European journal of radiology · 2026
Value of transabdominal bowel ultrasound in monitoring the efficacy of ustekinumab in patients with postoperative recurrence of Crohn's disease.
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Yan Lihua, Luo Xiaodong, Chen Shuochun, Zhang Jifan, Zhang Shiyu, Cao Lanyi, Zhang Wenyi, Qiu Manyan, Lin Jiang, Li Yingjia
Аннотация
PURPOSE: To evaluate the longitudinal evolution of transabdominal bowel ultrasound parameters during ustekinumab therapy in patients with postoperative recurrence of Crohn's disease (CD), and to investigate the association between ultrasound changes and clinical and biochemical outcomes.
METHODS: This retrospective longitudinal study included 65 patients with endoscopically confirmed postoperative recurrence of CD who received ustekinumab therapy between April 2020 and December 2024. Patients were classified into improvement and non-improvement groups according to endoscopic outcomes at week 24. Serial transabdominal bowel ultrasound examinations were performed at baseline and at weeks 8, 16, and 24, including assessment of bowel wall thickness, Limberg vascularity grade, bowel wall stratification, perienteric fat edema, and luminal stenosis. Longitudinal changes in ultrasound parameters were analyzed using mixed-effects models and generalized estimating equations, as appropriate for each outcome type. Associations between bowel wall thickness changes and clinical/biochemical outcomes were evaluated using Spearman correlation analysis.
RESULTS: Distinct temporal response patterns were observed among bowel ultrasound parameters during ustekinumab therapy. In the improvement group, bowel wall thickness and Limberg grade improved as early as week 8, bowel wall stratification improved at week 16, and perienteric fat edema improved at week 24, whereas no significant longitudinal changes were observed in the non-improvement group.Linear mixed-effects model analysis demonstrated a significant time × group interaction for bowel wall thickness (P < 0.001). Generalized estimating equation analyses demonstrated significant time × group interactions for Limberg grade, bowel wall stratification, and perienteric fat edema (all P < 0.001), while luminal stenosis remained relatively stable throughout follow-up (all P > 0.05).At week 24, patients in the improvement group showed significantly lower CRP levels (P < 0.001) and HBI scores (P = 0.006) than those in the non-improvement group. Furthermore, reductions in bowel wall thickness were significantly correlated with reductions in CRP levels (rs = 0.678, 95 % CI: 0.503-0.806, P < 0.001) and HBI scores (rs = 0.566, 95 % CI: 0.359-0.722, P < 0.001).
CONCLUSION: Transabdominal bowel ultrasound may dynamically reflect transmural inflammatory changes during ustekinumab therapy in patients with postoperative recurrence of CD. Different ultrasound parameters demonstrated distinct temporal recovery patterns, with bowel wall thickness and vascularity showing the earliest improvement. The association between bowel wall thickness changes and CRP/HBI further supports the potential clinical utility of bowel ultrasound as a noninvasive longitudinal monitoring tool in this high-risk postoperative population.
METHODS: This retrospective longitudinal study included 65 patients with endoscopically confirmed postoperative recurrence of CD who received ustekinumab therapy between April 2020 and December 2024. Patients were classified into improvement and non-improvement groups according to endoscopic outcomes at week 24. Serial transabdominal bowel ultrasound examinations were performed at baseline and at weeks 8, 16, and 24, including assessment of bowel wall thickness, Limberg vascularity grade, bowel wall stratification, perienteric fat edema, and luminal stenosis. Longitudinal changes in ultrasound parameters were analyzed using mixed-effects models and generalized estimating equations, as appropriate for each outcome type. Associations between bowel wall thickness changes and clinical/biochemical outcomes were evaluated using Spearman correlation analysis.
RESULTS: Distinct temporal response patterns were observed among bowel ultrasound parameters during ustekinumab therapy. In the improvement group, bowel wall thickness and Limberg grade improved as early as week 8, bowel wall stratification improved at week 16, and perienteric fat edema improved at week 24, whereas no significant longitudinal changes were observed in the non-improvement group.Linear mixed-effects model analysis demonstrated a significant time × group interaction for bowel wall thickness (P < 0.001). Generalized estimating equation analyses demonstrated significant time × group interactions for Limberg grade, bowel wall stratification, and perienteric fat edema (all P < 0.001), while luminal stenosis remained relatively stable throughout follow-up (all P > 0.05).At week 24, patients in the improvement group showed significantly lower CRP levels (P < 0.001) and HBI scores (P = 0.006) than those in the non-improvement group. Furthermore, reductions in bowel wall thickness were significantly correlated with reductions in CRP levels (rs = 0.678, 95 % CI: 0.503-0.806, P < 0.001) and HBI scores (rs = 0.566, 95 % CI: 0.359-0.722, P < 0.001).
CONCLUSION: Transabdominal bowel ultrasound may dynamically reflect transmural inflammatory changes during ustekinumab therapy in patients with postoperative recurrence of CD. Different ultrasound parameters demonstrated distinct temporal recovery patterns, with bowel wall thickness and vascularity showing the earliest improvement. The association between bowel wall thickness changes and CRP/HBI further supports the potential clinical utility of bowel ultrasound as a noninvasive longitudinal monitoring tool in this high-risk postoperative population.