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Comparative performance of intestinal ultrasound activity indices in pediatric ulcerative colitis: a prospective
Sara Massironi1, Giacomo Mulinacci2, Giovanna Zuin3
1Medicine and Surgery, Vita e Salute San Raffaele University, Milan, Italy.
Insights
Intestinal ultrasound (IUS) indices accurately detect moderate-to-severe pediatric ulcerative colitis (UC) activity. Combining IUS with fecal calprotectin or PUCAI may enhance noninvasive disease monitoring.
Area of Science:
- Gastroenterology
- Pediatric Gastroenterology
- Medical Imaging
Background:
- Endoscopic assessment of pediatric ulcerative colitis (UC) disease activity is invasive.
- Intestinal ultrasound (IUS) offers a promising noninvasive alternative.
- Comparative data on IUS-based activity indices in children are limited.
Purpose of the Study:
- Evaluate the accuracy of three IUS indices (Milan Ultrasound Criteria [MUC], UC-Intestinal Ultrasound [UC-IUS], Civitelli) for detecting moderate-to-severe endoscopic activity in pediatric UC.
- Explore the added value of fecal calprotectin (FC) and Pediatric UC Activity Index (PUCAI) in conjunction with IUS.
Main Methods:
- Prospective bicentric study involving 75 pediatric UC patients.
- IUS performed within 7 days of colonoscopy.
- Moderate-to-severe endoscopic activity defined as Mayo Endoscopic Subscore (MES) ≥ 2; diagnostic accuracy assessed via ROC analysis.
Main Results:
- 73.3% of patients had moderate-to-severe endoscopic activity.
- All IUS indices (MUC, UC-IUS, Civitelli) significantly discriminated disease severity (AUCs ranging from 0.76 to 0.80).
- Bowel wall thickness (BWT) alone showed similar accuracy (AUC 0.80). Combined models with FC or PUCAI showed higher AUCs (0.83-0.87).
Conclusions:
- MUC, UC-IUS, and Civitelli indices demonstrate comparable accuracy in detecting moderate-to-severe pediatric UC.
- BWT alone is as accurate as composite IUS indices.
- Multimodal approaches combining IUS with FC or PUCAI may offer additional diagnostic value for noninvasive disease monitoring.
Background & Aims:
Endoscopic assessment of disease activity in pediatric ulcerative colitis (UC) is invasive and burdensome. Intestinal ultrasound (IUS) represents a promising noninvasive alternative, but comparative data on IUS-based activity indices in children remain limited. This study evaluated the accuracy of 3 IUS activity indices, the Milan Ultrasound Criteria (MUC), the Ulcerative Colitis-Intestinal Ultrasound (UC-IUS) index, and the Civitelli index, for detecting moderate-to-severe endoscopic activity in pediatric UC and explored the added value of fecal calprotectin (FC) and the Pediatric Ulcerative Colitis Activity Index (PUCAI).
Methods:
In this prospective bicentric study, 75 pediatric patients with UC underwent IUS within 7 days of colonoscopy. Moderate-to-severe endoscopic activity was defined as Mayo Endoscopic Subscore (MES) ≥ 2. Diagnostic accuracy was assessed using receiver operating characteristic analysis.
Results:
Moderate-to-severe endoscopic activity was present in 73.3% of patients. All IUS indices significantly discriminated moderate-to-severe from no-to-mild disease (P < .001), with comparable performance (AUC 0.80 [0.68-0.92] for MUC, 0.79 [0.66-0.93] for UC-IUS, and 0.76 [0.62-0.90] for Civitelli). Bowel wall thickness (BWT) alone showed similar accuracy (AUC 0.80 [0.68-0.91]). Models combining IUS indices with FC or PUCAI yielded higher AUC (0.83 and 0.87, respectively), although differences were not statistically significant. Accuracy was highest in severe disease (MES = 3).
Conclusions:
MUC, UC-IUS, and Civitelli demonstrated comparable accuracy for detecting moderate-to-severe endoscopic activity in pediatric UC. BWT alone performed similarly to composite indices. Combining IUS with FC or PUCAI may provide modest additional diagnostic value, supporting a multimodal, noninvasive approach for disease monitoring and treat-to-target strategies.
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