Superb Microvascular Imaging Is Superior to Doppler Imaging in Ruling Out Ulcerative Colitis Disease Activity.

Background: There is an unmet medical need for noninvasive techniques to determine disease activity in inflammatory bowel disease (IBD) and intestinal ultrasound (IUS) has shown promising performance in this regard. In addition to parameters such as bowel wall thickness, stratification, and mesenteric fat, color Doppler signals are used to determine inflammatory activity in the gut. However, whether superb microvascular imaging (SMI), a microvascular flow imaging technique, improves the diagnostic accuracy is currently unclear.

Methods: We performed a prospective single-center cross-sectional cohort study including 62 patients with ulcerative colitis (UC). IUS was performed on the sigmoid colon within 30 days of colonoscopy and the International Bowel Ultrasound (IBUS) group Segmental Activity Score (SAS) as well as SMI signals were determined and correlated to established endoscopic, clinical, and biochemical read-outs of disease activity.

Results: Semiquantitative scoring of SMI signals had a substantial interobserver agreement between 2 blinded and expert central readers. It showed excellent correlation to endoscopic, clinical, and biochemical disease activity. While SMI did not improve the overall diagnostic performance of the IBUS-SAS to predict endoscopic disease activity, SMI alone was highly precise and superior to Doppler imaging in predicting endoscopic remission.

Conclusions: IUS is a highly precise noninvasive diagnostic tool to monitor disease activity in UC, in particular for predicting endoscopic remission. Assessing the SMI signals in the bowel wall of patients with IBD seems a promising tool to simplify IUS diagnostics in IBD that warrants further research.