Kerri L Novak1, Gilaad G Kaplan, Remo Panaccione, Elnaz Ehteshami Afshar, Divine Tanyingoh, Mark Swain, Amelia Kellar, Stephanie Wilson. 1. *Inflammatory Bowel Disease Clinic, Calgary Division of Gastroenterology and Hepatology, Alberta Health Services, and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; †Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada; and ‡Inflammatory Bowel Disease Clinic, Calgary Division of Gastroenterology and Hepatology, Alberta Health Services, and Department of Diagnostic Imaging, University of Calgary, Alberta, Canada.
Abstract
BACKGROUND: Ultrasound is accurate in the detection of Crohn's disease. Our aim was to identify ultrasound parameters contributing to inflammatory disease activity, develop a simple score, and validate this score prospectively. METHODS: This study comprised 2 single-center investigations. The first was a retrospective study on a population that had received colonoscopies (as a gold-standard diagnostic) within 60 days of ultrasound. The second was a prospective study on 2 populations: patients requiring induction with adalimumab and patients on adalimumab maintenance therapy. Ultrasound and endoscopy were preformed within 14 days in both prospective groups. The endoscopy results were graded with the Simple Endoscopic Score and the Rutgeerts score and compared with 5 ultrasound parameters. We used a proportional odds model to determine which ultrasound parameters correlated significantly with the endoscopy results. We then developed a predictive ultrasound score for disease activity, plotted the receiver operating characteristic curves, and undertook prospective validation of the score. RESULTS: We evaluated 160 patients retrospectively to compare ultrasound and colonoscopy. Two of 5 parameters were found to correlate significantly with disease activity: bowel wall thickness (P = <0.0001) and color Doppler signal (P = 0.0292). We developed a score that uses weighted variables. The area under the corresponding receiver operating characteristic curve was 0.8658. CONCLUSIONS: A simple ultrasonographic score that accurately identifies Crohn's disease activity has been developed and validated. Ultrasound may be a surrogate for endoscopy to guide disease management, but future studies should be conducted to establish interrater variability.
BACKGROUND: Ultrasound is accurate in the detection of Crohn's disease. Our aim was to identify ultrasound parameters contributing to inflammatory disease activity, develop a simple score, and validate this score prospectively. METHODS: This study comprised 2 single-center investigations. The first was a retrospective study on a population that had received colonoscopies (as a gold-standard diagnostic) within 60 days of ultrasound. The second was a prospective study on 2 populations: patients requiring induction with adalimumab and patients on adalimumab maintenance therapy. Ultrasound and endoscopy were preformed within 14 days in both prospective groups. The endoscopy results were graded with the Simple Endoscopic Score and the Rutgeerts score and compared with 5 ultrasound parameters. We used a proportional odds model to determine which ultrasound parameters correlated significantly with the endoscopy results. We then developed a predictive ultrasound score for disease activity, plotted the receiver operating characteristic curves, and undertook prospective validation of the score. RESULTS: We evaluated 160 patients retrospectively to compare ultrasound and colonoscopy. Two of 5 parameters were found to correlate significantly with disease activity: bowel wall thickness (P = <0.0001) and color Doppler signal (P = 0.0292). We developed a score that uses weighted variables. The area under the corresponding receiver operating characteristic curve was 0.8658. CONCLUSIONS: A simple ultrasonographic score that accurately identifies Crohn's disease activity has been developed and validated. Ultrasound may be a surrogate for endoscopy to guide disease management, but future studies should be conducted to establish interrater variability.
Authors: Emily K Wright; Ian Wang; Darren Wong; Sally J Bell; William R Connell; Alexander J Thompson; Kerri L Novak; Michael A Kamm Journal: Australas J Ultrasound Med Date: 2020-07-24
Authors: Shellie Jean Radford; Chris Clarke; Bethany Shinkins; Paul Leighton; Stuart Taylor; Gordon Moran Journal: Frontline Gastroenterol Date: 2021-06-23
Authors: Johan F K F Ilvemark; Tawnya Hansen; Thomas M Goodsall; Jakob B Seidelin; Heba Al-Farhan; Mariangela Allocca; Jakob Begun; Robert V Bryant; Dan Carter; Britt Christensen; Marla C Dubinsky; Krisztina B Gecse; Torsten Kucharzik; Cathy Lu; Christian Maaser; Giovanni Maconi; Kim Nylund; Carolina Palmela; Stephanie R Wilson; Kerri Novak; Rune Wilkens Journal: J Crohns Colitis Date: 2022-05-10 Impact factor: 10.020