Predicting the clinical response to cytapheresis in steroid-refractory or -dependent ulcerative colitis using contrast-enhanced ultrasonography

Abstract

Objective. To evaluate the usefulness of transabominal ultrasound (US), including contrast-enhanced ultrasonography (CEUS), in predicting the response to cytapheresis therapy in patients with steroid-refractory or -dependent ulcerative colitis (UC). Material and methods. Between January 2005 and June 2008, 26 consecutive patients with steroid-refractory or -dependent UC were treated with granulocyte and monocyte adsorption apheresis (GCAP) or leukocytapheresis (LCAP) at our institute. The clinical activity of UC was evaluated by patients’ C-reactive protein (CRP) levels and clinical activity index (CAI) scores. All patients were evaluated by grey-scale US, power Doppler US (PDUS), and CEUS. In CEUS, the color signal patterns were classified as 1 of 2 patterns. In pattern 1, color signals were partially detected in the bowel wall (excluding muscularis propria, the outer thin layer of the bowel wall), whereas in pattern 2, color signals were detected in the entire bowel wall (excluding muscularis propria). Differences between remission or clinical response (group R) and no response (group N) were ascertained for clinical features, clinical activities, and US findings. Results. Differences between the two groups were not considered significant for the clinical features, clinical activities, and grey-scale US and PDUS findings. Using CEUS, 4 patients in group R showed pattern 2 (21%), while in group N, all patients showed this pattern, indicating a significant difference between the two groups (p<0.01). Conclusion. CEUS findings may be helpful in predicting the clinical response to cytapheresis for steroid-refractory or -dependent UC.