Intestinal ultrasound detects an increased diameter and submucosal layer thickness in the appendix of patients with ulcerative colitis compared to healthy controls - a prospective cohort study

A Mesenteric Fat-Derived Radiomic Model to Identify Colonic Fibrosis and Predict Treatment Response to Biologics in Chronic Ulcerative Colitis

BACKGROUND

Evidence suggests the lesion of ulcerative colitis stretches beyond the mucosa. The application of radiomics on ulcerative colitis fibrosis is unclear.

OBJECTIVE

We aimed to characterize colonic fibrosis and treatment response to biologics in chronic ulcerative colitis using radiomic features extracted from the bowel wall and mesenteric adipose tissue.

DESIGN

Retrospective analysis of a prospective database.

SETTINGS

This study was conducted in a single tertiary center.

PATIENTS

A total of 72 patients who underwent proctocolectomy and 47 patients who received biologics induction were included.

INTERVENTION

CT images were collected and radiomic features were extracted to develop radiomic models using logistic regression.

MAIN OUTCOME MEASURES

The main outcome was colonic fibrosis, classified as mild and severe based on histological scoring.

RESULTS

The area under the curve of the bowel wall model to predict severe fibrosis was 0.931 ( p < 0.001) and 0.869 ( p < 0.001) in the training cohort and the test cohort, respectively. For the mesenteric adipose tissue model, the area under the curve was 0.947 ( p < 0.001) and 0.837 ( p < 0.001), respectively. The mesenteric adipose tissue model was superior to the bowel wall model (area under the curve, 0.809, p < 0.001 and 0.722, p = 0.006) in predicting response to biologics in chronic ulcerative colitis.

LIMITATIONS

A retrospective single-center study.

CONCLUSIONS

Two radiomic models derived from bowel wall and mesenteric adipose tissue features readily predicted colonic fibrosis and treatment response of biologics in chronic ulcerative colitis. The mesentery harbored critical information and was essentially involved in fibrogenesis. See Video Abstract .

UN MODELO RADIMICO DERIVADO DE LA GRASA MESENTRICA PARA IDENTIFICAR LA FIBROSIS COLNICA Y PREDECIR LA RESPUESTA AL TRATAMIENTO CON PRODUCTOS BIOLGICOS EN LA COLITIS ULCEROSA CRNICA

ANTECEDENTES:La evidencia sugiere que la lesión de la colitis ulcerosa se extiende más allá de la mucosa. La aplicación de la radiómica en la colitis ulcerosa fibrosa no está clara.OBJETIVO:Nuestro objetivo fue caracterizar la fibrosis del colon y la respuesta al tratamiento con productos biológicos en la colitis ulcerosa crónica utilizando características radiómicas extraídas de la pared intestinal y del tejido adiposo mesentérico.DISEÑO:Análisis retrospectivo de una base de datos prospectiva.AJUSTES:Este estudio se realizó en un único centro terciario.PACIENTES:Se incluyeron un total de 72 pacientes sometidos a proctocolectomía y 47 pacientes que recibieron inducción biológica.INTERVENCIÓN:Se recogieron imágenes de tomografía computarizada y se extrajeron características radiómicas para desarrollar modelos radiómicos mediante regresión logística.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la fibrosis colónica, que se clasificó en leve y grave según la puntuación histológica.RESULTADOS:El área bajo la curva del modelo de pared intestinal para predecir la fibrosis grave fue de 0,931 ( p < 0,001) y 0,869 ( p < 0,001) en la cohorte de entrenamiento y de prueba, respectivamente. Para el modelo de tejido adiposo mesentérico, el área bajo la curva fue de 0,947 (p < 0,001) y 0,837 ( p < 0,001), respectivamente. El modelo de tejido adiposo mesentérico fue superior al modelo de pared intestinal (área bajo la curva, 0,809, p <0,001 y 0,722, p = 0,006) para predecir la respuesta a los productos biológicos en la colitis ulcerosa crónica.LIMITACIONES:Estudio retrospectivo de un solo centro.CONCLUSIONES:Dos modelos radiómicos derivados de las características de la pared intestinal y del tejido adiposo mesentérico predijeron fácilmente la fibrosis colónica y la respuesta al tratamiento con productos biológicos en la colitis ulcerosa crónica. El mesenterio alberga información crítica y estuvo esencialmente involucrado en la fibrogénesis. (Traducción-Dr Yolanda Colorado ).

Role of intestinal ultrasound in ulcerative colitis: A systematic review

BACKGROUND

Intestinal ultrasound (IUS) is an emerging, non-invasive, and highly sensitive diagnostic tool in inflammatory bowel disease (IBD), including ulcerative colitis (UC). Despite its potential, its adoption in clinical practice is limited due to a lack of standardization and awareness.

AIM

To perform a comprehensive scoping review based on a systematic literature review on IUS in UC to inform current practice.

METHODS

Ninety-nine original articles about ultrasonography in UC were identified among 7608 citations searching PubMed and EMBASE databases for systematic review.

RESULTS

IUS can be useful as an initial diagnostic strategy in patients with suspected IBD/UC. In UC, IUS can predict endoscopic response, histologic healing, and steroid responsiveness in acute severe cases. IUS can predict response to biologics/small molecules (as early as 2 wk). IUS correlates well with ileo-colonoscopy, but IUS could miss rectal, jejunal, and upper GI lesions in suspected IBD and colon polyps or extra-intestinal manifestations in known IBD. IUS is useful in special situations (children, pregnancy, and postoperative Crohn's disease). Inter-observer agreement is acceptable and trained physicians have comparable diagnostic accuracy. Point-of-care ultrasound impacted management in 40%-60% of cases. Hand-held IUS has excellent agreement with conventional IUS.

CONCLUSION

IUS is a non-invasive, highly sensitive tool in the diagnosis and monitoring of UC, offering excellent patient satisfaction. Point-of-care ultrasound by IBD physicians can significantly impact clinical decision-making.