Seeing Beyond the Surface: Superior Performance of Ultrasound Elastography over Milan Ultrasound Criteria in Distinguishing Fibrosis of Ulcerative Colitis.

Feng Zhu, Xin Chen, Xueni Qiu, Wenwen Guo, Xuesong Wang, Junying Cao, Jianfeng Gong
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Abstract

Background: Colonic fibrosis has important clinical implications in ulcerative colitis [UC]. Ultrasound imaging has emerged as a convenient and reliable tool in diagnosis of inflammatory bowel disease. We aimed to explore the potential use of ultrasound to evaluate UC fibrosis.

Methods: Consecutive UC patients who had proctocolectomy from July 2022 to September 2023 were enrolled in the study. Patients underwent bowel ultrasound examination and ultrasound elastography imaging prior to surgery. Milan ultrasound criteria [MUC] were calculated and bowel wall stiffness was determined using two mean strain ratios [MSRs]. Degree of colonic fibrosis and inflammation was measured upon histological analysis. Receiver operating characteristic [ROC] analysis was used to evaluate the performance of ultrasound-derived parameters to predict fibrosis.

Results: In all, 56 patients were enrolled with 112 segments included in analysis. The median fibrosis score was 2 [0-4] and the median Geboes score was 5 [0-13] and these two scores were significantly correlated [p < 0.001]. The muscularis mucosa thickness was significantly higher in moderate-severe fibrosis than none-mild fibrosis [p = 0.003] but bowel wall thickness was not [p = 0.082]. The strain ratios [p < 0.001] and MUC [p = 0.010] were significantly higher in involved than non-involved segments. The strain ratios were correlated with fibrosis score [p < 0.001] but not MUC [p = 0.387]. At ROC analysis, mean strain ratio 1 [MSR1] had an area under the curve [AUC] of 0.828 [cutoff value 3.07, 95% CI 0.746-0.893, p < 0.001] to predict moderate-severe fibrosis.

Conclusion: Ultrasound elastography imaging could predict the degree of colonic fibrosis in UC. Application of this technique could help disease monitoring and decision making in UC patients.

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透过表面看本质:在鉴别溃疡性结肠炎纤维化方面,超声弹性成像的性能优于米兰超声标准。
背景:结肠纤维化对溃疡性结肠炎有重要的临床影响。超声成像已成为诊断炎症性肠病的一种方便可靠的工具。我们旨在探索利用超声波评估溃疡性结肠炎纤维化的可能性:研究对象为 2022 年 7 月至 2023 年 9 月期间接受直肠切除术的连续 UC 患者。患者在术前接受了肠道超声检查和超声弹性成像。计算米兰超声标准(MUC),并使用两个平均应变比(MSR)确定肠壁硬度。结肠纤维化和炎症程度通过组织学分析进行测量。采用 ROC 分析评估超声参数预测纤维化的性能:结果:56名患者参与了研究,其中112个节段被纳入分析。纤维化评分的中位数为 2(0-4),Geboes 评分的中位数为 5(0-13),这两个评分有显著的相关性(p 结论:超声弹性成像可预测肝纤维化:超声弹性成像可预测 UC 结肠纤维化的程度。这项技术的应用有助于 UC 患者的疾病监测和决策。
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