Diagnostic classification of endosonography for differentiating colorectal ulcerative diseases: A new statistical method

Table 1 Sex and age of all patients

Total			Sex		Age, yr
			Male	Female	Range	Mean
Diseases	CD	2771	151	126	12-71	31.85
	PIL	60	37	23	18-73	43.76
	ITB	431	27	16	17-69	45.73

¹Five CD and four ITB cases received treatment in the out-patient clinic, so were absent from the in-patient system. CD: Crohn’s disease; ITB: Intestinal tuberculosis; PIL: Primary intestinal lymphoma.

Table 2 Comparison of the mean total wall thickness in Crohn’s disease, primary intestinal lymphoma and intestinal tuberculosis

		TWT, mm		P value
		Range	Mean ± SD
Diseases	CD	2.7-19.4	8.48 ± 2.90	(CD and PIL)	< 0.001
	PIL	3.7-29.6	13.49 ± 6.38	(PIL and ITB)	0.002
	ITB	3.2-22.0	10.19 ± 6.14	(ITB and CD)	0.080
	F		23.389
	P		< 0.001

Data was analyzed by the LSD-t test. The difference was significant (P = 0.05). CD: Crohn’s disease; ITB: Intestinal tuberculosis; PIL: Primary intestinal lymphoma; TWT: Total wall thickness.

Table 3 Common endoscopic ultrasound parameters of the bowel wall in Crohn’s disease, primary intestinal lymphoma and intestinal tuberculosis n (%)

	CD	PIL	ITB
Thickened layers
None	6 (3.0)	0 (0)	2 (10.0)
M	21 (10.5)	5 (16.7)	14 (70.0)
SM	160 (80.0)	2 (6.7)	0 (0)
M + SM	4 (2.0)	0 (0)	1 (5.0)
SM + MP	3 (1.5)	0 (0)	0 (0)
All	2 (1.0)	0 (0)	0 (0)
Layers disappeared1	4 (2.0)	23 (76.7)	3 (15.0)
Thinned layers
SM	0 (0)	0 (0)	6 (30.0)
M/SM border
Clear	85 (42.5)	3 (10.0)	8 (40.0)
Unclear	111 (55.5)	4 (13.3)	9 (45.0)
Invisible	4 (4.0)	23 (76.7)	3 (15.0)
SM/MP border
Clear	157 (78.5)	3 (10.0)	12 (60.0)
Unclear	41 (21.5)	4 (13.3)	5 (25.0)
Invisible	2 (1.0)	23 (76.7)	3 (15.0)
Echo level of main lesion or changed layer
1 (hyperechoic)	14 (7.0)	0 (0)	4 (20.0)
2	166 (83.0)	0 (0)	12 (60.0)
3 (medium)	3 (1.5)	3 (10.0)	1 (5.0)
4	11 (5.5)	5 (16.7)	1 (5.0)
5 (hypoechoic)	6 (3.0)	22 (73.3)	2 (10.0)
Echo homogeneity2
Homogeneous	87 (43.5)	23 (76.7)	5 (25)
Heterogeneous	106 (53)	7 (23.3)	13 (65)
Diffuse lesion	3 (1.5)	26 (86.7)	0 (0)
Serosal integrity
Smooth	185 (92.5)	14 (46.7)	15 (75)
Non-smooth	9 (4.5)	2 (6.6)	4 (20)
Interrupted	6 (3)	14 (46.7)	1 (5)

¹Absent layers were included in the thickened layers because when the layers disappeared it was impossible to recognize the thickness change;

²Seven CD and two ITB cases were excluded because the thickness of the layers was too small and the echo homogeneity was difficult to determine. The options without matched cases are not given. CD: Crohn’s disease; ITB: Intestinal tuberculosis; M: Mucosa; MP: Muscularis propria; PIL: Primary intestinal lymphoma; SM: Submucosa.

Table 4 Special bowel wall signs and extra-luminal presentation of Crohn’s disease, primary intestinal lymphoma and intestinal tuberculosis n (%)

	CD	PIL	ITB
Special bowel wall signs
Cobblestone	18 (9.0)	0 (0)	0 (0)
Vasculature in SM	19 (9.5)	0 (0)	0 (0)
≤ 2 mm	11 (5.5)	0 (0)	0 (0)
> 2 mm	8 (4.0)	0 (0)	0 (0)
Extra-luminal presentations
Abscesses	2 (1.0)	0 (0)	0 (0)
Sinus or fistulae	7 (3.5)	0 (0)	0 (0)
Ascites	7 (3.5)	2 (6.7)	2 (10.0)
Lymph nodes	36 (18.0)	19 (63.3)	5 (25.0)
Single	22 (11.0)	3 (10.0)	4 (20.0)
Multiple	14 (7.0)	16 (53.3)	1 (5.0)
Merged	2 (1.0)	4 (13.3)	0 (0)

CD: Crohn’s disease; ITB: Intestinal tuberculosis; PIL: Primary intestinal lymphoma; SM: Submucosa.

Table 5 Univariate logistic regression analysis of endoscopic ultrasound parameters

Parameters	CD		PIL		ITB		Score
	OR	P value	OR	P value	OR	P value	CD	PIL	ITB
Layer changed (discrete variable)
M normal	67.81	< 0.001	0.02	< 0.001	0.04	< 0.001	0	-1	-1
M thickened	0.23	< 0.001	0.85	0.75	18.56	< 0.001	-1	0	1
SM normal	0.22	< 0.001	0.82	0.708	24.75	< 0.001	-1	0	0
SM thickened	92.38	< 0.001	0.02	< 0.001	0.02	< 0.001	1	-1	-1
MP normal	29.87	< 0.001	0.01	< 0.001	0.85	0.804	0	-1	0
S normal	53.08	< 0.001	0.01	< 0.001	0.75	0.668	0	-1	0
Layer disappeared	0.01	< 0.001	141.29	< 0.001	1.45	0.576	-1	1	0
Layer borders (discrete variable)
M/SM clear	2.62	0.009	0.15	0.003	1.08	0.878	0	-1	0
M/SM unclear	3.55	< 0.001	0.13	< 0.001	0.82	0.668	1	-1	0
M/SM invisible	0.02	< 0.001	99.98	< 0.001	1.33	0.668	-1	1	0
SM/MP clear	8.52	< 0.001	0.03	< 0.001	0.66	0.379	0	-1	0
SM/MP invisible	0.01	< 0.001	141.29	< 0.001	1.45	0.576	-1	1	0
Echo level (discrete variable)
1 (hyperechoic)	0.87	0.807	In	N/A	3.86	0.03	0	-1	1
2	15.46	< 0.001	In	N/A	0.58	0.253	1	-1	1
3 (medium)	0.18	0.026	6	0.023	1.96	0.541	-1	1	0
4	0.11	1.217	3.47	0.03	0.7	0.74	0	1	0
5 (hypoechoic)	0.03	< 0.001	72.87	< 0.001	0.8	0.775	-1	1	0
Echo homogeneity (discrete variable)
Homogeneous	0.6	0.115	4.57	< 0.001	0.36	0.058	0	1	0
Heterogeneous	1.69	0.102	0.26	0.003	1.92	0.179	1	-1	1
Diffuse lesion	0.01	< 0.001	470.17	< 0.001	In	N/A	-1	1	-1
Serosa integrity (discrete variable)
Smooth	9.62	< 0.001	0.08	< 0.001	0.45	0.148	0	-1	0
Non-smooth	0.35	0.055	1.14	0.87	4.98	0.012	0	0	1
Interrupted	0.07	< 0.001	26.62	< 0.001	0.55	0.573	-1	1	0
Lymph nodes (ordinal variable)
Multiple	0.13	< 0.001	17.36	< 0.001	0.39	0.369	0	1	0
Emerged	0.12	0.015	16.77	0.003	In	N/A	-1	1	-1

The reference category of CD, PIL and ITB was non-CD (PIL & ITB), non-PIL (CD & ITB), and non-ITB (CD & PIL), respectively. The options with statistical insignificance in the three diseases are not given. The right section shows the scores of each option for each disease. CD: Crohn’s disease; In: Infinitesimal; ITB: Intestinal tuberculosis; M: Mucosa; MP: Muscularis propria; N/A: Not available; PIL: Primary intestinal lymphoma; S: Serosa; SM: Submucosa.

Table 6 Tendency scores of endoscopic ultrasound options in Crohn’s disease, primary intestinal lymphoma and intestinal tuberculosis

	CD	PIL	ITB
+1	SM thickened M/SM unclear Echo level 2 Heterogeneous Lesion echo	Layer disappeared Echo level 3-5 Homogeneous and diffuse Lesion echo Interrupted S Multiple and emerged lymph nodes	M thickened Echo level 1and 2 Heterogeneous Echo Non-smooth S
-1	M thickened SM normal Layer disappeared Echo level 3 and 5 Diffuse lesion echo Interrupted S Lymph nodes emerged	M, MP, S normal SM thickened Visible layer borders Echo level 1 and 2 Heterogeneous echo level Smooth S	M normal SM thickened Diffuse lesion Echo Lymph nodes emerged

Data are presented as n (%). CD: Crohn’s disease; ITB: Intestinal tuberculosis; M: Mucosa; MP: Muscularis propria; PIL: Primary intestinal lymphoma; S: Serosa; SM: Submucosa.