Korean J Gastroenterol.  2010 Dec;56(6):346-352. 10.4166/kjg.2010.56.6.346.

The Usefulness of Doppler Sonography in the Assessment of Disease Activity of Ulcerative Colitis

• Oh YS
• Chung WC
• Hwang SS
• Lee KM
• Paik CN
• Cho YS
• Lee BI
• Choi GY

• KMID: 1775849
• DOI: http://doi.org/10.4166/kjg.2010.56.6.346

Abstract

BACKGROUND/AIMS
Disease activity in ulcerative colitis (UC) is generally assessed using symptoms, laboratory data, endoscopic findings, and histology of the biopsy specimens. In this study, we compared disease activity of UC as determined by clinical features and endoscopic findings, and aimed to assess the clinical usefulness of Doppler sonography.
METHODS
The duplex Doppler sonography of superior mesenteric artery (SMA) and inferior mesenteric artery (IMA) of 10 patients with clinically inactive UC and 20 patients with active UC were evaluated by one radiologist who was blinded to clinical information. Peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI), and pulsatility index (PI) of the SMA and IMA were evaluated. All patients underwent biochemical and endoscopic evaluations thereafter. Correlation between disease activity by the Truelove-Witts classification and the Mayo scoring system was measured, and we compared hemodynamic parameters between active and inactive UC.
RESULTS
Correlation rate of disease activity between these two scoring systems was 93.3%. Flow velocities (PSV, p<0.001 and EDV, p=0.03) and PI (p=0.03) were significantly higher in patients with active UC than inactive UC. PSVs of the SMA and IMA were also significantly correlated with disease severity. The active UC could be accurately diagnosed using Doppler sonography (AUC=0.83; 95% confidence interval 0.68-0.99).
CONCLUSIONS
In patients with UC, clinical stage was well matched with endoscopic disease activity. Doppler sonography was a readily available method, and PSV of SMA would be clinically useful in predicting of disease activity and severity.

Keyword

Ulcerative colitis; Doppler sonography

MeSH Terms

Adult
Aged
Area Under Curve
Blood Flow Velocity
Colitis, Ulcerative/pathology/*ultrasonography
Colonoscopy
Female
Humans
Male
Mesenteric Artery, Inferior/ultrasonography
Mesenteric Artery, Superior/ultrasonography
Middle Aged
ROC Curve
Sensitivity and Specificity
Severity of Illness Index
*Ultrasonography, Doppler, Duplex

Figure

• 

  Fig. 1. Duplex doppler sonographic examination. (A) The sampling cursor was placed within the lumen of the vessel, 2-3 cm distal to its origin, and the angle between the ultrasound beam and the SMA is maintained at 60 o. (B) Duplex Doppler sonography of the IMA was performed with 60 o of the insonation angle. The hemodynamic parameters were calculated automatically by the spectral analyzer of the ultrasound system.

• 

  Fig. 2. Hemodynamic parameters of SMA by doppler sonography. (Peak systolic velocity, PSV (A), End diastolic velocity, EDV (B), Resistance index, RI (C), Pulsatility index, PI (D)). When the PSV, EDV, PI and RI were measured according to disease severity classi-fied by the Mayo scoring system, only PSV was significantly correlated with disease severity (p＜0.001). SMA, superior mesenteric artery; PSV, peak systolic velocity; EDV, end diastolic velocity; RI, resistance index; PI, pulsatility index.

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