Milan ultrasound criteria are accurate in assessing disease activity in ulcerative colitis: external validation

Allocca, Mariangela; Filippi, Elisabetta; Costantino, Andrea; Bonovas, Stefanos; Fiorino, Gionata; Furfaro, Federica; Peyrin–Biroulet, Laurent; Fraquelli, Mirella; Caprioli, Flavio; Danese, Silvio

doi:10.1177/2050640620980203

Cited by 53 publications

(56 citation statements)

References 10 publications

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“…Concerning patients with UC, published studies use different cutoff values of bowel wall thickness for identifying active UC (>3 mm and 4 mm) [ 43 ]. Several IUS scores for UC have been proposed but, to date, only the Milan Ultrasound Criteria (MUC) has been validated [ 43 , 51 , 52 , 53 ]. The study for the MUC validation evaluated five initial IUS parameters, proposing a definitive score that includes bowel wall thickness and vascularization.…”

Section: Development Of Intestinal Ultrasound Scores For the Assessment Of Ibdmentioning

confidence: 99%

Role of Intestinal Ultrasound in the Management of Patients with Inflammatory Bowel Disease

Jauregui-Amezaga

Rimola

2021

Life

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Intestinal ultrasound (IUS) has gained popularity as a first line technique for the diagnosis and monitoring of patients with inflammatory bowel diseases (IBD) due to its many advantages. It is a non-invasive imaging technique with non-ionizing radiation exposure. It can be easily performed not only by radiologists but also by trained gastroenterologists at outpatient clinics. In addition, the cost of IUS equipment is low when compared with other imaging techniques. IUS is an accurate technique to detect inflammatory lesions and complications in the bowel in patients with suspected or already known Crohn’s disease (CD). Recent evidence indicates that IUS is a convenient and accurate technique to assess extension and activity in the colon in patients with ulcerative colitis (UC), and can be a non-invasive alternative to endoscopy. In patients with IBD, several non-specific pathological ultrasonographic signs can be identified: bowel wall thickening, alteration of the bowel wall echo-pattern, loss of bowel stratification, increased vascularization, decreased bowel peristalsis, fibro-fatty proliferation, enlarged lymph nodes, and/or abdominal free fluid. Considering the transmural CD inflammation, CD complications such as presence of strictures, fistulae, or abscesses can be detected. In patients with UC, where inflammation is limited to mucosa, luminal inflammatory ultrasonographic changes are similar to those of CD. As the technique is related to the operator’s experience, adequate IUS training, performance in daily practice, and a generalized use of standardized parameters will help to increase its reproducibility.

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Section: Development Of Intestinal Ultrasound Scores For the Assessment Of Ibdmentioning

confidence: 99%

Role of Intestinal Ultrasound in the Management of Patients with Inflammatory Bowel Disease

Jauregui-Amezaga

Rimola

2021

Life

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“…The diagnosis and the monitoring of CD is based on the combination of clinical, laboratory, and endoscopic findings; histopathological reports; and imaging studies. There are known advantages in terms of detection of BUS over endoscopy in several cases, such as an incomplete colonoscopy, proximal locations of disease (i.e., distant from the ileo-cecal valve), and complications (i.e., fistulas, abscesses, and strictures) [ 9 , 10 , 11 , 12 ]. The indications to perform BUS in CD patients are summarized in Table 2 .…”

Section: Crohn’s Disease In Bowel Ultrasoundmentioning

confidence: 99%

“…Data from comparative and prospective studies have shown a strong correlation between wall thickness (>3 and 4 mm) and colonic vascular flow with C-reactive protein values and the endoscopic score [ 9 , 10 , 41 ]. These studies have led to the full validation of an ultrasonographic score, the Milan ultrasound criteria, that can be easily calculated (1.4 × bowel thickness (mm) + 2 × vascular flow) and indicates activity when ≥6.3 [ 10 , 11 ]. In contrast with CD, in UC patients, the loss of bowel wall stratification with a hypoechoic pattern is rarely observed; when present, it is associated with a severe disease [ 45 ].…”

Section: Ulcerative Colitismentioning

confidence: 99%

“…The main advantages of BUS are its non-invasiveness and low costs compared to computed tomography (CT) or magnetic resonance imaging (MRI) [ 9 ]. It has been recently demonstrated that when performed by a skilled operator, BUS has a comparable sensitivity and specificity to second-level techniques for assessing disease activity and complications of IBD [ 9 , 10 , 11 ]. Moreover, BUS is readily available and can be performed bedside by the dedicated gastroenterologist upon need (i.e., point-of-care BUS (POCBUS)) [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Moreover, BUS is readily available and can be performed bedside by the dedicated gastroenterologist upon need (i.e., point-of-care BUS (POCBUS)) [ 12 ]. The monitoring through BUS of the bowel wall thickness (BWT) predicts the outcomes of IBD patients, particularly in CD for its transmural features [ 9 , 10 , 11 ]. In this review, we aim to examine and summarize the technical aspects and the current evidence on BUS in the management of IBD, focusing on the detection of disease activity, complications, and the newly emerging transperineal approach.…”

Section: Introductionmentioning

confidence: 99%

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Bowel Ultrasound in Inflammatory Bowel Disease: How Far in the Grayscale?

Furfaro

Buono

Allocca

et al. 2021

Life

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Bowel ultrasound (BUS) is a non-invasive and accurate technique for assessing activity, extension of disease, and complications in inflammatory bowel diseases. The main advantages of BUS are its safety, reproducibility, and low costs. Ancillary technologies of BUS (i.e., color Doppler and wave elastography) could broaden the diagnostic power of BUS, allowing one to distinguish between inflammation and fibrosis. Considering the costs and invasiveness of colonoscopy and magnetic resonance, BUS appears as a fast, safe, and accurate technique. The objective measures of disease allow one to make clinical decisions, such as optimization, switch, or swap of therapy. Previous studies reported a sensitivity and a specificity of more than 90% compared to endoscopy and magnetic resonance. Lastly, transperineal ultrasound (TPUS) is a promising approach for the evaluation of perianal disease in Crohn’s disease (CD) and disease activity in patients with ulcerative proctitis or pouchitis. Bowel ultrasound is being incorporated in the algorithm of managing inflammatory bowel diseases. Transmural healing evaluated through ultrasonography is emerging as a complementary target for disease treatment. In this review, we aimed to summarize and discuss the current evidence on BUS in the management of inflammatory bowel diseases and to address the challenges of a full validation of this technique.

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Four intestinal ultrasound scores and bowel wall thickness alone correlated well with pediatric ulcerative colitis disease activity

Hudson,

Isaac,

et al. 2024

J. pediatr. gastroenterol. nutr.

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ObjectivesIntestinal ultrasound (IUS) is a noninvasive tool in ulcerative colitis (UC), but scoring systems have mostly been developed for adults, Crohn's disease, and flaring UC. Our aim was to evaluate the performance of bowel wall thickness (BWT) and four IUS scores in pediatric patients with newly diagnosed UC.MethodsPatients <18 years old with suspected UC were prospectively enrolled. Baseline IUS was done, and ulcerative colitis intestinal ultrasound score (UC‐IUS), Milan criteria, simple pediatric activity ultrasound score (SPAUSS), and Civatelli index were calculated. Mayo endoscopic segment subscore, pediatric ulcerative colitis activity index (PUCAI), and biomarkers were correlated with IUS using nonparametric and receiver operating characteristic analyses.ResultsFifty‐two patients (56% male, median age 13.9 years, interquartile range [IQR] 11.2–16.3) with 206 colon segments were included. Patients who needed hospitalization (n = 27/52) had significantly worse IUS (BWT and all scores) compared to those not hospitalized. For all patients, IUS scores and BWT significantly correlated with baseline endoscopic, clinical, and biochemical disease activity (rho = 0.32–0.67, p < 0.05). BWT (τb = 0.53), UC‐IUS (τb = 0.55), and Milan (τb = 0.52) had the strongest endoscopic correlations. For differentiating between endoscopic disease severity, BWT, UC‐IUS, and Milan, had the highest areas under the curve (0.89–0.93). Using BWT alone, a thinner cut‐off had improved sensitivity while maintaining high specificity: ≥2.5 mm for moderate/severe endoscopic inflammation (sensitivity 66%; specificity 94%) and ≥3.5 mm for severe endoscopic inflammation (sensitivity 92%; specificity 86%).ConclusionsBWT and all four IUS scores correlated well with endoscopic, clinical, and biochemical disease activity, and was another useful marker of severity in identifying patients needing hospitalization. Pediatric patients needed a thinner BWT cut‐off, which should be accounted for when developing pediatric‐specific scores. BWT alone may be just as clinically useful as composite US scores.

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Milan ultrasound criteria are accurate in assessing disease activity in ulcerative colitis: external validation

Cited by 53 publications

References 10 publications

Role of Intestinal Ultrasound in the Management of Patients with Inflammatory Bowel Disease

Role of Intestinal Ultrasound in the Management of Patients with Inflammatory Bowel Disease

Bowel Ultrasound in Inflammatory Bowel Disease: How Far in the Grayscale?

Four intestinal ultrasound scores and bowel wall thickness alone correlated well with pediatric ulcerative colitis disease activity

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