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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.
Insights
Intestinal ultrasonography (IUS) is a valuable tool for assessing pediatric bowel inflammation. A new bowel wall thickness (BWT) cutoff is proposed for children, as the adult standard misses significant inflammation.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Inflammatory Bowel Disease
Background:
- Intestinal ultrasonography (IUS) is a noninvasive method to evaluate bowel inflammation.
- A standard bowel wall thickness (BWT) cutoff of 0.30 cm is used in adults, but a pediatric-specific value is lacking.
- Accurate assessment of pediatric gut inflammation is crucial for timely diagnosis and treatment.
Purpose of the Study:
- To determine an optimal BWT cutoff value for detecting intestinal inflammation in children using IUS.
- To compare the diagnostic accuracy of the adult BWT cutoff in pediatric populations.
- To identify potential differences in optimal BWT cutoffs based on age, sex, or weight.
Main Methods:
- 144 IUS examinations were conducted in 133 children within 30 days before or 7 days after colonoscopy.
- Bowel wall thickness (BWT) measurements from the terminal ileum to the rectum were correlated with colonoscopy findings (809 paired segments).
- Receiver operating characteristic (ROC) analysis was used to determine the optimal BWT cutoff for inflammation detection.
Main Results:
- IUS showed high accuracy (AUC 0.907) for moderate/severe inflammation in children ≥6 years old, but lower accuracy for mild inflammation (AUC 0.690) or in children <6 years old (AUC 0.667).
- The adult BWT cutoff of 0.30 cm missed 32% of inflammation in children.
- A BWT cutoff of 0.27 cm in children ≥6 years old detected 85% of moderate/severe and 43% of mild inflammation; lower cutoffs (0.24 cm) were better for girls and children <40 kg.
Conclusions:
- IUS is effective for moderate/severe pediatric bowel inflammation but less accurate in children <6 years old.
- The adult BWT cutoff is suboptimal for children, missing over 30% of inflammatory cases.
- Recommended BWT cutoffs range from 0.27-0.30 cm for boys and 0.23-0.25 cm for girls and/or children <40 kg to indicate active gut inflammation.
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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