A predictive model for differentiating perianal Crohn's disease activity with 3D transrectal ultrasonography

The study aimed to evaluate the utility of 3D transrectal ultrasonography (3D-TRUS) for perianal Crohn's disease (pCD) activity stratification.

Retrospectively enrolled Crohn's disease patients underwent both 3D-TRUS and magnetic resonance imaging (MRI) within 4 weeks between January 2021 and June 2023, excluding those with recent perianal surgery (≤ 4 weeks), suboptimal image quality, or lesions beyond detection range. 3D-TRUS examined parameters as follows: the number of fistulas, the length, diameter, echogenicity, color Doppler and internal openings of the main fistula, rectal wall thickness, gas in the fistula and collections. MRI was used as the reference standard. The least absolute shrinkage and selection operator regression was used to identify key ultrasound features for nomogram construction. Model performance in terms of accuracy, discrimination and clinical utility was evaluated by receiver operating characteristic curves, calibration curves and decision curve analysis, respectively.

Our study included a total of 105 patients, with 49 classified as high activity (median age, 27 years [13-65 years]) and 56 as low activity (median age, 30 years [13-79 years]). A nomogram for identifying perianal CD activity was constructed, incorporating ultrasound characteristics including the number of fistulas, echogenicity and length of main fistula, collections, and gas in the fistula. The area under the curve of this model was 0.934 (95% CI: 0.883-0.988), and it exhibited good internal reliability and clinical net benefit.

3D-TRUS serves as a clinically valuable imaging method for assessing pCD activity, and the nomogram developed based on this modality demonstrates good diagnostic efficacy.

Question The study explores the role of 3D transrectal ultrasonography (3D-TRUS) in evaluating perianal Crohn's disease (pCD) activity. Findings The nomogram model based on 3D-TRUS has good differentiation ability for pCD activity. Clinical relevance 3D-TRUS is a reliable tool for distinguishing disease activity of pCD and serves as a clinically valuable imaging modality, facilitating clinical management and follow-up.