Intestinal ultrasound versus magnetic resonance enterography for detecting small bowel Crohn's disease in children
Johanna M. B. W. Vos, Elsa A. van Wassenaer, Anouk J. Konert, Joost van Schuppen, Rick R. van Rijn, Tim G.J. de Meij, Johan E. van Limbergen, Krisztina B. Gecse, Geert R. A. M. D'Haens, Marc A. Benninga, Bart G. P. Koot,Abstract
Objectives
In Crohn's disease (CD), magnetic resonance enterography (MRE) is used to assess small bowel disease activity. Intestinal ultrasound (IUS) is a less invasive, cheaper and more easily accessible imaging modality in CD. This study assesses the diagnostic accuracy of IUS versus MRE and defines an optimal bowel wall thickness (BWT) cut‐off in children.
Methods
Children with CD undergoing MRE as routine care had IUS within 7 days. MRE disease activity was assessed using the segmental grading system and compared to IUS BWT and IUS scores. The terminal ileum (TI), ileum and jejunum were analysed separately.
Results
Seventy‐eight paediatric CD patients (median age: 15 years; 49% female) were included. Based on MRE, 44 bowel segments had mild and 37 moderate‐severe disease activity. The area under the receiver operating characteristic of IUS BWT for disease activity in the TI was 0.91 (95% confidence interval [CI] 0.84–0.98) with an optimal cut‐off of 2.4 mm, 0.80 (95% CI 0.66–0.94) for the ileum with an optimal cut‐off of 2.0 mm (sensitivity 76%; specificity 93%) and 0.69 (95% CI 0.52–0.86) for the jejunum. Due to the low number of affected segments in the jejunum, an accurate BWT cut‐off value could not be determined. Previously developed IUS scores did not outperform BWT.
Conclusions
IUS is an accurate tool to non‐invasively assess CD activity in the TI and ileum. Based on our results, a BWT cut‐off of 2.4 mm in the TI and 2.0 mm in the ileum in paediatric CD is optimal to distinguish active from inactive disease.