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Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study
A Ronald Bremner1, Mark Griffiths, Julie D Argent
1Paediatric Medical Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
Insights
Transabdominal sonography can help detect moderate to severe inflammatory bowel disease (IBD) in children. Increased bowel wall thickness (BWT) on ultrasound shows good predictive value for moderate/severe colon and ileum disease.
Area of Science:
- Pediatric gastroenterology
- Diagnostic imaging
- Inflammatory bowel disease (IBD) research
Background:
- Pediatric inflammatory bowel disease (IBD) diagnosis involves invasive procedures.
- Current diagnostic methods include contrast radiology and endoscopy.
- There is a need for less invasive diagnostic tools for pediatric IBD.
Purpose of the Study:
- To evaluate transabdominal sonography for diagnosing IBD in children.
- To compare ultrasound findings with colonoscopy and barium radiology.
- To assess the utility of ultrasound in visualizing the colon and distal ileum.
Main Methods:
- A cohort of 44 children with suspected or known IBD was prospectively studied.
- Transabdominal sonography was performed before colonoscopy or barium follow-through.
- Bowel wall thickness (BWT) was measured and compared with endoscopic and radiological findings.
Main Results:
- Bowel wall thickness (BWT) correlated with moderate to severe disease.
- A BWT >2.9 mm in the colon had 48% sensitivity and 93% specificity for moderate/severe disease.
- A BWT >2.5 mm in the terminal ileum had 75% sensitivity and 92% specificity.
Conclusions:
- Increased BWT on ultrasound is a valuable predictor of moderate to severe IBD in children.
- Ultrasound can effectively assess the colon and terminal ileum in pediatric IBD.
- BWT thresholds can aid in diagnosing pediatric IBD, complementing other methods.
Background:
Children with inflammatory bowel disease (IBD) undergo invasive and repeated investigations, including contrast radiology and endoscopy.
Objective:
To assess transabdominal sonography of the colon and distal ileum compared to colonoscopy and barium radiology in known or suspected IBD.
Materials And Methods:
A prospectively recruited cohort of 44 children (median age 12 years, range 3.5-16.5 years; 24 males) underwent transabdominal sonography prior to colonoscopy (n=33) or barium follow-through (n=25). Diagnoses were: Crohn disease (n=25), ulcerative colitis (n=12), indeterminate colitis (n=1), normal (n=6).
Results:
Bowel wall thickness (BWT) and endoscopic severity were compared in 153 colonic segments. No difference was found between normal and mildly affected segments. BWT was less in normal bowel than moderate (P<0.001) or severe (P<0.001) lesions. Where BWT was >2.9 mm, sensitivity for moderate/severe disease was 48%, specificity 93%, positive predictive value 83% (likelihood ratio 7). Barium radiology showed terminal ileum abnormality in ten patients (40%). Where ileal BWT was >2.5 mm, comparative sensitivity was 75%, specificity 92%, positive predictive value 88% (likelihood ratio 9). Superior mesenteric artery Doppler did not correlate with disease severity.
Conclusion:
Increased BWT has good positive predictive value for moderate/severe disease in the colon proximal to the rectum (>3 mm), and terminal ileum (>2.5 mm). BWT below this cannot exclude moderate/severe mucosal lesions.
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