1.Intestinal ultrasound for intestinal Behçet disease reflects endoscopic activity and histopathological findings
Katsuki YAGUCHI ; Reiko KUNISAKI ; Sho SATO ; Kaori HIRAI ; Misato IZUMI ; Yoshimi FUKUNO ; Mami TANAKA ; Mai OKAZAKI ; Rongrong WU ; Yurika NISHIKAWA ; Yusuke MATSUNE ; Shunsuke SHIBUI ; Yoshinori NAKAMORI ; Masafumi NISHIO ; Mao MATSUBAYASHI ; Tsuyoshi OGASHIWA ; Ayako FUJII ; Kenichiro TORITANI ; Hideaki KIMURA ; Eita KUMAGAI ; Yukiko SASAHARA ; Yoshiaki INAYAMA ; Satoshi FUJII ; Toshiaki EBINA ; Kazushi NUMATA ; Shin MAEDA
Intestinal Research 2024;22(3):297-309
Background/Aims:
Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease.
Methods:
We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists.
Results:
Bowel wall thickness (P< 0.001), vascularity (P< 0.001), loss of bowel wall stratification (P= 0.015), and white-plague sign (P= 0.013) were significantly exacerbated in the endoscopic active ulcer stage. Receiver operating characteristic curve analysis revealed that a bowel wall thickness of > 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom.
Conclusions
Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease.
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