P0424 Utility of superb microvascular imaging for predicting terminal ileal lesion activity in Crohn’s disease
Authors: Nasuno M , Shimoyama K , Hamada T , Shimazaki H , Sugiyama K , Miyakawa M , Tanaka H 
Published: January 2025

Abstract

Background
Superb microvascular imaging (SMI) is rarely used in intestinal ultrasonography (IUS) to evaluate Crohn’s disease (CD) activity. This study investigated SMI findings that can predict small or large ulcers in the terminal ileum and compared them with endoscopic findings of patients with CD.

Methods
Data were retrospectively collected from patients with CD who underwent IUS between September 2020 and April 2024 at our clinic and ileocolonoscopy to evaluate the terminal ileum within 3 months before or after IUS. Patients with a history of small bowel resection were excluded from the study. Based on the endoscopic findings, the lesions in the terminal ileum were classified as follows: no, aphthous (&lt;5 mm), small (5–20 mm) and large (&gt;20 mm) ulcers. IUS was performed using Aplio a550. SMI signals were evaluated using our simplified grading system based on the Limberg score: grade 0, no vascularisation; grade 1, short stretches of vascularity as spots; grade 2, longer stretches of vascularity or grade 3, longer stretches of vascularity reaching the mesentery 1). The modified Limberg score using SMI (mLS-SMI) was applied, with the substituted SMI grade, and the proportion of patients with endoscopic findings indicating small or large ulcers in each mLS-SMI and SMI grades was evaluated. The sensitivity and specificity of the respective mLS-SMI and SMI grades for predicting endoscopic findings of small or large ulcers were also assessed.

Results
This study included 204 patients (median age, 29.0 years; median disease duration, 5.2 years), 50 of whom were female. The endoscopic findings were as follows: no (n = 96), aphthous (n = 68), small (n = 25) and large (n = 15) ulcers. In total, 164, 14, 13, 11 and 5 patients presented with mLS-SMI grades 0, 1, 2, 3 and 4, respectively. Moreover, 157, 27, 12 and 8 patients exhibited SMI grades 0, 1, 2 and 3, respectively. Further, 10%, 29%, 69%, 64% and 80% of patients with mLS-SMI grades 0, 1, 2, 3 and 4, respectively, and 8%, 52%, 67% and 75% of those with SMI grades 0, 1, 2 and 3, respectively, presented with endoscopic findings indicating small or large ulcers. The sensitivity and specificity of mLS-SMI grades ≥1, ≥2, ≥3 and ≥4 for predicting small or large ulcers were 60% and 88%, 50% and 95%, 28% and 97% and 10% and 99%, respectively. The sensitivity and specificity of SMI grades ≥1, ≥2 and ≥3 for predicting small or large ulcers were 70% and 88%, 35% and 96%, and 15% and 99%, respectively.

Conclusion
The proportion of patients with endoscopic small or large ulcers increased with mLS-SMI and SMI grades. The sensitivity and specificity of SMI grade ≥1 were comparable to mLS-SMI grade ≥1, suggesting that SMI grade alone may suffice for evaluation.

References
1)Nasuno M, Shimazaki H, Nojima M, Hamada T, Sugiyama K, Miyakawa M, Tanaka H. Serum leucine-rich alpha-2 glycoprotein levels for predicting active ultrasonographic findings in intestinal lesions of patients with Crohn’s disease in clinical remission. Medicine (Baltimore). 2023;102(32):e34628. doi: 10.1097/MD.0000000000034628.