Ultrasound in the Management of Patients with Nonspecific Inflammatory Bowel Disease

Introduction : Crohn’s disease (CD) and ulcerative colitis (UC) are included in the group of inflammatory bowel diseases (IBD) and belong to the group of potentially disabling diseases with an unknown etiology. Study objective : Determine the most significant differential diagnostic ultrasound signs of Crohn’s disease and ulcerative colitis. Material and methods : Based on morphological data, the analysis of diagnostic and treatment results of 142 patients was performed. According to the nosological form and stage of the disease, the patients were divided into 3 groups and several subgroups: Group 1 (n = 84) — patients with UC; Group 2 (n = 58) — patients with CD; Group 3 (control) (n = 27) — somatically healthy volunteers. The main method of radiation diagnostics was ultrasound. Results : In primary diagnostics, the most informative ultrasound signs of IBD are: thickening and decreased echogenicity of the colon wall, loss of colon haustration, increased echogenicity of paracolic tissue, multiple blood flow loci in the colon wall during CDC — the sensitivity of signs in patients with UC was 94.5 %, specificity 97 %, in CD 94 % and 97 %, respectively (p < 0.001). The most significant differential diagnostic ultrasound criteria for CD are identified: local thickening of the colon wall by more than 10 mm, intestinal lumen narrowed by less than 3 mm, regional lymph nodes more than 10 mm; and ulcerative colitis — local thickening of the colon wall from 3 to 10 mm, dilated intestinal lumen (more than 15 mm), regional lymph nodes from 8 to 10 mm (p < 0.001). When conducting ROC analysis, the threshold value of the “wall thickness” criterion in the differential diagnosis of CD and UC, with the maximum specificity of the test was 10.5 mm (sensitivity 97 %, specificity — 100 %); “lumen diameter”— 13 mm (sensitivity 80.6 %, specificity — 97 %), respectively. Conclusions : The obtained results allow us to recommend transabdominal ultrasound of the intestine as the method of choice for timely non-invasive diagnosis of patients with the most common forms of IBD.