Consistency of Trans-Abdominal and Water-Immersion Ultrasound Images of Diseased Intestinal Segments in Crohn’s Disease

Abstract

The aim of this study is to clarify whether trans-abdominal ultrasound (TAUS) can reflect actual intestinal conditions in Crohn’s disease (CD) as effectively as water-immersion ultrasound (WIUS) does. This retrospective study enrolled 29 CD patients with 113 intestinal lesions. Five ultrasound (US) parameters (distinct presence/indistinct presence/disappearance of wall stratification in the submucosal and mucosal layers; thickened submucosal layer; irregular mucosal surface; increased fat wrapping around the bowel wall; and fistula signs) that may indicate different states in CD were determined by TAUS and WIUS for the same lesion. Using WIUS as a reference standard, the sensitivity, specificity, and accuracy of TAUS were calculated. The degree of agreement between TAUS and WIUS was evaluated by the kappa coefficient. All US parameters of TAUS had an accuracy >70% (72.6–92.7%). The highest efficacy of TAUS was obtained for fistula signs (sensitivity, specificity, and accuracy values were 63.6%, 96.0%, and 92.7%, respectively). All US parameters between TAUS and WIUS had a definitive (p ≤ 0.001) and moderate-to-substantial consistency (kappa value = 0.446–0.615). The images of TAUS showed substantial similarity to those of WIUS, suggesting that TAUS may function as a substitute to evaluate the actual intestinal conditions of CD.

Small Intestinal Contrast Ultrasonography (SICUS) in Crohn’s Disease: Systematic Review and Meta-Analysis

“…The ultrasound pattern evocating a possible fistula may not be univocal, and several possible signs have been proposed, often related to the experience of the examiner [21]. Indeed, some further evidence showed a sensitivity close to 70% for detecting fistulae, even when other ancillary techniques, such as water immersion, were adopted [22]. However, results are conflicting in the literature, as an additional study showed a sensitivity of 100% and a specificity of 98% [23], thus underlining that the expertise of the observer may be a main issue and a bias to be highlighted when reporting results in a systematic review.…”

Interventional ultrasound and contrast‐enhanced ultrasound in the diagnosis of small intestine‐iliopsoas fistula: A case report

“…12 However, ultrasound is more sensitive than X-ray examination as it is able to reveal gas accumulation in the abdominal cavity and the intestinal wall swelling; thus, the diagnosis can be made at the early stage of the disease. 13 The combined use of CEUS, ultrasound-guided diagnostic puncture and drainage not only can identify quickly the nature of the lesion, but contributes to the success of further systematic therapy as well. 14,15 A drainage tube placed at the external fistula can be used to locate the fistula by using contrast under X-ray examination.…”