disease at endoscopy were wall thickness, color grade, and contrast parameters. A score based on those variables showed high accuracy in predicting active disease, with an area under the ROC curve of 0.972. A simpler index, without contrast parameters, also showed high accuracy in detecting disease activity (AUC, 0.923). Conclusion A score based on wall thickness, color Doppler grade, and contrast parameters showed high accuracy in predicting active disease. A score without including the use of contrast agent had practically similar results and is easier to use in monitoring response to treatment.

Intestinal ultrasonography and fecal calprotectin for monitoring inflammation of ileal Crohn’s disease: two complementary tests

“…6 A simple index based on wall thickness and color Doppler grade has shown high accuracy in detecting endoscopic activity in patients with CD. 7 Recently, transmural healing in IUS has been associated with better long-term outcomes. 8 Calprotectin is a calcium and zinc binding protein, present in the cytoplasm of the neutrophils.…”

Defining Transabdominal Intestinal Ultrasound Treatment Response and Remission in Inflammatory Bowel Disease: Systematic Review and Expert Consensus Statement

“… 12 , 22 Although less reliable, 62 loss of bowel wall stratification [BWS] is associated with ulcers, 65 and inflammatory fat [I-fat] has been shown to be present in endoscopically active disease only. 66 Combined with our clinical experience, we suggest that BWS and I-fat can be used as contributory parameters when assessing the worst segment. 7 , 12 However, since the interrater reliability of IUS parameters assessed by 12 IUS experts in CD patients was low to moderate for BWS and I-fat, κ = 0.39 and κ = 0.51, respectively, assessment of these parameters should be carefully considered in combination with more reliable parameters.…”

“… 7 , 12 After the RAND/UCLA process, several new scores have been published, using different combinations of BWT, CDS, BWS, I-fat, clinical symptoms, contrast IUS, and elastography. 62 , 64 , 66 , 67 , 70–75 Interestingly, Saevik et al . used only BWT and CDS in their score, excluding BWS and I-fat due to poor interobserver agreement.…”

Ultrasonographic Evaluation of Intestinal Fibrosis and Inflammation in Crohn’s Disease. The State of the Art

“…Recently, a score combining the US wall thickness, the color Doppler grade and contrast parameters showed an high degree of accuracy in the prediction of endoscopic CD activity. A similar accuracy was maintained even without considering CE results in a simpler version of the score (Ripollés et al, 2021).…”