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Article Abstract
Background & Aims: Crohn's disease (CD) strictures exhibit varying levels of inflammation and chronicity. We evaluate whether intestinal ultrasound (IUS) is accurate in characterizing stricture composition.
Methods: This prospective, cross-sectional study included patients with CD who underwent IUS prior to a small bowel segment resection. Histology in the resection specimen was assessed in location-matched tissue sections. Following a consensus session, 2 pathologists blindly assessed the predominant phenotype (inflammatory [IP], chronic [CP], or mixed [MP]) in the strictures. The primary objective of the study was to find a parameter to identify strictures with IP.
Results: A total of 36 patients were included (IP, 7 [20%]; CP, 16 [44%]; MP, 13 [36%]). Univariate analysis showed a positive association with an IP for loss of wall layer stratification (WLS) (odds ratio [OR], 7.86; P = .029) and higher contrast-enhanced ultrasound (CEUS) parameters. Bowel wall thickness (5.74 vs 7.46 mm; P = .002) was lower and color Doppler signal (OR, 0.14; P = .03) and loss of WLS (OR, 0.14; P = .027) were less present in CP. In multivariate analysis, loss of WLS and wash-in area under the curve at CEUS indicated an IP, whereas lower bowel wall thickness and color Doppler signal ≤2 indicated a CP. With these parameters, the Stricture Score Amsterdam was constructed and demonstrated accuracy for IP (area under the receiver operating curve, 0.88; P = .002) and CP (area under the receiver operating curve, 0.90; P < .0001), respectively. Inter-observer agreement for the score was good (intraclass correlation coefficient, 0.73; P < .0001).
Conclusion: A combination of IUS and CEUS is accurate to differentiate between inflammatory and chronic strictures in CD. The Stricture Score Amsterdam needs external validation and confirmation in its potential as a diagnostic decision aid when choosing between surgical and available medical treatments.
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| http://dx.doi.org/10.1016/j.cgh.2025.05.013 | DOI Listing |
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