Diagnostic accuracy of intestinal ultrasound and magnetic resonance enterography for the detection of endoscopy-based disease activity in ileocolonic Crohn’s disease

Abstract

Background Crohn’s disease (CD) is characterised by chronic gastrointestinal inflammation with relapsing–remitting behaviour and often requires endoscopic and/or radiologic assessment. Objective The objective of this study was to compare the diagnostic accuracy of intestinal ultrasound (IUS) and magnetic resonance enterography (MRE) for the assessment of disease activity in CD using a simple endoscopic score for CD as a reference standard. Patients and methods A prospective observational study was carried out in 71 consecutive adult patients with known CD, attending our tertiary inflammatory bowel disease clinic, between November 2014 and July 2016. Ileocolonoscopy, IUS and MRE were performed within 1 month prospectively. The simple endoscopic score-CD 0–2 was accepted as remission. Results The sensitivity of IUS and MRE for detecting endoscopic activity was found similar with regard to bowel wall thickening and mesenteric fibrofatty proliferation (P>0.05). The overall accuracy for detecting mural lesions was similar between IUS and MRE. When mural lesions were analysed, the sensitivity of MRE in detecting the loss of wall stratification and stenosis was significantly higher than IUS (P<0.001 for both). IUS showed higher specificity for bowel wall thickening, loss of wall stratification and stenosis (P=0.009, P<0.001 and P<0.001, respectively). Sensitivity and accuracy of IUS were higher in detecting ascites in active disease (P=0.002). Discussion Our results showed that IUS and MRE were equally accurate in detecting endoscopic activity. IUS may be the preferred technique for the evaluation of disease activity and for the follow-up of CD.

Ultrasonographic Evaluation of Intestinal Fibrosis and Inflammation in Crohn’s Disease. The State of the Art

“…Even if data are conflicting about the concordance and degree of accuracy of these scores, a recent study demonstrated a high and equal efficacy in the detection of mucosal healing (Buisson et al, 2017), showing a substantial accuracy in the detection of endoscopic ulcerations with high specificity (81-82%) and high negative predictive value (82% NPV), while sensitivity and positive predictive values were moderate. Likewise, in a recent study by Yuksel et al, IUS showed a comparable accuracy to MRE in detecting endoscopic activity (Yuksel et al, 2019) where in endoscopically active disease, the most frequent IUS signs were increased BWT (>3 mm) and fibrofatty proliferation (not defined in the study). These findings are in keeping with another study by Livne et al, where IUS parameters, and in particular terminal ileum thickness and mesenteric fat hypertrophy, showed a significant correlation with the MaRIA score (Livne et al, 2020).…”

“…However, the specificity of US was superior to MRE for bowel wall thickness, loss of wall stratification and stenosis, while the MRE had higher sensitivity in the detection of loss of wall stratification and stenosis. US had higher sensitivity in the detection of ascites, while other mesenteric parameters were similar for both techniques (Yuksel et al, 2019).…”

Diagnostic Accuracy of Non-Invasive Imaging for Detection of Colonic Inflammation in Patients with Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis

“…Multiple disease scoring systems were used. The modified Baron score was used in three studies [13][14][15], the Simple Clinical Colitis Activity Index (SCCAI) in two studies [13,16], the CD Endoscopic Index of Severity (CDEIS) in two studies [17,18], Crohn's Disease Activity Index (CDAI) in three studies [19][20][21], Pediatric Crohn's Disease Activity Index (PCDAI) in one study [22], Mayo Endoscopic Subscore (MES) in two studies [16,23], Truelove and Witts score in two studies [21,24], and the Simple Endoscopic Score for CD (SES-CD) was used in four studies [13,[25][26][27] The performance of MRI and US was assessed in 24 and 17 studies, respectively, while CT was assessed only in two studies hence excluding this imaging modality from the meta-analyses. The diagnostic test values (TP, FP, TN, and FN) of the colonic segments and the sensitivity and specificity values were not presented in all the included studies.…”

“…The diagnostic test values (TP, FP, TN, and FN) of the colonic segments and the sensitivity and specificity values were not presented in all the included studies. The meta-analyses were carried out only in two separate groups, including 13 MRI studies [13,14,17,25,[28][29][30][31][32] and 5 US studies [14,25,32,33], which they had either the calculated TP, FP, TN, and FN or the reported sensitivity and specificity values presented.…”

“…analyses were carried out only in two separate groups, including 13 MRI studies [13,14,17,25,[28][29][30][31][32] and 5 US studies [14,25,32,33], which they had either the calculated TP, FP, TN, and FN or the reported sensitivity and specificity values presented.…”