Graded Compression and Power Doppler Ultrasonography Versus Endoscopy to Assess Paediatric Crohn Disease Activity Pre- and Posttreatment

Thomson, Mike*; Rao, Prithviraj*; Berger, Les; Rawat, David

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3181f8b55d
Original Articles: Gastroenterology
Abstract

Objective: The aim of this study was to assess whether power Doppler ultrasound (PDU) can serve as a reliable replacement for endoscopy in follow-up assessment of disease activity in children with Crohn disease.

Methods: Nineteen children (13 boys), median age 14.8 (5.4–15.8) years, with macroscopically diagnosed Crohn disease were included in the study. Clinical parameters, histological evaluation, and graded PDU assessments were undertaken in all patients at diagnosis and following their initial treatment. Discriminant analysis was used to build predictive models from the PDU data for the histological evaluation.

Results: The median Pediatric Crohn's Disease Activity Index (PCDAI) was 31.5 (15.5–42.0) at diagnosis. All clinical and ultrasonographic parameters and the histological evaluation showed an improvement between pre- versus posttreatment results; 1-way analysis of variance showed a significant difference because of treatment (P < 0.005) for all variables apart from the superior mesenteric artery flow (SMA); paired sample t tests indicated that these differences were statistically significant (P < 0.001), with the exception of SMA (P = 0.178). There was a statistically significant correlation (P < 0.001) between the platelet count and the bowel wall stratification (STRAT). Significant correlation was also observed between the histology findings and the mean mucosal, transmural, and segmental flow (MFL) and STRAT and between platelets and both MFL and small bowel thickening (SBT) (P < 0.01 in all cases). There was a statistically significant correlation (P < 0.05) between C-reactive protein and MFL and between histology and SBT, MFL, and STRAT. Discriminant analysis using discriminating factors SBT, STRAT, and MFL could assign 84.6% of cases to the correct classification of “no/mild inflammation” or “medium/severe inflammation.”

Conclusions: Results obtained using power Doppler ultrasonography and endoscopy showed statistically significant correlations. Power Doppler sonography, in the hands of an experienced examiner, can be used for follow-up assessment of disease activity in children with Crohn disease.

Author Information

*Centre for Paediatric Gastroenterology, Sheffield Children's NHS Trust, Sheffield

Centre for Paediatric Gastroenterology, Royal Free Hospital, London

Section of Paediatrics, Division of Medicine, Imperial College Faculty of Medicine, Chelsea & Westminster Campus, London, UK.

Address correspondence and reprint requests to Dr Mike Thomson, Centre for Paediatric Gastroenterology, Sheffield Children's NHS Trust, Western Bank, Sheffield S10 2TH, UK (e-mail: mike.thomson@sch.nhs.uk).

Received 6 September, 2009

Accepted 23 August, 2010

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN