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Bowel Wall Thickness Cutoff Value for Assessing Inflammatory Bowel Disease Activity Using Intestinal Ultrasonography
Laura Räisänen1,2,3, Ray Lang3, Michael Couper4
1Tampere Center for Child, Adolescent, and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University , Tampere, Finland.
Background And Aims:
Intestinal ultrasonography (IUS) is a noninvasive tool for assessing bowel inflammation. In adults, a bowel wall thickness (BWT) cutoff of 0.30 cm is used to indicate inflammation, but children do not have a widely accepted value. We propose an optimal BWT cutoff value for children.
Methods:
We performed 144 IUS examinations during 2019-2024 in 133 children within 30 days before to 7 days after colonoscopy. Assessed values for the BWT from the terminal ileum to the rectum were paired with colonoscopy findings at each segment (n = 809 pairs). The cutoff value for detecting inflammation was explored with receiver operating characteristic (ROC) analysis.
Results:
In children ≥6 years old IUS demonstrated excellent accuracy for detecting moderate/severe inflammation (area under the curve [AUC] 0.907) but poor accuracy for mild inflammation (AUC 0.690) or in children <6 years old (AUC, 0.667). The adult cutoff (0.30 cm) missed 32% of inflammation in children. In children ≥6 years old, a BWT cutoff of 0.27 cm detected 85% of moderate/severe and 43% of mild inflammation. Lower cutoff values (0.24 cm) were more optimal for girls and children weighing <40 kg.
Conclusions:
Although IUS is an excellent tool for detecting moderate/severe bowel inflammation, this method showed limited accuracy in children <6 years old. The adult BWT cutoff missed over 30% of bowel inflammation in children. BWT cutoff of 0.27-0.30 cm in boys and 0.23-0.25 cm in girls and/or children <40 kg indicated active gut inflammation.
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