Noninvasive Diagnosis of Small Bowel Crohn’s Disease

Castiglione, Fabiana; Mainenti, Pier Paolo; Palma, Giovanni Domenico De; Testa, Anna; Bucci, Luigi; Pesce, Giuseppe; Camera, Luigi; Diaferia, M.; Rea, Matilde; Caporaso, Nicola; Salvatore, Marco; Rispo, Antonio

doi:10.1097/mib.0b013e3182802b87

Cited by 118 publications

(41 citation statements)

References 51 publications

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“…Our study agreed with different trials in which it was shown that detection rate of fistulas, depending on their localization, had sensitivity between 67% and 82% and specificity between 90% and 100%[ 8 , 9 , 21 - 23 ].…”

Section: Discussionsupporting

confidence: 92%

“…A bowel wall thickness cutoff value of 3 mm in our study showed sensitivity (83.3%), specificity (50%), and accuracy (60%) in comparison to other studies, which showed sensitivities of 88% to 94%; however, specificity (93%-97%,) and diagnostic accuracy (94%) were higher in previous studies than in our study[ 9 , 15 ]. This finding can be explained by the lack of international agreement about standardized measurement parameters, which leads to interobserver variability between examiners[ 18 ].…”

Section: Discussioncontrasting

confidence: 83%

“…An abscess was indicated by bowel ultrasound as an irregular, avascular hypoechoic area with a small amount of internal echoes or air in the form of hyperechoic streaks[ 9 ].…”

Section: Methodsmentioning

confidence: 99%

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Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients

Kamel

Sakr

Hamed

et al. 2020

WJG

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BACKGROUND Bowel ultrasound and magnetic resonance enterography (MRE) are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications. They assess the degree of activity, help clinicians to identify patients in need of surgery, and can be used for patient follow-up. AIM To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease (IBD) patients in Egypt. METHODS The study was conducted on 40 patients with IBD. All patients were subjected to clinical assessment, laboratory investigations, bowel ultrasound, MRE, and colonoscopy up to the terminal ileum with biopsies for histopathological examination. RESULTS This study was conducted on 14 patients (35%) with ulcerative colitis and 26 patients (65%) with Crohn's disease; 34 (85%) of these patients had active disease. Bowel ultrasound detected different bowel lesions with the following accuracies: ileum (85%), large bowel (70%), fistula (95%), stricture and proximal dilatation (95%) and abscesses (100%). Also, it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy. CONCLUSION In comparison to MRE, bowel ultrasound is a useful, non-invasive, and feasible bedside imaging tool for the detection of inflammation, detection of complications, and follow-up of IBD patients when performed by the attending physician.

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Section: Discussionsupporting

confidence: 92%

Section: Discussioncontrasting

confidence: 83%

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Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients

Kamel

Sakr

Hamed

et al. 2020

WJG

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“…Reference standards may also be applied inconsistently, with endoscopy, surgery and imaging all variably employed. For example, in a comparative study with US, Castiglione et al 31 used MRE without any additional reference standard in many recruits. The potential for incorporation bias is self-evident.…”

Section: Discussionmentioning

confidence: 99%

“…By way of example, in the largest study of US to date (296 participants), 30 the standard of reference was simple barium fluoroscopic studies in > 70% of recruited participants. Similarly, in their single-centre comparative study of MRE and US in 249 participants with suspected CD (120 with a confirmed diagnosis), Castiglione et al 31 used MRE itself as the standard of reference for small bowel Crohn's disease (SBCD) extent in the majority of participants who did not have surgical reference standard, clearly risking incorporation bias. There is no single reference standard for defining the location, extent and activity of CD.…”

Section: Existing Literature On the Diagnostic Accuracy Of Magnetic Rmentioning

confidence: 99%

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Taylor

Mallett

Bhatnagar

et al. 2019

Health Technol Assess

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Background Magnetic resonance enterography and enteric ultrasonography are used to image Crohn’s disease patients. Their diagnostic accuracy for presence, extent and activity of enteric Crohn’s disease was compared. Objective To compare diagnostic accuracy, observer variability, acceptability, diagnostic impact and cost-effectiveness of magnetic resonance enterography and ultrasonography in newly diagnosed or relapsing Crohn’s disease. Design Prospective multicentre cohort study. Setting Eight NHS hospitals. Participants Consecutive participants aged ≥ 16 years, newly diagnosed with Crohn’s disease or with established Crohn’s disease and suspected relapse. Interventions Magnetic resonance enterography and ultrasonography. Main outcome measures The primary outcome was per-participant sensitivity difference between magnetic resonance enterography and ultrasonography for small bowel Crohn’s disease extent. Secondary outcomes included sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease extent, and sensitivity and specificity for small bowel Crohn’s disease and colonic Crohn’s disease presence; identification of active disease; interobserver variation; participant acceptability; diagnostic impact; and cost-effectiveness. Results Out of the 518 participants assessed, 335 entered the trial, with 51 excluded, giving a final cohort of 284 (133 and 151 in new diagnosis and suspected relapse cohorts, respectively). Across the whole cohort, for small bowel Crohn’s disease extent, magnetic resonance enterography sensitivity [80%, 95% confidence interval (CI) 72% to 86%] was significantly greater than ultrasonography sensitivity (70%, 95% CI 62% to 78%), with a 10% difference (95% CI 1% to 18%; p = 0.027). For small bowel Crohn’s disease extent, magnetic resonance enterography specificity (95%, 95% CI 85% to 98%) was significantly greater than ultrasonography specificity (81%, 95% CI 64% to 91%), with a 14% difference (95% CI 1% to 27%). For small bowel Crohn’s disease presence, magnetic resonance enterography sensitivity (97%, 95% CI 91% to 99%) was significantly greater than ultrasonography sensitivity (92%, 95% CI 84% to 96%), with a 5% difference (95% CI 1% to 9%). For small bowel Crohn’s disease presence, magnetic resonance enterography specificity was 96% (95% CI 86% to 99%) and ultrasonography specificity was 84% (95% CI 65% to 94%), with a 12% difference (95% CI 0% to 25%). Test sensitivities for small bowel Crohn’s disease presence and extent were similar in the two cohorts. For colonic Crohn’s disease presence in newly diagnosed participants, ultrasonography sensitivity (67%, 95% CI 49% to 81%) was significantly greater than magnetic resonance enterography sensitivity (47%, 95% CI 31% to 64%), with a 20% difference (95% CI 1% to 39%). For active small bowel Crohn’s disease, magnetic resonance enterography sensitivity (96%, 95% CI 92% to 99%) was significantly greater than ultrasonography sensitivity (90%, 95% CI 82% to 95%), with a 6% difference (95% CI 2% to 11%). There was some disagreement between readers for both tests. A total of 88% of participants rated magnetic resonance enterography as very or fairly acceptable, which is significantly lower than the percentage (99%) of participants who did so for ultrasonography. Therapeutic decisions based on magnetic resonance enterography alone and ultrasonography alone agreed with the final decision in 122 out of 158 (77%) cases and 124 out of 158 (78%) cases, respectively. There were no differences in costs or quality-adjusted life-years between tests. Limitations Magnetic resonance enterography and ultrasonography scans were interpreted by practitioners blinded to clinical data (but not participant cohort), which does not reflect use in clinical practice. Conclusions Magnetic resonance enterography has higher accuracy for detecting the presence, extent and activity of small bowel Crohn’s disease than ultrasonography does. Both tests have variable interobserver agreement and are broadly acceptable to participants, although ultrasonography produces less participant burden. Diagnostic impact and cost-effectiveness are similar. Recommendations for future work include investigation of the comparative utility of magnetic resonance enterography and ultrasonography for treatment response assessment and investigation of non-specific abdominal symptoms to confirm or refute Crohn’s disease. Trial registration Current Controlled Trials ISRCTN03982913. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 42. See the NIHR Journals Library website for further project information.

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Magnetic Resonance Enterography

Vanslembrouck

Vanbeckevoort

Chawla³

et al. 2014

Endoscopy in Inflammatory Bowel Disease

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Noninvasive Diagnosis of Small Bowel Crohn’s Disease

Abstract: BS and MR enterography are 2 accurate procedures for the diagnosis of small bowel CD, although MR seems to be more sensitive in defining its extension. BS could be used to select the patients for subsequent MRI examination.

Cited by 118 publications

References 51 publications

Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients

Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients

Magnetic resonance enterography compared with ultrasonography in newly diagnosed and relapsing Crohn’s disease patients: the METRIC diagnostic accuracy study

Magnetic Resonance Enterography

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