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

You Suk Oh; Woo Chul Chung; Sung Su Hwang; Kang-Moon Lee; Chang Nyol Paik; Young Seok Cho; Bo In Lee; Gyu Yong Choi

doi:10.4166/kjg.2010.56.6.346

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Oh, Chung, Hwang, Lee, Paik, Cho, Lee, and Choi: The Usefulness of Doppler Sonography in the Assessment of Disease Activity of Ulcerative Colitis

Original Article

Korean J Gastroenterol 2010;56(6):346-352.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.6.346

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

You Suk Oh, M.D., Woo Chul Chung, M.D., Sung Su Hwang, M.D.^∗, Kang-Moon Lee, M.D., Chang Nyol Paik, M.D., Young Seok Cho, M.D., Bo In Lee, M.D., Gyu Yong Choi, M.D.

Department of Internal Medicine, The Catholic University College of Medicine, Seoul, Korea

^∗Department of Radiology, The Catholic University College of Medicine, Seoul, Korea

Correspondence to: Woo Chul Chung, M.D. Department of Internal Medicine, The Catholic University, College of Medicine, 93-6, Ji-dong, Paldal-gu, Suwon 442- 723, Korea Tel: +82-31-249-7137, Fax: +82-31-253-8898 E-mail: jwchulkr@catholic.ac.kr

Received 26 April 2010 Accepted 13 July 2010

Abstract

Background/Aims

Disease activity in ulcerative colitis (UC) is generally assessed using symptoms, laboratory da-ta, 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.

Keywords: Ulcerative colitis, Doppler sonography

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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.

Table 1.

Comparison of the Parameters Measured by Doppler Sonography between the Active and Inactive Ulcerative Colitis Patients

Group	SMA (60 ^o)				SMA (90 ^o)		IMA (60 ^o)				CRP
Group	PSV	EDV	RI	PI	PSV	PI	PSV	EDV	RI	PI	CRP
Inactive	128.2±30.1	18.3±9.7	0.84±0.09	3.0±0.4	626.1±273.3	3.1±0.5	133.9±40.2	13.9±8.3	0.91±0.05	3.9±0.7	0.16±0.18
Active	184±40.7	23.7±7.1	0.88±0.05	3.5±0.7	1,189±647.0	3.4±0.7	237.6±104.4	25.3±13.8	0.89±0.05	3.7±0.9	1.22±1.34
p-value	0.001^∗	0.03^∗	0.45	0.03^∗	0.02^∗	0.29	0.005^∗	0.03^∗	0.32	0.53	0.006^∗
SMA, superior mesenteric artery; IMA, inferior mesenteric artery; PSV, peak systolic velocity; EDV, end diastolic velocity; RI, resistance index; PI, pulsatility index; CRP, C reactive protein.

^∗ Mann-Whitney U test.

Table 2.

Comparison of the Parameters Measured by Doppler Sonography according to the Disease Severity Categorized by Truelove Witts Classification

Group	SMA (60 ^o)				IMA (60 ^o)				CRP
Group	PSV	EDV	RI	PI	PSV	EDV	RI	PI	CRP
Inactive	128.2±30.1	18.3±9.7	0.84±0.09	3.0±0.4	133.9±40.2	13.9±8.3	0.91±0.05	3.9±0.7	0.16±0.18
Mild	160.1±36.4	22.5±7.3	0.86±0.04	3.5±0.5	223.9±83.2	17.4±4.0	0.92±0.03	4.2±0.9	0.42±0.41
Moderate to severe	200.0±36.3	24.6±7.1	0.89±0.05	3.5±0.8	246.3±119.4	30.4±15.2	0.87±0.46	3.4±0.8	1.76±1.49
p-value	0.001^∗	0.07	0.15	0.57	0.01^∗	0.02^∗	0.06	0.1	0.03^∗
SMA, superior mesenteric artery; IMA, inferior mesenteric artery; PSV, peak systolic velocity; EDV, end diastolic velocity; RI, resistance index; PI, pulsatility index; CRP, C reactive protein.

^∗ Kruskal-Wallis test.

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