Mariangela Allocca1,2, Gionata Fiorino1,2, Cristiana Bonifacio3, Federica Furfaro1, Daniela Gilardi1, Marjorie Argollo4, Laurent Peyrin-Biroulet5, Silvio Danese1,2. 1. IBD Centre, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy. 2. Department of Biomedical Sciences, Humanitas University, Rozzano, Milan, Italy. 3. Radiology, IRCCS Humanitas, Rozzano, Milano, Italy. 4. Department of Gastroenterology, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil. 5. Department of Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France.
Abstract
BACKGROUND: The comparative accuracy of bowel ultrasound [US] versus magnetic resonance enterography [MRE] in combination with colonoscopy [CS] in assessing Crohn's disease [CD] and influencing the decision-making process is unknown. METHODS: Consecutive ileo-colonic CD patients seen in a tertiary referral centre were prospectively assessed by MRE, CS, and bowel US, within 1 week. Sensitivity, specificity, accuracy, positive predictive value [PPV], and negative predictive value [NPV] of bowel US in assessing localisation, enhancement [presence of vascularisation at Power Doppler], active disease [presence of ulcers at colonoscopy], strictures, fistulas, and abscesses were calculated using CS + MRE findings together as a reference standard. Two blinded inflammatory bowel disease [IBD] specialists reviewed MRE and bowel US findings and were asked to decide the therapeutic strategy [continue versus change therapy]. Kappa agreement with clinical decision was calculated. RESULTS: Sixty CD patients [36 with endoscopic disease activity, 28 with complications] were enrolled. For localisation, sensitivity, specificity, accuracy, PPV, and NPV of bowel US were 88%, 96%, 91%, 96%, and 85%, respectively; for enhancement, 87%, 92%, 89%, 93%, and 86%; for activity, 92%, 100%, 96%, 100%, and 94%; for strictures, 75%, 86%, 81%, 78%, and 83%; for fistulas, 100%, 98%, 98%, 66%, and 100%; for abscesses, 100%, 96%, 96%, 33%, and 100%. The concordance of management of CD patients based on bowel US or MRE findings, alone, compared with clinical decision, was 0.768 and 0.767, respectively [p <0.001]. The concordance between bowel US and MRE on management of CD patients was 0.800 [p <0.001]. CONCLUSIONS: Bowel US is very accurate in assessing CD and is a non-invasive, easy-to-use tool to manage CD patients in clinical practice.
BACKGROUND: The comparative accuracy of bowel ultrasound [US] versus magnetic resonance enterography [MRE] in combination with colonoscopy [CS] in assessing Crohn's disease [CD] and influencing the decision-making process is unknown. METHODS: Consecutive ileo-colonic CD patients seen in a tertiary referral centre were prospectively assessed by MRE, CS, and bowel US, within 1 week. Sensitivity, specificity, accuracy, positive predictive value [PPV], and negative predictive value [NPV] of bowel US in assessing localisation, enhancement [presence of vascularisation at Power Doppler], active disease [presence of ulcers at colonoscopy], strictures, fistulas, and abscesses were calculated using CS + MRE findings together as a reference standard. Two blinded inflammatory bowel disease [IBD] specialists reviewed MRE and bowel US findings and were asked to decide the therapeutic strategy [continue versus change therapy]. Kappa agreement with clinical decision was calculated. RESULTS: Sixty CD patients [36 with endoscopic disease activity, 28 with complications] were enrolled. For localisation, sensitivity, specificity, accuracy, PPV, and NPV of bowel US were 88%, 96%, 91%, 96%, and 85%, respectively; for enhancement, 87%, 92%, 89%, 93%, and 86%; for activity, 92%, 100%, 96%, 100%, and 94%; for strictures, 75%, 86%, 81%, 78%, and 83%; for fistulas, 100%, 98%, 98%, 66%, and 100%; for abscesses, 100%, 96%, 96%, 33%, and 100%. The concordance of management of CD patients based on bowel US or MRE findings, alone, compared with clinical decision, was 0.768 and 0.767, respectively [p <0.001]. The concordance between bowel US and MRE on management of CD patients was 0.800 [p <0.001]. CONCLUSIONS: Bowel US is very accurate in assessing CD and is a non-invasive, easy-to-use tool to manage CD patients in clinical practice.
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