The Value Of Ultrasonography In Predicting The Activity Of Intestinal Lesions In Crohn’s Disease

Objective: The objective of the present paper is tantamount to explore the predictive value of ultrasound on the activity of Crohn’s disease(CD)intestinal lesions in order to provide a reference value for clinical treatment decisions of Crohn’s disease.Materials and methods: The materials collected were the clinical and imaging data of patients diagnosed with Crohn’s disease in the Department of Gastroenterology in our hospital from January 2018 to November 2019.The clinical diagnostic criteria of the CD are based on the consensus on the diagnosis and treatment of inflammatory bowel disease in China in 2018.In this study,ultrasonography was used to locate the whole intestine of the patients,and observe the thickness,stratification,Limberg blood flow grade of the intestinal wall,mesenteric fat hypertrophy,enlarged mesenteric lymph nodes,abdominal complications,perianal lesions and other ultrasonic signs.The results of ultrasound were compared with those of magnetic resonance enterography(MRE)or computer tomography enterography(CTE),in order to evaluate the accuracy of ultrasound in diagnosing the location and extent of intestinal lesions in CD.According to the results of Crohn’s disease activity index(CDAI),the subjects were divided into two groups: the remission group(CDAI < 150)and activity group(CDAI≥ 150).The similarities and differences between remission group and activity group were analyzed,and the total data were randomly divided into training set and verification set.In the training set,the binary logical regression was used to analyze the ultrasound image features of universal significance,screen out the ultrasonic risk signs of CD activity,and construct the predictive model of CD activity which was evaluated in the verification set.The present study compared the diagnostic efficiency of the predictive model in the training set and the verification set.It also compared the diagnostic efficiency of the following models:the model only including the intestinal wall thickness,the model only including the intestinal wall blood flow,the model including the former two ultrasonic signs,and the predictive model.According to the level of C-reactive protein(CRP),the patients were divided into two groups: the non-elevated CRP group(CRP ≤ 8 mg/L)and the elevated CRP group(CRP > 8mg/L),which were compared to find out their ultrasonographic features and CDAI scores.Results:(1)A total of 111 patients were included.Based on the location and range of lesions in MRE or CTE,the sensitivity of ultrasonography in detecting terminal ileum lesions was 80%(71 / 89),and the specificity was 100%(22 / 22);The sensitivity of ultrasonography in detecting colon lesions was 70%(55/79),and the specificity was 97%(31/32);19cases of sigmoid colon,transverse colon and / or rectum were missed.(2)In university analysis,the intestinal wall thickness of the active group was thicker than that of the remission group,and there was a significant difference between the two groups(P < 0.001).The incidence of the loss of mural stratification,mesenteric fat hypertrophy,abdominal complications and III-IV grade blood flow of the intestinal wall in the active group was higher than the incidence of those in the remission group(P < 0.01),but there was no significant difference between the two groups in the incidence of perianal lesions and enlarged mesenteric lymph nodes.(3)The independent risk factors of clinical activity included in the binary logistic regression prediction model were intestinal wall thickening,the loss of moral stratification,mesenteric fat hypertrophy and III-IV grade blood flow grading.A binary logical regression prediction model: logit(P)= 1.911*the loss of mural stratification + 2.599*mesenteric fat hypertrophy + 2.491*III-IV grade blood flow grading + 3.082*intestinal wall thickness was established.The area under the ROC curve of the prediction model in the training set and verification set was 0.928 and 0.889,and there was no significant difference between them(P = 0.594).In the whole data,the areas under the ROC curve of the four models mentioned in the present study were as follows: the model including intestinal wall thickness(0.764),the model including intestinal wall blood flow(0.765),the model including the former two ultrasonic signs(0.825)and the dichotomous logical regression prediction model(0.913).There was a significant difference in the area under the ROC curve between each of the prior three models and the binary logical regression prediction model.(4)The intestinal wall thickness in the elevated CRP group was larger than that in the nonelevated CRP group,and there was a significant difference between the two groups(P < 0.001).The incidence of the loss of mural stratification,mesenteric fat hypertrophy,III-IV grade blood flow grading,enlarged mesenteric lymph nodes and abdominal complications in the elevated CRP group was higher than the incidence of those in the non-elevated CRP group(P < 0.001).The incidence of clinical activity in the elevated CRP group was higher than that in the non-elevated CRP group,and there was a noteworthy difference between the two groups(P < 0.001).Conclusion: 1.Intestinal wall thickening,the loss of moral stratification,mesenteric fat hypertrophy and III-IV blood flow of the intestinal wall are independent risk factors for the activity of intestinal lesions in CD.2.The diagnostic value of the clinical activity prognostic model based on these independent risk factors is higher than the models that only include one or two ultrasonic signs,in that it uses simple ultrasonic signs and is better in identification.Therefore,it becomes of practical importance.Ultrasonic signs that are simple and easy to identify can be used to evaluate the clinical activity of CD,which can serve as a guide for clinical treatment decision-making.