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. 2023 Sep-Oct;56(5):242-247.
doi: 10.1590/0100-3984.2023.0039-en.

Evaluation of bowel wall flow by color Doppler ultrasound in the assessment of inflammatory bowel disease activity in pediatric patients

Marco Aurélio Castellano  1   2 , Vanessa Scheeffer  1 , Vanessa Petersen  1 , Themis Reverbel da Silveira  3
Affiliations

Evaluation of bowel wall flow by color Doppler ultrasound in the assessment of inflammatory bowel disease activity in pediatric patients

Marco Aurélio Castellano et al. Radiol Bras. 2023 Sep-Oct.

Abstract
in English, Portuguese

Objective: To assess inflammatory bowel disease (IBD) activity with Doppler ultrasound in pediatric patients, comparing the accuracy of the ultrasound findings with that of the concentrations of fecal calprotectin (FC).

Materials and methods: In a consecutive series, we evaluated 53 examinations of 44 pediatric patients seen between 2014 and 2020: 28 with Crohn's disease, 15 with ulcerative colitis, and one with IBD unclassified. The diagnosis of IBD was made in accordance with the Porto criteria. The alteration studied in the greatest detail was bowel wall flow, which was classified by the lead investigator and two pediatric radiologists, all of whom were blinded to the FC concentrations and the other ultrasound findings. Bowel wall flow was categorized as low if there were up to 2 Doppler ultrasound signals/cm2, moderate if there were 3-5 signals/cm2, and high if there were more than 5 signals/cm2.

Results: The agreement among the radiologists was substantial (kappa = 0.73). In cases in which ultrasound showed low bowel wall flow, the median FC concentration was 92 µg/g (interquartile range, 33-661 µg/g), whereas it was 2,286 µg/g (interquartile range, 1,728-5,612 µg/g) in those in which ultrasound showed high bowel wall flow. In the sample as a whole, the sensitivity and specificity of ultrasound was 89.7% and 92.0%, respectively, for the detection of inflammatory activity; 95.5% and 90.9%, respectively, for the detection of Crohn's disease; and 81.3% and 100.0%, respectively, for the detection of ulcerative colitis.

Conclusion: Ultrasound of the bowel wall showed a strong correlation with FC concentrations in the assessment of inflammatory activity in pediatric patients with IBD.

Objetivo: Avaliar a atividade da doença inflamatória intestinal (DII) por ultrassonografia (US) com Doppler em cores, comparada à concentração de calprotectina fecal (CF) em pacientes pediátricos.

Materiais e métodos: Em uma série consecutiva, no período entre 2014 e 2020, foram avaliados 53 exames de 44 pacientes pediátricos: 28 casos de doença de Crohn, 15 de colite ulcerativa e um de colite indeterminada. O diagnóstico da DII foi feito pelos critérios de Porto. O fluxo parietal foi a alteração estudada mais detalhadamente e classificada pelo pesquisador principal e por dois radiologistas pediátricos cegados aos valores de CF e de US Doppler. Baixo fluxo parietal foi definido pela captação de até 2 sinais de US Doppler/cm2, fluxo moderado entre 3 e 5 sinais/cm2 e alto fluxo mais de 5 sinais/cm2.

Resultados: Houve concordância substancial entre os radiologistas (kappa = 0,73). Nos exames com baixo fluxo parietal a CF média foi 92 µg/g (intervalo interquartil: 33-661 µg/g) e nos exames com alto fluxo a CF média foi 2.286 µg/g (intervalo interquartil: 1.728-5.612 µg/g). Na amostra total, a US demonstrou sensibilidade de 89,7% e especificidade de 92,0% para detecção da atividade inflamatória, 95,5% e 90,9% na doença de Crohn e 81,3% e 100,0% na colite ulcerativa, respectivamente.

Conclusão: Houve forte correlação entre a US da parede intestinal e os valores da concentração de CF na avaliação da atividade inflamatória na DII de pacientes pediátricos.

Keywords: Colitis, ulcerative; Crohn disease; Inflammatory bowel diseases; Leukocyte L1 antigen complex; Ultrasonography.

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Figures

Figure 1
Figure 1
Correlation between FC concentrations and bowel wall flow on color Doppler ultrasound (Spearman’s correlation coefficient = 0.72).
Figure 2
Figure 2
Color Doppler ultrasound image of a 9-year-old female patient with Crohn’s disease, showing mild inflammatory activity in the ileum, as evidenced by minimal bowel wall flow. FC concentration, 9.9 µg/g.
Figure 3
Figure 3
Color Doppler ultrasound image of a 12-year-old female patient with ulcerative colitis, showing moderate inflammatory activity in the descending colon, as evidenced by the presence of 3-5 Doppler signals/cm2 in the bowel wall. FC concentration, 1,733 µg/g.
Figure 4
Figure 4
Color Doppler ultrasound image of a 13-year-old male patient with Crohn’s disease, showing severe inflammatory activity in the ileum, as evidenced by a high bowel wall flow. FC concentration, 1,800 µg/g.
See this image and copyright information in PMC

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