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Graded compression and power Doppler ultrasonography versus endoscopy to assess paediatric Crohn disease activity
Mike Thomson1, Prithviraj Rao, Les Berger
1Centre for Paediatric Gastroenterology, Sheffield Children's NHS Trust, Sheffield, UK. mike.thomson@sch.nhs.uk
Insights
Power Doppler ultrasound (PDU) effectively monitors Crohn disease activity in children, offering a reliable alternative to endoscopy for follow-up assessments. This non-invasive imaging technique aids in evaluating treatment response and disease progression in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Inflammatory Bowel Disease Research
Background:
- Crohn disease (CD) is a chronic inflammatory bowel disease affecting children.
- Endoscopy is invasive and often used for disease activity assessment.
- Non-invasive methods for monitoring pediatric CD are needed.
Purpose of the Study:
- To evaluate Power Doppler Ultrasound (PDU) as a non-invasive tool for assessing Crohn disease activity in children.
- To compare PDU findings with traditional assessment methods like endoscopy and histology.
- To determine if PDU can replace endoscopy in routine follow-up care.
Main Methods:
- Nineteen children with diagnosed Crohn disease underwent clinical evaluation, histological assessment, and PDU at diagnosis and post-treatment.
- Discriminant analysis was used to correlate PDU data with histological findings.
- Key PDU parameters included bowel wall thickening (SBT), stratification (STRAT), and mean mucosal, transmural, and segmental flow (MFL).
Main Results:
- All clinical, ultrasonographic, and histological parameters showed significant improvement post-treatment (P < 0.005).
- Significant correlations were found between PDU parameters (SBT, STRAT, MFL) and histological findings (P < 0.01).
- Discriminant analysis accurately classified 84.6% of cases based on inflammation severity using SBT, STRAT, and MFL.
Conclusions:
- Power Doppler Ultrasound (PDU) demonstrates statistically significant correlations with endoscopy and histology in pediatric Crohn disease.
- PDU is a reliable, non-invasive method for follow-up assessment of disease activity in children with Crohn disease.
- Experienced PDU examination can guide treatment decisions and monitor disease progression effectively.
Objective:
The aim of this study was to assess whether power Doppler ultrasound (PDU) can serve as a reliable replacement for endoscopy in follow-up assessment of disease activity in children with Crohn disease.
Methods:
Nineteen children (13 boys), median age 14.8 (5.4-15.8) years, with macroscopically diagnosed Crohn disease were included in the study. Clinical parameters, histological evaluation, and graded PDU assessments were undertaken in all patients at diagnosis and following their initial treatment. Discriminant analysis was used to build predictive models from the PDU data for the histological evaluation.
Results:
The median Pediatric Crohn's Disease Activity Index (PCDAI) was 31.5 (15.5-42.0) at diagnosis. All clinical and ultrasonographic parameters and the histological evaluation showed an improvement between pre- versus posttreatment results; 1-way analysis of variance showed a significant difference because of treatment (P < 0.005) for all variables apart from the superior mesenteric artery flow (SMA); paired sample t tests indicated that these differences were statistically significant (P < 0.001), with the exception of SMA (P = 0.178). There was a statistically significant correlation (P < 0.001) between the platelet count and the bowel wall stratification (STRAT). Significant correlation was also observed between the histology findings and the mean mucosal, transmural, and segmental flow (MFL) and STRAT and between platelets and both MFL and small bowel thickening (SBT) (P < 0.01 in all cases). There was a statistically significant correlation (P < 0.05) between C-reactive protein and MFL and between histology and SBT, MFL, and STRAT. Discriminant analysis using discriminating factors SBT, STRAT, and MFL could assign 84.6% of cases to the correct classification of "no/mild inflammation" or "medium/severe inflammation."
Conclusions:
Results obtained using power Doppler ultrasonography and endoscopy showed statistically significant correlations. Power Doppler sonography, in the hands of an experienced examiner, can be used for follow-up assessment of disease activity in children with Crohn disease.
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