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Reliability and Validity of Mesenteric Fat Assessment by Intestinal Ultrasound in Pediatric Crohn's Disease Using the
Amelia Kellar1,2, Tessa George1, Michael T Dolinger3
1Section of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, University of Chicago, Chicago, IL, United States.
Insights
Intestinal ultrasound (IUS) reliably assesses mesenteric fat (MF) wrapping in pediatric Crohn
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Inflammatory Bowel Disease Research
Background:
- Intestinal ultrasound (IUS) offers a noninvasive method for evaluating Crohn's disease (CD), including mesenteric fat (MF) wrapping.
- The reliability of MF assessment and its correlation with disease activity in children using IUS were previously unknown.
Purpose of the Study:
- To assess the interrater reliability (IRR) of binary MF assessment and a novel semi-quantitative index (Chicago Mesenteric Fat Index, CMFI) for grading MF wrapping via IUS.
- To determine the correlation between MF assessment and disease activity biomarkers in pediatric CD patients.
Main Methods:
- Three expert sonographers independently graded MF (present/absent and CMFI) in pediatric CD patients (≤18 years) with ileal involvement undergoing IUS.
- Interrater reliability was calculated using Fleiss' kappa coefficient.
- Correlations between MF grading and clinical characteristics, inflammatory markers, and other IUS findings were analyzed.
Main Results:
- Eighty IUS exams from 67 pediatric CD patients were analyzed.
- Substantial IRR was found for both binary MF (κ=0.744) and CMFI (κ=0.618).
- Higher CMFI grades significantly correlated with increased bowel wall thickness, ileal stricture, and hyperemia.
Conclusions:
- Mesenteric fat assessment using IUS is reproducible and reliable in pediatric Crohn's disease.
- The Chicago Mesenteric Fat Index (CMFI) serves as a valuable biomarker reflecting biochemical and sonographic indicators of disease activity in pediatric CD.
Background:
Intestinal ultrasound (IUS) provides a noninvasive means of assessing Crohn's disease (CD), including visualization of mesenteric fat (MF) wrapping. Reliability of MF assessment and correlation with disease activity biomarkers in children is unknown. This study assessed the interrater reliability (IRR) of a binary assessment and a novel semi-quantitative index for grading MF wrapping using IUS (Chicago Mesenteric Fat Index [CMFI]) and correlation with disease activity biomarkers in pediatric patients with CD.
Methods:
Children (≤18 years of age) with ileal CD who underwent IUS at 2 centers were enrolled. Three expert sonographers independently graded MF as present/absent and by the CMFI. IRR was calculated using Fleiss' kappa coefficient. Correlations between MF and clinical characteristics, inflammatory markers, and IUS data were calculated.
Results:
Eighty IUS exams in 67 patients were included. The IRR was substantial for binary MF (κ = 0.744) and CMFI (κ = 0.618). Increasing CMFI grade was associated with bowel wall thickness (P < .001; odds ratio [OR], 16.35; 95% confidence interval [CI], 5.74-46.58), presence of ileal stricture (P < .001; OR, 30.32; 95% CI, 5.74-160.15), and presence of hyperemia (P = .001; OR, 6.59; 95% CI, 2.27-19.09).
Conclusion:
Assessment of MF on IUS is reproducible and reliable in pediatric CD. The CMFI can be used as a biomarker that mirrors biochemical and sonographic indicators of pediatric CD activity.
