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Published on: December 15, 2017
Relevance of sonographic parameters for inflammatory bowel disease in children
Alessandra Dell'Era1, Rosanna Cannatelli1, Francesca Ferretti1
1Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy.
Insights
Intestinal ultrasound (IUS) effectively detects pediatric inflammatory bowel disease (IBD). Combining increased bowel wall thickening, altered bowel patterns, and mesenteric hypertrophy improves diagnostic accuracy for IBD in children.
Area of Science:
- Pediatric gastroenterology
- Diagnostic imaging
- Inflammatory Bowel Disease (IBD) research
Background:
- Intestinal ultrasound (IUS) is a primary diagnostic tool for suspected pediatric inflammatory bowel disease (IBD).
- Accurate IBD detection in children relies on identifying specific ultrasound indicators.
Purpose of the Study:
- To evaluate the diagnostic accuracy of various IUS parameters for detecting IBD in pediatric patients.
- To assess the role of increased bowel wall thickening (BWT) and other sonographic findings in identifying IBD.
Main Methods:
- A cohort of 113 pediatric patients (aged 2-18 years) with suspected IBD underwent IUS as a first-line investigation.
- Eligibility required a complete IUS, clinical/biochemical assessments, and either ileocolonoscopy or a one-year uneventful follow-up.
Main Results:
- Twenty-three patients (20.4%) were diagnosed with IBD (ulcerative colitis, Crohn's disease, indeterminate colitis).
- Multivariate analysis identified increased BWT (>3 mm), altered IUS bowel pattern (IUS-BP), and mesenteric hypertrophy (MH) as significant independent predictors of IBD.
- While individual parameters showed high specificity, combining BWT, IUS-BP, and MH achieved 100% specificity for IBD detection, albeit with reduced sensitivity.
Conclusions:
- Increased BWT, MH, and altered echopattern are independent sonographic predictors of pediatric IBD.
- Combining multiple IUS parameters enhances diagnostic accuracy for IBD compared to relying solely on BWT.
Purpose:
Intestinal ultrasound (IUS) is widely used as the first exam in patients with suspected inflammatory bowel disease (IBD). This study investigated the accuracy of several IUS parameters, including increased bowel wall thickening (BWT), in detecting IBD in a paediatric population.
Methods:
The study included an unselected series of 113 patients aged 2-18 years (mean age 10.8 years, 65 male), referred for recurrent abdominal pain or altered bowel habits, without known organic diseases, to perform an IUS as first investigation of a diagnostic workup. Patients with full systematic IUS examination, clinical and biochemical exams, and ileocolonoscopy or an uneventful follow-up at least one year follow up were eligible.
Results:
23 IBD patients (20.4%; 8 ulcerative colitis, 12 Crohn's disease and 3 indeterminate colitis) were diagnosed. We found that increased BWT > 3 mm (OR 5.4), altered IUS bowel pattern (IUS-BP, OR 9.8) and mesenteric hypertrophy (MH, OR 5.2) accurately identified IBD at the multivariate analysis. IUS-BP, MH and BWT > 3 mm had a sensitivity of 78.3%, 65.2% and 69.6% and a specificity of 93.3%, 92.2% and 96.7%, respectively. The combination of these three alterations increased the specificity up to 100%, whilst decreased sensitivity to 56.5%.
Conclusion:
Among several US parameters suggestive of IBD, the increased BWT, MH and altered echopattern are independent predictors of IBD. The ultrasonographic diagnosis of IBD could be more accurate if relied on combination of different sonographic parameters, than on the sole BWT evaluation.
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