P0460 Intestinal ultrasound in inflammatory bowel disease: Do we really need experts to monitor our patients?
A Achemlal, O Taibi, S Ouahid, T Salaheddine, R Saouab, M TamzaourteAbstract
Background
Intestinal ultrasound (IUS) has emerged as an important tool in monitoring inflammatory bowel disease (IBD) due to its accessibility, cost-effectiveness, and non-invasive nature, making it an attractive option for gastroenterologists. Our study aimed to assess the agreement between young sonographers and experts in the interpretation of IUS examinations in patients with IBD
Methods
We video-recorded the IUS of a patient with ulcerative colitis in severe acute relapse. A cine-loop of the sigmoid colon was made from the video including a longitudinal and transverse B-mode and CDS-mode. The cine-loop and an electronic form, were sent to 30 radiology residents (Ten in their 2nd year, ten 3rd year and ten 4th year, chosen randomly), along with an IUS expert with 10 years’ experience. Participants were asked to complete the electronic form including key parameters in IUS, such as bowel wall thickness [BWT], color Doppler signal [CDS] (using the modified Limberg score), inflammatory fat [i-fat], bowel wall stratification loss [BWS], haustration loss and presence of lymph nodes. Two scores covering these parameters were also used: Milan ultrasound criteria (MUC) and the International Bowel Ultrasound Segmental Activity Score [IBUS-SAS]. Inter-observer reliability was analyzed using Cohen’s Kappa coefficient (Jamovi version 2.3)
Results
The expert’s findings compared to the average values reported by all residents were as follows: BWT (6.04mm vs 6.3mm ± 3.63), MUC (10.46 vs 10.7 ± 4.81), IBUS (87.17 vs 65.6 ± 21.7). A strong positive association was found between the 3rd and 4th years for BWT (r= 0.562), although not statistically significant (p= 0.091). Fair agreement was found for BWS [κ = 0.329, p= 0.003]. No significant differences in BWT, MUC, IBUS, and modified Limberg score values were found between the three groups of residents (p= 0.762, p= 0.759, p= 0.922, and p= 0.781 respectively). When compared with the expert’s values, there were no significant differences between the BWT and MUC values (2nd year p= 0.625, 3rd year p = 0.492, 4th year p= 0.375). In contrast, the residents’ IBUS and modified Limberg score values were significantly different from the expert’s values (IBUS: 2nd year p= 0.002, 3rd year p= 0.05, 4th year p= 0.01, Limberg: 2nd year p= 0.01, 3rd year: p= 0.017, 4th year p= 0.025)
Conclusion
This study has shown us that our young sonographers are providing encouraging results in the monitoring of IBD. However, the presence of an expert in intestinal ultrasound remains essential in the evaluation of the various ultrasound parameters. Current recommendations in gastroenterology place IUS for IBD in the spotlight, and it is essential that our collaborators can easily help us in the monitoring of these patients