Intestinal Ultrasound to Assess Ulcerative Colitis Disease Activity in Children: External Validation and Comparison of 2 Intestinal Ultrasound Activity Indices

Abstract

Background There is currently no consensus on the definition of an abnormal intestinal ultrasound (IUS) for children with ulcerative colitis (UC). This cross-sectional study aimed to externally validate and compare 2 existing IUS indices in children with UC. Methods Children undergoing colonoscopy for UC assessment underwent IUS the day before colonoscopy, assessed with the Mayo endoscopic subscore. The UC-IUS index and the Civitelli index were compared with the Mayo endoscopic score in the ascending, transverse, and descending colon. The area under the receiver-operating characteristic curve for detecting a Mayo endoscopic score ≥2 of both scores was compared and sensitivity and specificity were calculated. Results A total of 35 UC patients were included (median age 15 years, 39% female). The area under the receiver-operating characteristic curve was higher for the UC-IUS index in the ascending colon (0.82 [95% confidence interval (CI), 0.67-0.97] vs 0.76 [95% CI, 0.59-0.93]; P = .046) and transverse colon (0.88 [95% CI, 0.76-1.00] vs 0.77 [95% CI, 0.60-0.93]; P = .01). In the descending colon, there was no difference (0.84 [95% CI, 0.70-0.99] vs 0.84 [95% CI, 0.70-0.98]). The optimal cutoff for the UC-IUS was <1 point to rule out a Mayo endoscopic score ≥2 (sensitivity: 88%, 100%, and 90% in the ascending, transverse, and descending colon, respectively) and a Mayo endoscopic score ≥2 could be detected using a cutoff of >1 (specificity: 84%, 83%, and 87%, respectively). For the Civitelli index, in our cohort, the optimal cutoff was <1 to rule out a Mayo endoscopic score ≥2 (sensitivity 75%, 65%, and 80%, respectively) and a cutoff >1 to detect a Mayo endoscopic score ≥2 (specificity 89%, 89%, and 93%, respectively). Conclusions In this cohort, the UC-IUS index performed better than the Civitelli index. The UC-IUS index had both a high sensitivity and specificity in this cohort, when using 1 point as cutoff for a Mayo endoscopic score ≥2.

Intestinal ultrasound scan predicts corticosteroid failure and colectomy risk in patients with ulcerative colitis

“…However, endoscopic procedures are often difficult to perform during ASUC flares, and the information provided is often limited to rectosigmoidoscopy examinations, which only visualize the distal colon. IUS is a noninvasive, easily accessible, and cost-effective tool proven to determine disease extent, monitor disease activity, and assess treatment response [17,[27][28][29][30][31]. Despite its efficacy, IUS is underutilized in assessing ulcerative colitis severity assessment and predicting severe cases.…”

Ultrasound in Pediatric Inflammatory Bowel Disease—A Review of the State of the Art and Future Perspectives

“…These included bowel wall thickness (>3 mm), bowel wall stratification, vascularity, the presence of haustra coli, and enlarged mesenteric lymph nodes (51). Similarly, Wassenaer et al investigated pediatric UC, reporting the so-called ulcerative colitis intestinal ultrasound (UC-IUS) index [99]. UC-IUS performed better than the Civitelli score with respect to the endoscopic subscore [102].…”