Superior Mesenteric Artery Doppler Ultrasound as a Non-Invasive Tool for Monitoring Disease Activity in Crohn's Disease: Validation Against Quantitative Magnetic Resonance Imaging-Based Reference Standards
SMA Doppler in Crohn's disease activity monitoring
Abstract
Background: Crohn's disease activity monitoring is expensive in low-resource settings. Superior mesenteric artery (SMA) Doppler measuring flow rate, pulsatility index (PI) and resistive index (RI) can detect splanchnic hyperaemia of active intestinal inflammation. We validated SMA Doppler indices against quantitative MR enterography (MRE) indices, the simplified Magnetic Resonance Index of Activity (sMaRIA) and London score.
Methods: Cross-sectional diagnostic accuracy study in 50 Crohn's disease patients. Activity was classified by sMaRIA (active, score of 1 or more; inactive, score of 0) and London score (active, 4.1 or more). Receiver operating characteristic curve analysis assessed diagnostic accuracy; Spearman's correlation examined Doppler-MRE associations.
Results: Fifteen patients (30%) had active and 35 (70%) had inactive disease. Active disease showed higher SMA flow rate (712 vs 322 ml/min), lower PI (1.66 vs 2.68) and lower RI (0.70 vs 0.83; all p<0.001). Flow rate achieved the highest accuracy (area under the curve 0.992; 95% CI 0.971–1.000); at a cut-off of 514 ml/min or more, sensitivity was 100%, specificity 97.1%, positive predictive value 93.8% and negative predictive value 100%. PI of 1.88 or less gave 97.1% specificity. Flow rate correlated strongly with sMaRIA (rho +0.770) and moderately with London score (rho +0.662; both p<0.001).
Conclusion: SMA Doppler reliably tracks Crohn's disease activity against quantitative MRE reference standards. A two-step strategy, flow rate 514 ml/min or more confirmed by PI 1.88 or less, identifies active disease without radiation, supporting SMA Doppler as a low-cost surrogate for serial monitoring in resource-limited settings.
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References
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