VALIDATION OF US EVALUATION OF ULCERATIVE COLITIS ACTIVITY

This study was aimed at validating the inter-rater grading agreement for assessing disease activity in patients with established ulcerative colitis (UC) using transabdominal ultrasonography (US) versus colonoscopy (CS). Fifty-seven patients underwent US and CS at four facilities. UC disease activity was assessed using the original US grading system and CS Matts classification. Initially, the US and CS grades were assessed at each examining facility, and still images and movie clips were re-assessed at the central facility. Grading agreement between the examining and central facilities was evaluated. Grading agreement for US and CS were 0.75 and 0.72 in all segments and 0.82 and 0.70 in the maximum grade of each patient, respectively (all p < 0.001). US grading agreement was "almost perfect" for the maximum grade and "moderate" to "substantial" for other assessments. The inter-rater US grading agreement was good and not inferior to that of CS for evaluating UC disease activity. (C) 2019 World Federation for Ultrasound in Medicine & Biology. All rights reserved

Altered oscillation of Doppler-derived renal and renal interlobar venous flow velocities in hypertensive and diabetic patients

Background and purpose Flow velocity oscillation rate (FVOR) of the renal interlobar vein has been reported to be decreased in patients with urinary obstruction or diabetic nephropathy, and increased in those with hypertension during pregnancy. To clarify the clinical role of the renal interlobar venous FVOR, we investigated the flow velocity patterns of the renal vessels in patients with hypertension (HT) and/or diabetes (DM). Methods and results Pulsed-wave Doppler sonography was performed in 34 patients: 15 with HT, 10 with DM, and nine with both HT and DM (HT-DM). Each FVOR of the right and left interlobar veins was closely and positively correlated with the ipsilateral interlobar arterial resistive index (RI), especially in the HT group, but not with the estimated glomerular filtration rate. The right interlobar venous FVOR was decreased in the DM and HT-DM groups compared to the HT group. Conclusion The renal interlobar venous FVOR is strongly influenced by the arterial RI in HT patients, and is reduced in DM patients without an obvious relationship with diabetic nephropathy. These findings should be noted for the clinical application of renal interlobar venous flow analysis

Sonographic findings of immunoglobulin G4-related sclerosing sialadenitis

Purpose: We evaluated the sonographic findings of immunoglobulin G4-related sclerosing sialadenitis (IgG4-SS). Methods: Nineteen patients with IgG4-SS and 12 healthy volunteers (controls) were enrolled. The following sonographic features were evaluated: (1) enlargement of the submandibular gland by measurement of the longitudinal diameter and thickness; (2) the contour texture of the submandibular gland (smooth or rough); (3) the internal echo texture, categorized into three sonographic patterns (homogeneous, multiple hypoechoic nodule, and diffuse hypoechoic); and (4) quantitative color Doppler signaling. Results: The longitudinal diameter and the thickness (mean ± SD) of the submandibular gland were significantly greater in patients than in controls (p = 0.005 and p < 0.001, respectively). Contour roughness was seen in 62.9 and 8.3 % of patients and controls (p < 0.001), respectively. Homogeneous echo textures alone were seen in controls, whereas multiple hypoechoic nodule patterns were seen in 60 % of the patients, and diffuse hypoechoic patterns were seen in 40 %. Color Doppler signaling (mean ± SD) was significantly higher in patients as compared with controls (p < 0.001). Conclusion: Patients could be distinguished from healthy volunteers using four distinctive sonographic findings, suggesting that ultrasonography would be a useful diagnostic tool for IgG4-SS

Crohn's Disease Activity Evaluation by Transabdominal Ultrasonography Correlation with Double-Balloon Endoscopy

Objectives Transabdominal ultrasonography (US) has been reported as a useful tool for evaluating Crohn's disease (CD) activity. Endoscopic findings and Crohn's disease activity index (CDAI) are currently considered the gold standard for assessing CD activity. We assessed the correlation between US and double-balloon endoscopy (DBE), and CDAI for evaluating CD activity. Methods We analyzed patients with CD undergoing US and DBE within 10 days between the procedures. The intestine was divided into four segments and analyzed by the US scoring system (US-CD) and the simple endoscopic score for Crohn's disease (SES-CD). CDAI was compared with US-CD and SES-CD. Spearman's rank correlation coefficient was used for statistical analysis. Results Twenty-five patients with CD (11 women, 14 men; mean age 35.4 +/- 14.9 years, range 16-65 years) were enrolled. Twenty-four patients received antitumor necrosis factor inhibitor therapy. CDAI was 128.1 (range 36-227). A significant moderate correlation was found between the US-CD and SES-CD in all segments (rho = .64, P < .01). The US-CD showed a strong correlation with CDAI (rho = .78, P < .01), whereas the SES-CD showed a moderate correlation (rho = .55, P < .05). Conclusions US-CD and SES-CD showed a moderate correlation for assessing CD activity. US-CD showed a stronger correlation with CDAI than SES-CD, suggesting that US could more accurately evaluate the disease activity

Novel Ultrasonographic Scoring System of Sinusoidal Obstruction Syndrome after Hematopoietic Stem Cell Transplantation

Sinusoidal obstruction syndrome (SOS)/hepatic veno-occlusive disease (VOD) is a well-documented complication after hematopoietic stem cell transplantation (HSCT). Transabdominal ultrasonography (US) enables the visualization of blood flow abnormalities and is therefore useful for the diagnosis of SOS/VOD. We herein prospectively evaluated accuracy of a novel US diagnostic scoring system of SOS/VOD based on US findings. We carried out US in 106 patients on day 14 and when SOS/VOD was suspected after allogeneic HSCT. Among 106 patients, 10 patients (9.4%) were diagnosed as SOS/VOD by Baltimore or Seattle criteria. According to uni-variate analysis of 17 US findings (US-17 screening), we established a novel scoring system (HokUS-10) consisting of 10 parameters, such as gallbladder wall thickening, ascites, and blood flow signal in the paraumbilical vein. The sensitivity and specificity were 100% and 95.8%, respectively. Diagnostic performance of the HokUS-10 was significantly better than US-17 screening. In 4 of 10 patients US detection of SOS/VOD preceded to clinical diagnosis. The HokUS-10 scoring system is useful in the diagnosis of SOS/VOD; however, our results should be validated in other cohorts

Refined ultrasonographic criteria for sinusoidal obstruction syndrome after hematopoietic stem cell transplantation

Hepatic sinusoidal obstruction syndrome (SOS)/veno-occlusive disease is a life-threatening complication after hematopoietic stem cell transplantation (HSCT). We previously reported the efficacy of the Hokkaido Ultrasonography (US)-based scoring system (HokUS-10) for US findings. To establish easier-to-use criteria, we retrospectively evaluated US findings from 441 patients, including 30 patients with SOS using the HokUS-10 scoring system. Using logistic regression analysis, we established the novel diagnostic criteria HokUS-6. In the presence of ascites, US diagnosis was made in the presence of two of the following 6 parameters: moderate amount of ascites, the appearance of a paraumbilical vein blood flow signal, gallbladder wall thickening, portal vein dilatation, portal vein velocity decrease, and hepatic artery resistive index increase. The AUC, sensitivity, and specificity of HokUS-6 were 0.974 (95% confidence interval 0.962-0.990), 95.2%, and 96.9%, respectively. The scores were significantly higher in patients with severe SOS than in those with non-severe SOS (p = 0.013). Furthermore, the scores before HSCT were significantly higher in patients who developed SOS than in controls (p = 0.001). The HokUS-6 is an easy and useful way to diagnose and identify the risk of SOS

Characteristics and usefulness of transabdominal ultrasonography in immune-mediated colitis

Background/Aims: The usefulness of ultrasonography (US) in diseases of the gastrointestinal tract has been reported recently. This prospective study aimed to determine the features of US findings in immune-mediated colitis (IMC), an adverse event induced by immune checkpoint inhibitor, and examine the correlation between US findings, colonoscopy (CS) findings, and severity of colitis. Methods: We studied patients examined using CS and US upon suspicion of IMC in Hokkaido University Hospital between April 2018 and February 2021. Endoscopic findings of IMC were assessed using the Ulcerative Colitis Endoscopic Index of Severity (UCEIS). The severity of US findings in IMC was evaluated using US grade, which is the ultrasonographic grading scale in ulcerative colitis. Bowel wall thickness and the intensity of the color Doppler signal were also analyzed. Severity of colitis was evaluated using Common Terminology Criteria for Adverse Events (CFCAE) grade version 5. Results: Fourteen patients with LMC were enrolled. The US findings were bowel wall thickening, loss of stratification, ulceration and increased blood flow signal. The US grade was moderately correlated with the UCEIS (r= 0.687, P = 0.009) and CTCAE grade (r= 0.628, P= 0.035). Bowel wall thickness and UCEIS (r= 0.628, P= 0.020), as well as color Doppler signal grade and CTCAE grade (r= 0.724, P= 0.008), were significantly correlated. Conclusions: US findings in IMC were mainly similar to those of ulcerative colitis, but there were some findings that were characteristic only of LMC. Significant correlation was found between US findings, CS findings, and severity of colitis. Hence, US could be useful for the evaluation of IMC

Usefulness of transabdominal ultrasonography for assessing ulcerative colitis : a prospective, multicenter study

BackgroundTransabdominal ultrasonography (US) has been reported to be a useful tool for evaluating ulcerative colitis (UC) although with less well-established data than for Crohn's disease. This prospective multicenter study aimed to establish the usefulness of US compared with colonoscopy (CS) for assessing disease extent and activity of UC.MethodsAltogether, 173 patients with UC were prospectively enrolled, among whom 156 were eligible for this study. All patients underwent US and CS within 2days at five facilities. We divided the colon into six segments and examined each segment and the rectum using US and CS. US severity was graded 1-4 regarding bowel wall thickness, stratification, and ulceration. CS severity was also graded 1-4 according to Matts' endoscopic classification. Concordance between US and CS grades for all colonic segments was analyzed using kappa statistics. US and CS findings were also compared with the clinical disease activity index (CAI) and histological grade using Spearman's correlation coefficient.ResultsThere was moderate concordance between US and CS grades in all colonic segments (weighted =0.55, p<0.001). Concordance was rated moderate for each colonic segment but only slight for the rectum. The US grade was significantly correlated with the CAI score (r=0.40, p<0.001) and histological grade (r=0.35, p<0.001).ConclusionsThis prospective multicenter study showed moderate concordance between US and CS for assessing the disease activity of UC. Hence, US may be used more generally for evaluating UC in daily clinical practice