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Nazarian M, Patel R, Anupindi S, Dane B. Multimodality Imaging of Small Bowel Crohn Disease. Radiol Clin North Am 2025; 63:315-330. [PMID: 40221177 DOI: 10.1016/j.rcl.2024.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2025]
Abstract
Computed tomography enterography, magnetic resonance enterography, and bowel ultrasound are complementary tools central to diagnosing and monitoring Crohn disease. These modalities can identify active inflammation, penetrating, and stricturing disease. Crohn disease must be monitored frequently to guide therapy, and resolution of inflammation on imaging correlates directly with steroid-free clinical remission. While disease activity assessment is qualitative, newer quantitative techniques to assess active inflammation are emerging. These as well as other techniques, such as contrast-enhanced ultrasound (US) and US elastography, will offer new tools for future radiologists.
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Affiliation(s)
- Matthew Nazarian
- University of Pennsylvania, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA 19104, USA.
| | - Richa Patel
- Stanford University, 300 Pasteur Drive H1307, Stanford, CA 94305, USA
| | - Sudha Anupindi
- Children's Hospital of Pennsylvania, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Bari Dane
- New York University, 660 1st Avenue, New York, NY 10016, USA
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Wild J, Nandi N, Chew TS, Rea B, Sidhu R. Small bowel ultrasound: friend or foe? Curr Opin Gastroenterol 2025; 41:154-163. [PMID: 39998917 DOI: 10.1097/mog.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2025]
Abstract
PURPOSE OF REVIEW Crohn's disease (CD), requires accurate diagnosis and regular monitoring to manage disease activity, prevent complications, and improve outcomes. Intestinal ultrasound (IUS) has emerged as a noninvasive, real-time imaging modality, offering a valuable alternative to traditional diagnostic techniques such as magnetic resonance enterography (MRE), endoscopy and capsule endoscopy (CE). This review examines recent advances in IUS for the diagnosis and monitoring of small bowel CD, with a focus on its applications, benefits, and limitations. RECENT FINDINGS Recent studies have demonstrated that IUS provides high sensitivity and specificity in detecting key markers of disease activity, including bowel wall thickness (BWT), bowel wall flow (BWF), and bowel wall stratification (BWS). Advances in IUS techniques, such as elastography and contrast-enhanced ultrasound (CEUS), have expanded its diagnostic and prognostic capabilities, potentially enabling differentiation between inflammation and fibrosis. However, challenges remain, including operator dependency, variability in scoring systems, and reduced sensitivity for superficial mucosal abnormalities. Efforts to standardize parameters and improve training have shown promise in addressing these limitations. SUMMARY IUS is a critical complementary tool for assessing disease activity, transmural healing, and postoperative recurrence in small bowel CD. Its noninvasiveness, cost-effectiveness, and real time assessment make it well suited for routine clinical use. Nonetheless, further multicentre studies are needed to validate scoring systems, optimize integration with other modalities, and improve consistency across clinical settings. IUS holds significant potential for advancing personalized care in small bowel CD, though ongoing research is required to refine its applications and maximize its clinical utility.
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Affiliation(s)
| | - Nicoletta Nandi
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust
| | - Thean Soon Chew
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | | | - Reena Sidhu
- Academic Unit of Gastroenterology and Hepatology, Sheffield Teaching Hospitals, NHS Foundation Trust
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Hameed M, Kumar S, Taylor SA. How I Do It: Cross-sectional Imaging in Small-Bowel Crohn Disease and Ulcerative Colitis. Radiology 2025; 314:e241452. [PMID: 39932413 DOI: 10.1148/radiol.241452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2025]
Abstract
Cross-sectional imaging, especially MR enterography (MRE) and intestinal US, plays an increasingly important role in the diagnosis and monitoring of Crohn disease. In this article, the authors share their approach to imaging Crohn disease, drawing on their clinical and research experience. They consider how to select the most appropriate modality for different clinical indications and discuss technical aspects to maximize diagnostic accuracy. The focus then shifts to how to use imaging to assess disease activity and treatment response in day-to-day clinical practice and the clinical potential of disease activity scores from MRE and intestinal US. The authors finish by discussing the benefits of intestinal US in ulcerative colitis.
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Affiliation(s)
- Maira Hameed
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, United Kingdom
| | - Shankar Kumar
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, United Kingdom
| | - Stuart A Taylor
- From the Centre for Medical Imaging, University College London, 43-45 Foley St, London W1W 7TS, United Kingdom
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Pal P, Mateen MA, Pooja K, Rajadurai N, Gupta R, Tandan M, Duvvuru NR. Role of intestinal ultrasound in ulcerative colitis: A systematic review. World J Meta-Anal 2024; 12:97210. [DOI: 10.13105/wjma.v12.i3.97210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 08/07/2024] [Accepted: 08/14/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Intestinal ultrasound (IUS) is an emerging, non-invasive, and highly sensitive diagnostic tool in inflammatory bowel disease (IBD), including ulcerative colitis (UC). Despite its potential, its adoption in clinical practice is limited due to a lack of standardization and awareness.
AIM To perform a comprehensive scoping review based on a systematic literature review on IUS in UC to inform current practice.
METHODS Ninety-nine original articles about ultrasonography in UC were identified among 7608 citations searching PubMed and EMBASE databases for systematic review.
RESULTS IUS can be useful as an initial diagnostic strategy in patients with suspected IBD/UC. In UC, IUS can predict endoscopic response, histologic healing, and steroid responsiveness in acute severe cases. IUS can predict response to biologics/small molecules (as early as 2 wk). IUS correlates well with ileo-colonoscopy, but IUS could miss rectal, jejunal, and upper GI lesions in suspected IBD and colon polyps or extra-intestinal manifestations in known IBD. IUS is useful in special situations (children, pregnancy, and postoperative Crohn's disease). Inter-observer agreement is acceptable and trained physicians have comparable diagnostic accuracy. Point-of-care ultrasound impacted management in 40%-60% of cases. Hand-held IUS has excellent agreement with conventional IUS.
CONCLUSION IUS is a non-invasive, highly sensitive tool in the diagnosis and monitoring of UC, offering excellent patient satisfaction. Point-of-care ultrasound by IBD physicians can significantly impact clinical decision-making.
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Affiliation(s)
- Partha Pal
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Mohammad Abdul Mateen
- Department of Diagnostic Radiology and Imaging, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Kanapuram Pooja
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Nandhakumar Rajadurai
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Rajesh Gupta
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Manu Tandan
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
| | - Nageshwar Reddy Duvvuru
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
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Kumar S, De Kock I, Blad W, Hare R, Pollok R, Taylor SA. Magnetic Resonance Enterography and Intestinal Ultrasound for the Assessment and Monitoring of Crohn's Disease. J Crohns Colitis 2024; 18:1450-1463. [PMID: 38554104 PMCID: PMC11369078 DOI: 10.1093/ecco-jcc/jjae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/20/2024] [Indexed: 04/01/2024]
Abstract
Magnetic resonance enterography [MRE] and intestinal ultrasound [IUS] have developed rapidly in the past few decades, emerging as the primary non-invasive options for both diagnosing and monitoring Crohn's disease [CD]. In this review, we evaluate the pertinent data relating to the use of MRE and IUS in CD. We summarise the key imaging features of CD activity, highlight their increasing role in both the clinical and the research settings, and discuss how these modalities fit within the diagnostic pathway. We discuss how they can be used to assess disease activity and treatment responsiveness, including the emergence of activity scores for standardised reporting. Additionally, we address areas of controversy such as the use of contrast agents, the role of diffusion-weighted imaging, and point-of-care ultrasound. We also highlight exciting new developments, including the applications of artificial intelligence. Finally, we provide suggestions for future research priorities.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London, London, UK
| | | | - William Blad
- Department of Gastroenterology, University College Hospitals NHS Foundation Trust, London, UK
| | - Richard Hare
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard Pollok
- Department of Gastroenterology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
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Chavannes M, Dolinger MT, Cohen-Mekelburg S, Abraham B. AGA Clinical Practice Update on the Role of Intestinal Ultrasound in Inflammatory Bowel Disease: Commentary. Clin Gastroenterol Hepatol 2024; 22:1790-1795.e1. [PMID: 39001773 DOI: 10.1016/j.cgh.2024.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/20/2024] [Accepted: 04/23/2024] [Indexed: 07/15/2024]
Abstract
DESCRIPTION In the past 3 years, the use of intestinal ultrasound (IUS) for monitoring inflammatory bowel disease in clinical practice has grown substantially in the United States. This American Gastroenterological Association (AGA) Institute Clinical Practice Update (CPU) aims to review the available evidence and guidance regarding the role of intestinal ultrasound in inflammatory bowel disease care. METHODS This CPU was commissioned and approved by the AGA Institute Clinical Practice Updates Committee (CPUC) and the AGA Governing Board to provide timely guidance on a topic of high clinical importance to the AGA membership and underwent internal peer review by the CPUC and external peer review through standard procedures of Clinical Gastroenterology and Hepatology. This expert commentary incorporates important and recently published studies in this field, and it reflects the experiences of the multidisciplinary group of authors composed of adult and pediatric gastroenterologists.
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Affiliation(s)
- Mallory Chavannes
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Los Angeles, California; Department of Pediatrics, University of Southern California, Los Angeles, California.
| | - Michael Todd Dolinger
- Division of Pediatric Gastroenterology, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shirley Cohen-Mekelburg
- Division of Gastroenterology & Hepatology, University of Michigan, Ann Arbor, Michigan; VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Bincy Abraham
- Division of Gastroenterology & Hepatology, Houston Methodist-Weill Cornell, Houston, Texas
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Goodsall TM, An YK, Andrews JM, Begun J, Friedman AB, Lee A, Lewindon PJ, Spizzo P, Rodgers N, Taylor KM, White LS, Wilkens R, Wright EK, Zou L, Maguire BR, Parker CE, Rémillard J, Novak KL, Panaccione R, Feagan BG, Jairath V, Ma C, Bryant RV. Reliability of Intestinal Ultrasound for Evaluating Crohn's Disease Activity Using Point-of-care and Central Reading. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00773-0. [PMID: 39209200 DOI: 10.1016/j.cgh.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 08/14/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND & AIMS Intestinal ultrasound (IUS) is increasingly used to assess Crohn's disease (CD) activity in clinical practice. However, application in clinical trials has been limited by heterogeneous scoring methods and concerns about reliability. We aimed to determine the inter- and intra-rater reliability of locally and centrally read IUS parameters for evaluating CD using prospectively performed scans. METHODS Twenty-four participants with CD and 6 gastroenterologists participated in a 2-day workshop where each participant underwent 6 IUS scans in total. Eight IUS parameters (bowel wall thickness [BWT], bowel wall stratification [BWS], color Doppler signal [CDS], inflammatory mesenteric fat [i-fat], submucosal prominence, submucosal layer thickness, haustra coli/peristalsis, and affected segment length) and an overall measure of sonographic disease activity were blindly assessed by the 6 local readers and 4 central gastroenterologist-sonographers. Reliability was quantified using intraclass correlation coefficients (ICCs). Institutional review board approval was granted for this study (12938). RESULTS Five IUS parameters demonstrated at least moderate (ICC ≥0.41) inter- and intra-rater reliability when local and central reading was performed (BWT, CDS, i-fat, submucosal prominence, and affected segment length). Reliability was generally better with central, in distinction to local, reading. ICCs for BWS and i-fat were highest when evaluated as binary outcomes. Sensitivity analyses demonstrated that IUS parameters are most reliable when evaluated in the worst affected segment. Fair reliability was observed when local readers identified the worst affected segment. CONCLUSIONS Local and central reading of IUS demonstrated at least moderate inter- and intra-rater reliability for several parameters. This study supports refining existing activity indices and incorporating IUS central reading into clinical trials.
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Affiliation(s)
- Thomas M Goodsall
- IBD Service, Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Yoon-Kyo An
- Mater Hospital Brisbane, University of Queensland, Brisbane, Queensland, Australia; Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Jane M Andrews
- Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia; Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Jakob Begun
- Mater Hospital Brisbane, University of Queensland, Brisbane, Queensland, Australia; Mater Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Antony B Friedman
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Andrew Lee
- Department of Gastroenterology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Peter J Lewindon
- Department of Gastroenterology, Queensland Children's Hospital, University of Queensland, Brisbane, Queensland, Australia
| | - Paul Spizzo
- Department of Gastroenterology, Southern Adelaide Local Health Network (SALHN) Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Nick Rodgers
- Clinpath Pathology Laboratory, Adelaide, South Australia, Australia
| | - Kirstin M Taylor
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Victoria, Australia
| | - Lauren S White
- Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Rune Wilkens
- Digestive Disease Centre, Copenhagen University Hospital, Bispebjerg, Copenhagen, Denmark; Copenhagen Intestinal Ultrasound (CIUS), Copenhagen, Denmark
| | - Emily K Wright
- Department of Gastroenterology, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Lily Zou
- Alimentiv Inc., London, Ontario, Canada
| | | | | | | | - Kerri L Novak
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Remo Panaccione
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brian G Feagan
- Alimentiv Inc., London, Ontario, Canada; Division of Gastroenterology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Division of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Vipul Jairath
- Alimentiv Inc., London, Ontario, Canada; Division of Gastroenterology, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada; Division of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Christopher Ma
- Copenhagen Intestinal Ultrasound (CIUS), Copenhagen, Denmark; Alimentiv Inc., London, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Robert V Bryant
- IBD Service, Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia; Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
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Hoffmann JC, Ungewitter T. Role of Intestinal Ultrasound for IBD Care: A Practical Approach. Diagnostics (Basel) 2024; 14:1639. [PMID: 39125517 PMCID: PMC11311560 DOI: 10.3390/diagnostics14151639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Revised: 07/25/2024] [Accepted: 07/26/2024] [Indexed: 08/12/2024] Open
Abstract
Intestinal ultrasound (IUS) has recently become the imaging technique of choice for patients with different types of intestinal inflammation. IUS has a high sensitivity, specificity, positive predictive value, and negative predictive value when diagnosing Crohn's disease or ulcerative colitis. Further, it is now the preferred imaging modality for routine IBD reevaluations because of its non-invasiveness, cost-effectiveness, availability (at least in Europe), and reproducibility in all age groups. However, the clinical success of IUS requires IUS training for doctors and technicians who perform IUS with a standardised description of ultrasound findings of the terminal ileum and entire colon. Complications such as abscess formation, fistulae, and stenosis can be detected by either conventional IUS or contrast-enhanced ultrasound (CEUS). Lately, several disease activity scores have been proposed for Crohn's disease, postoperative Crohn's disease, and ulcerative colitis both in adults (including elderly) and in children. IUS was successfully used in randomised clinical trials in order to measure the treatment response. Therefore, IUS now plays a central role in clinical decision making.
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Affiliation(s)
- Joerg C. Hoffmann
- Gastroenterologie am Herrngarten, Frankfurter Str. 3, 64293 Darmstadt, Germany
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Yaguchi K, Kunisaki R, Sato S, Hirai K, Izumi M, Fukuno Y, Tanaka M, Okazaki M, Wu R, Nishikawa Y, Matsune Y, Shibui S, Nakamori Y, Nishio M, Matsubayashi M, Ogashiwa T, Fujii A, Toritani K, Kimura H, Kumagai E, Sasahara Y, Inayama Y, Fujii S, Ebina T, Numata K, Maeda S. Intestinal ultrasound for intestinal Behçet disease reflects endoscopic activity and histopathological findings. Intest Res 2024; 22:297-309. [PMID: 39009376 PMCID: PMC11309824 DOI: 10.5217/ir.2023.00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/11/2024] [Accepted: 02/26/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND/AIMS Intestinal Behçet disease is typically associated with ileocecal punched-out ulcers and significant morbidity and mortality. Intestinal ultrasound is a noninvasive imaging technique for disease monitoring. However, no previous reports have compared intestinal ultrasound with endoscopic ulcer activity or histopathological findings for intestinal Behçet disease. We evaluated the usefulness of intestinal ultrasound for assessing the activity of ileocecal ulcers in intestinal Behçet disease. METHODS We retrospectively compared intestinal ultrasound findings with 73 corresponding endoscopic images and 6 resected specimens. The intestinal ultrasound findings were assessed for 7 parameters (bowel wall thickness, vascularity [evaluated using the modified Limberg score with color Doppler], bowel wall stratification, white-plaque sign [strong hyperechogenic lines or spots], mesenteric lymphadenopathy, extramural phlegmons, and fistulas), and endoscopic ulcer activity was classified into active, healing, and scar stages. Histopathological findings were evaluated by consensus among experienced pathologists. RESULTS Bowel wall thickness (P< 0.001), vascularity (P< 0.001), loss of bowel wall stratification (P= 0.015), and white-plague sign (P= 0.013) were significantly exacerbated in the endoscopic active ulcer stage. Receiver operating characteristic curve analysis revealed that a bowel wall thickness of > 5.5 mm (sensitivity 89.7%, specificity 85.3%) was potentially useful for detecting active lesions. When compared with histopathological findings, an increase in bowel wall thickness reflected the ulcer marginal ridge, and the white-plaque sign reflected the ulcer bottom. CONCLUSIONS Intestinal ultrasound is useful for monitoring intestinal ulcer activity in intestinal Behçet disease.
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Affiliation(s)
- Katsuki Yaguchi
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Sho Sato
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Yokohama, Japan
| | - Kaori Hirai
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Yokohama, Japan
| | - Misato Izumi
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshimi Fukuno
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Yokohama, Japan
| | - Mami Tanaka
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Yokohama, Japan
| | - Mai Okazaki
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Yokohama, Japan
| | - Rongrong Wu
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yurika Nishikawa
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Matsune
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shunsuke Shibui
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Yoshinori Nakamori
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Masafumi Nishio
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Mao Matsubayashi
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Tsuyoshi Ogashiwa
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Ayako Fujii
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Kenichiro Toritani
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Eita Kumagai
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yukiko Sasahara
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoshiaki Inayama
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Fujii
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
- Department of Molecular Pathology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
| | - Toshiaki Ebina
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Yokohama, Japan
| | - Kazushi Numata
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
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10
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Mahdy NS, El-Gaafary SM, Mageed KHA, Shehata KAA, AbdelKarim MAS, Abdulhafiz EM. Comparative study between ultrasound and MR enterography in evaluation of Crohn’s disease. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2024; 55:106. [DOI: 10.1186/s43055-024-01278-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 05/18/2024] [Indexed: 01/02/2025] Open
Abstract
Abstract
Background
Crohn’s disease is a chronic inflammatory bowel disease that can affect any part of the gut. Endoscopy is the gold standard for diagnosis, but it only assesses mucosal lesions. Magnetic resonance enterography (MRE) can assess disease presence and activity, but it has limitations such as motion sensitivity, long scan time, and high cost. Bowel sonography has been introduced as a non-invasive, practical, safe, and low-cost technique to assess disease activity and complications. In our study we aim to assess the comparability of ultrasound to MRE in evaluation of patients with Crohn’s disease, and its complications.
Results
Twenty-five patients with 38 Crohn’s disease affected segments were evaluated by bowel ultrasound (BUS) and MRI enterography (MRE), where BUS and MRE showed equivalent diagnostic performance for disease detection and localization (97.4%, 100%), for sensitivity and specificity of both modalities. Peri-mural fluid (89.5%, 94.4%) and mural stratification loss (100%, 100%) showed high sensitivity and specificity by BUS compared to MRE, while for assessment of mural vascularity, BUS showed high sensitivity and specificity for high grade vascularity (100%, 83.3%), but low sensitivity and high specificity for low and moderate vascularity (0%–62.5%, 81.8%) compared to MRE. Complications including fistulae and abscessed were all correctly identified in BUS compared to MRE.
Conclusion
BUS showed comparable results to MRE for identification, localization, assessment of findings related to disease activity, and complications in cases of Crohn’s disease rendering it a viable alternative to MRE.
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11
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Lu C, Rosentreter R, Delisle M, White M, Parker CE, Premji Z, Wilson SR, Baker ME, Bhatnagar G, Begun J, Bruining DH, Bryant R, Christensen B, Feagan BG, Fletcher JG, Jairath V, Knudsen J, Kucharzik T, Maaser C, Maconi G, Novak K, Rimola J, Taylor SA, Wilkens R, Rieder F. Systematic review: Defining, diagnosing and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound. Aliment Pharmacol Ther 2024; 59:928-940. [PMID: 38436124 DOI: 10.1111/apt.17918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/29/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Stricturing Crohn's disease (CD) occurs most commonly in the terminal ileum and poses a clinical problem. Cross-sectional imaging modalities such as intestinal ultrasound (IUS), computed tomography enterography (CTE), and magnetic resonance enterography (MRE) allow for assessment of the entire bowel wall and associated peri-enteric findings. Radiologic definitions of strictures have been developed for CTE and MRE; their reliability and responsiveness are being evaluated in index development programs. A comprehensive assessment strategy for strictures using IUS is needed. AIMS To provide a detailed summary of definitions, diagnosis and monitoring of strictures on IUS as well as technical aspects of image acquisition. METHODS We searched four databases up to 6 January 2024. Two-stage screening was done in duplicate. We assessed risk of bias using QUADAS-2. RESULTS There were 56 studies eligible for inclusion. Definitions for strictures on IUS are heterogeneous, but the overall accuracy for diagnosis of strictures is high. The capability of IUS for characterising inflammation versus fibrosis in strictures is not accurate enough to be used in clinical practice or trials. We summarise definitions for improvement of strictures on IUS, and discuss parameters for image acquisition and standardisation. CONCLUSIONS This systematic review is the first step for a structured program to develop a stricture IUS index for CD.
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Affiliation(s)
- Cathy Lu
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Ryan Rosentreter
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Maxime Delisle
- Department of Medicine, Division of Gastroenterology, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mattie White
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | | | - Zahra Premji
- Libraries, University of Victoria, Victoria, British Columbia, Canada
| | - Stephanie R Wilson
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada
| | - Mark E Baker
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gauraang Bhatnagar
- Centre for Medical Imaging, University College London, London, UK
- Frimley Health NHS Foundation Trust, Surrey, UK
| | - Jakob Begun
- Department of Gastroenterology, Mater Hospital, Brisbane, Queensland, Australia
| | - David H Bruining
- Department of Gastroenterology, Queen Elizabeth Hospital, Adelaide, South Australia
| | - Robert Bryant
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Britt Christensen
- Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Brian G Feagan
- Alimentiv Inc., London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Vipul Jairath
- Alimentiv Inc., London, Ontario, Canada
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Department of Medicine, Western University, London, Ontario, Canada
| | - John Knudsen
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Torsten Kucharzik
- Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lüneburg, Lüneburg, Germany
| | - Christian Maaser
- Outpatients' Department of Gastroenterology, University Teaching Hospital Lüneburg, Lüneberg, Germany
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Kerri Novak
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Jordi Rimola
- IBD Unit, Radiology Department, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Rune Wilkens
- Digestive Disease Center, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
- Copenhagen Intestinal Ultrasound, Bispebjerg Hospital, Copenhagen, Denmark
| | - Florian Rieder
- Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Cleveland Clinic Center for Global Translational Inflammatory Bowel Diseases, Cleveland, Ohio, USA
- Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Kumar S, Parry T, Mallett S, Plumb A, Bhatnagar G, Beable R, Betts M, Duncan G, Gupta A, Higginson A, Hyland R, Lapham R, Patel U, Pilcher J, Slater A, Tolan D, Zealley I, Halligan S, Taylor SA. Diagnostic performance of sonographic activity scores for adult terminal ileal Crohn's disease compared to magnetic resonance and histological reference standards: experience from the METRIC trial. Eur Radiol 2024; 34:455-464. [PMID: 37526665 PMCID: PMC10791915 DOI: 10.1007/s00330-023-09958-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES The simple ultrasound activity score for Crohn's disease (SUS-CD) and bowel ultrasound score (BUSS) are promising intestinal ultrasound (IUS) indices of CD, but studied mainly in small settings with few sonographers. We compared SUS-CD and BUSS against histological and magnetic resonance enterography (MRE) reference standards in a post hoc analysis of a prospective multicentre, multireader trial. METHODS Participants recruited to the METRIC trial (ISRCTN03982913) were studied, including those with available terminal ileal (TI) biopsies. Sensitivity and specificity of SUS-CD and BUSS for TI CD activity were calculated with 95% confidence intervals (CI), from the prospective observations of the original METRIC trial sonographers against the histological activity index (HAI) and the simplified magnetic resonance index of activity (sMARIA). RESULTS We included 284 patients (median 31.5 years, IQR 23-46) from 8 centres, who underwent IUS and MRE. Of these, 111 patients had available terminal ileal biopsies with HAI scoring. Against histology, sensitivity and specificity for active disease were 79% (95% CI 69-86%) and 50% (31-69%) for SUS-CD, and 66% (56-75%) and 68% (47-84%) for BUSS, respectively. Compared to sMARIA, the sensitivity and specificity for active CD were 81% (74-86%) and 75% (66-83%) for SUS-CD, and 68% (61-74%) and 85% (76-91%) for BUSS, respectively. The sensitivity of SUS-CD was significantly greater than that of BUSS against HAI and sMARIA (p < 0.001), but its specificity was significantly lower than of BUSS against the MRE reference standard (p = 0.003). CONCLUSIONS Particularly when compared to MRE activity scoring, SUS-CD and BUSS are promising tools in a real-world clinical setting. CLINICAL RELEVANCE STATEMENT When tested using data from a multicentre, multireader diagnostic accuracy trial, the simple ultrasound activity score for Crohn's disease (SUS-CD) and bowel ultrasound score (BUSS) were clinically viable intestinal ultrasound indices that were reasonably sensitive and specific for terminal ileal Crohn's disease, especially when compared to a magnetic resonance reference standard. KEY POINTS The simple ultrasound activity score for Crohn's disease and bowel ultrasound score are promising intestinal ultrasound indices of Crohn's disease but to date studied mainly in small settings with few sonographers. Compared to histology and the magnetic resonance reference standard in a multicentre, multireader setting, the sensitivity of simple ultrasound activity score for Crohn's disease is significantly greater than that of bowel ultrasound score. The specificity of simple ultrasound activity score for Crohn's disease was significantly lower than that of bowel ultrasound score compared to the magnetic resonance enterography reference standard. The specificity of both indices was numerically higher when the magnetic resonance enterography reference standard was adopted.
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Affiliation(s)
- Shankar Kumar
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Thomas Parry
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Sue Mallett
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Andrew Plumb
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Gauraang Bhatnagar
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
- Department of Radiology, Frimley Park Hospital, Surrey, UK
| | - Richard Beable
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Margaret Betts
- Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Gillian Duncan
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Arun Gupta
- Department of Radiology, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Antony Higginson
- Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Rachel Hyland
- Department of Radiology, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Roger Lapham
- Department of Radiology, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Uday Patel
- Department of Radiology, St Mark's Hospital, London North West University Healthcare NHS Trust, London, UK
| | - James Pilcher
- Department of Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Andrew Slater
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Damian Tolan
- Department of Radiology, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Ian Zealley
- Department of Radiology, Ninewells Hospital and Medical School, Dundee, UK
| | - Steve Halligan
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London (UCL), 2nd Floor Charles Bell House, 43-45 Foley Street, W1W 7TS, London, UK.
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Dolinger MT. The Role of Noninvasive Surrogates of Inflammation in Monitoring Pediatric Inflammatory Bowel Diseases: The Old and the New. Gastroenterol Clin North Am 2023; 52:497-515. [PMID: 37543396 DOI: 10.1016/j.gtc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
Effectiveness of limited available therapies for pediatric inflammatory bowel disease has reached stagnation. Previous non-invasive monitoring strategies have relied upon cumbersome tools to evaluate clinical symptoms and biochemical markers that do not reflect endoscopic activity or respond quickly to treatments. Novel, patient-centric, and highly accurate, monitoring strategies with a focus on intestinal ultrasound for a direct, precise monitoring of activity to achieve disease modification are now possible. Ultimately, research on the optimal tight control monitoring strategies, individualized to each pediatric inflammatory bowel disease patient, are in development and offer a hope to potential therapeutic ceiling breakthrough on the horizon.
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Affiliation(s)
- Michael Todd Dolinger
- Division of Pediatric Gastroenterology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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14
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Dolinger MT, Calabrese E, Pizzolante F, Abreu MT. Current and Novel Uses of Intestinal Ultrasound in Inflammatory Bowel Disease. Gastroenterol Hepatol (N Y) 2023; 19:447-457. [PMID: 37772159 PMCID: PMC10524432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Intestinal ultrasound (IUS) is a patient-centric, noninvasive, real-time, point-of-care tool with the capability to aid in diagnosis and monitoring of disease activity in both Crohn's disease and ulcerative colitis without the need for bowel preparation. IUS can be used as a tool for precision monitoring of inflammatory bowel disease (IBD) treatment response. IUS as a cross-sectional imaging tool is as accurate as magnetic resonance enterography (MRE) for assessing the ileum and is more accurate than MRE for colonic assessment proximal to the rectum. Multiple simple ultrasound-based scoring systems have been internally validated with endoscopy in both Crohn's disease and ulcerative colitis, and changes in IUS parameters can be seen as early as 2 weeks after treatment initiation. IUS also plays a unique role in IBD activity monitoring of patients in whom avoidance of invasive testing is paramount, such as children and pregnant patients. Novel uses go beyond monitoring activity, with potential use of elastography to measure bowel wall stiffness to detect fibrosis and bowel damage for enhanced decision-making. Ultimately, IUS is likely to expand in the United States, facilitated by accessible expert training, access to equipment, and the development of a reimbursement model. This article provides a comprehensive review of the current and novel uses of IUS in IBD.
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Affiliation(s)
- Michael T. Dolinger
- Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Mount Sinai Hospital, Icahn School of Medicine, New York, New York
| | - Emma Calabrese
- Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Fabrizio Pizzolante
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maria T. Abreu
- University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Radford S, Leighton P, Coad J, Moran G. Stakeholder-identified barriers and enablers to ultrasound implementation in inflammatory bowel disease services in the UK: a qualitative interview study. BMJ Open 2023; 13:e067528. [PMID: 37349092 PMCID: PMC10314467 DOI: 10.1136/bmjopen-2022-067528] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 06/05/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVES The study sought to explore and better understand the perceptions and experiences of stakeholders in relation to the use of ultrasound for the assessment of inflammatory bowel disease (IBD) in adults in the UK. DESIGN A qualitative semistructured interview study, using template analysis and normalisation process theory, was undertaken. SETTING Interviews were conducted using virtual meeting software. RESULTS Fourteen participants were enrolled between 2nd of June 2021 and 6th of September 2021. Participants were from the following roles: medical gastroenterology and radiology doctors, IBD nurse specialists, patients living with IBD, healthcare service managers. Participants reported that perceived barriers included reliance on established imaging and care pathways, reluctance to change, lack of trust in ultrasound in relation to perceived lack of precision and the initial financial and time outlay in establishing an ultrasound service. Participants were enthusiastic for the uptake of ultrasound and discussed enablers to ultrasound uptake including the benefits to patients in terms of reduction in waiting times and earlier diagnosis and treatment allocation, reduced number of hospital appointments and patients having better understanding of their health. CONCLUSION There are perceived barriers to achieving implementation of ultrasound. There is scant literature to effectively assess these reported barriers. Therefore, there is further research required in the areas of the impact of the use of ultrasound for the assessment of IBD in the UK.
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Affiliation(s)
- Shellie Radford
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Jane Coad
- University of Nottingham School of Health Sciences, Nottingham, UK
| | - Gordon Moran
- Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
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16
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Dolinger MT, Kayal M. Intestinal ultrasound as a non-invasive tool to monitor inflammatory bowel disease activity and guide clinical decision making. World J Gastroenterol 2023; 29:2272-2282. [PMID: 37124889 PMCID: PMC10134421 DOI: 10.3748/wjg.v29.i15.2272] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023] Open
Abstract
Intestinal ultrasound (IUS) is a non-invasive, real-time, cross-sectional imaging tool that can be used at the point-of-care to assess disease activity in patients with Crohn’s disease or ulcerative colitis. IUS promotes quick and impactful treatment decisions that can modify disease progression and enhance patient compliance. This review will summarize the technical aspects of IUS, the evidence to support the use of IUS in disease activity monitoring, the comparison of IUS to current standard of care monitoring modalities such as colonoscopy and calprotectin, and the optimal positioning of IUS in a tight-control monitoring strategy.
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Affiliation(s)
- Michael T Dolinger
- Department of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Maia Kayal
- Department of Medicine, Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
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Intestinal Ultrasound for the Pediatric Gastroenterologist: A Guide for Inflammatory Bowel Disease Monitoring in Children: Expert Consensus on Behalf of the International Bowel Ultrasound Group (IBUS) Pediatric Committee. J Pediatr Gastroenterol Nutr 2023; 76:142-148. [PMID: 36306530 PMCID: PMC9848217 DOI: 10.1097/mpg.0000000000003649] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Crohn disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) often diagnosed in childhood. A strict monitoring strategy can potentially alter the disease course and facilitate early effective treatment before irreversible bowel damage occurs. Serial colonoscopy in children, the gold standard for monitoring, is impractical. Accurate, real-time, noninvasive markers of disease activity are needed. Intestinal ultrasound is an accurate, noninvasive, real-time, point-of-care, cross-sectional imaging tool used to monitor inflammation in pediatric IBD patients in Europe, Canada, and Australia. It is now emerging in a few expert centers in the United States as a safe, non-radiating, inexpensive, bedside tool used by the treating gastroenterologist for real-time decision-making. Unlike the standard biomarkers of pediatric IBD activity, C-reactive protein, and fecal calprotectin, intestinal ultrasound (IUS) facilitates disease localization, characterizes severity, extent, and accurately detects complications. Perhaps most importantly, IUS may enhance shared understanding and ease the burden of treatment decision-making for both the gastroenterologist and the patient. There is a lack of standardization for bedside IUS among pediatric gastroenterologists. The purpose is to outline a standardized approach to pediatric bedside IUS, including basic equipment requirements and technique, patient selection, preparation and positioning, technical considerations and limitations, documentation of mesenteric and luminal features of IBD, characterization of penetrating disease and strictures, and provide a proposed pediatric IUS monitoring algorithm to guide care.
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Perez O, Kumar Vadathya A, Beltran A, Barnett RM, Hindera O, Garza T, Musaad SM, Baranowski T, Hughes SO, Mendoza JA, Sabharwal A, Veeraraghavan A, O'Connor TM. The Family Level Assessment of Screen Use-Mobile Approach: Development of an Approach to Measure Children's Mobile Device Use. JMIR Form Res 2022; 6:e40452. [PMID: 36269651 PMCID: PMC9636534 DOI: 10.2196/40452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/30/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND There is a strong association between increased mobile device use and worse dietary habits, worse sleep outcomes, and poor academic performance in children. Self-report or parent-proxy report of children's screen time has been the most common method of measuring screen time, which may be imprecise or biased. OBJECTIVE The objective of this study was to assess the feasibility of measuring the screen time of children on mobile devices using the Family Level Assessment of Screen Use (FLASH)-mobile approach, an innovative method that leverages the existing features of the Android platform. METHODS This pilot study consisted of 2 laboratory-based observational feasibility studies and 2 home-based feasibility studies in the United States. A total of 48 parent-child dyads consisting of a parent and child aged 6 to 11 years participated in the pilot study. The children had to have their own or shared Android device. The laboratory-based studies included a standardized series of tasks while using the mobile device or watching television, which were video recorded. Video recordings were coded by staff for a gold standard comparison. The home-based studies instructed the parent-child dyads to use their mobile device as they typically use it over 3 days. Parents received a copy of the use logs at the end of the study and completed an exit interview in which they were asked to review their logs and share their perceptions and suggestions for the improvement of the FLASH-mobile approach. RESULTS The final version of the FLASH-mobile approach resulted in user identification compliance rates of >90% for smartphones and >80% for tablets. For laboratory-based studies, a mean agreement of 73.6% (SD 16.15%) was achieved compared with the gold standard (human coding of video recordings) in capturing the target child's mobile use. Qualitative feedback from parents and children revealed that parents found the FLASH-mobile approach useful for tracking how much time their child spends using the mobile device as well as tracking the apps they used. Some parents revealed concerns over privacy and provided suggestions for improving the FLASH-mobile approach. CONCLUSIONS The FLASH-mobile approach offers an important new research approach to measure children's use of mobile devices more accurately across several days, even when the child shares the device with other family members. With additional enhancement and validation studies, this approach can significantly advance the measurement of mobile device use among young children.
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Affiliation(s)
- Oriana Perez
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Anil Kumar Vadathya
- Department of Electrical & Computer Engineering, Rice University, Houston, TX, United States
| | - Alicia Beltran
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - R Matthew Barnett
- Center for Research Computing, Rice University, Houston, TX, United States
| | | | - Tatyana Garza
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Salma M Musaad
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Tom Baranowski
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Sheryl O Hughes
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Jason A Mendoza
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, United States.,Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Ashutosh Sabharwal
- Department of Electrical & Computer Engineering, Rice University, Houston, TX, United States
| | - Ashok Veeraraghavan
- Department of Electrical & Computer Engineering, Rice University, Houston, TX, United States
| | - Teresia M O'Connor
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
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Gorban VV, Matveeva EV, Gorban EV, Kameneva ES. The possibilities of transabdominal sonographic diagnosis of liver and intestinal lesions in comorbid gastroesophageal reflux disease. MEDITSINSKIY SOVET = MEDICAL COUNCIL 2022:134-143. [DOI: 10.21518/2079-701x-2022-16-15-134-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
Abstract
Introduction. The spread of gastroesophageal reflux disease (GERD), comorbid with non-alcoholic fatty liver disease, requires modification of methods for non-invasive diagnosis of liver steatosis and fibrosis and concomitant gastrointestinal syndromes.Aim. Substantiation of a modified complex outpatient transabdominal sonographic diagnosis of combined lesions of the liver and intestines in comorbid GERD.Materials and methods. 165 outpatients with GERD (mean age 40.4 ± 2.9 years) underwent clinical and laboratory examinations, ultrasound examination (UE) of the gastrointestinal tract (GIT), liver shear wave elastometry (SWE), esophagogastroduodenoscopy, colonoscopy (CS).Results and discussion. In patients with GERD, a pronounced transsyndromic comorbidity was observed. The degrees of steatosis and fibrosis of the liver according to SWE positively correlated with the biochemical indices APRI and FORNS. ST-index of liver steatosis was statistically significantly associated with the presence of esophagitis, bile sludge, gallbladder polyps and thickening of the colon wall according to ultrasound criteria, sigmoiditis according to CS. Steatosis on ultrasound was associated with male sex, increased waist circumference, lactase deficiency and deficiency of cholecalciferol in the blood, the presence of yeast-like fungi in feces. Liver fibrosis according to the FORNS index directly correlated with the volume of HE-reflux, duodenitis and intestinal damage according to the results of ultrasound, and according to the APRI index, it inversely correlated with the concentration of vitamin D3 in the blood. Fibrosis according to the ESP criteria directly correlated with the presence of hiatal hernia, bile sludge, and the volume of HE-refluxate according to ultrasound criteria; with lactase deficiency, as well as esophagitis and colitis on endoscopic signs.Conclusions. To identify steatosis and liver fibrosis, the SWE methodology can be considered priority, and serum panels of biomarkers – alternative. Ultrasound of the gastrointestinal tract and SWE allow you to identify the degree of steatosis and fibrosis of the liver, the pathology of the esophagus, colon and the biliary system.
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Affiliation(s)
| | - E. V. Matveeva
- Kuban State Medical University; Clinic “EUROMED” SLR “Modern Diagnostic Technologies”
| | - E. V. Gorban
- Kuban State Medical University; Regional Clinical Hospital No. 2
| | - E. S. Kameneva
- Kuban State Medical University; Regional Clinical Hospital No. 2
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20
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Al-Ani AH, Vaughan R, Christensen B, Bryant RV, Novak KL. Treat to transmural healing: how to incorporate intestinal ultrasound into the treatment of inflammatory bowel disease. Br J Radiol 2022; 95:20211174. [PMID: 35766939 PMCID: PMC10996947 DOI: 10.1259/bjr.20211174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intestinal ultrasound (IUS) is emerging as a key tool to achieving the therapeutic target of transmural healing in inflammatory bowel disease (IBD). IUS is a non-invasive, radiation-free, imaging modality comparable to MRI, CT and ileocolonoscopy (IC). With the appropriate training and equipment, IUS can be an easily repeatable bedside test for IBD diagnosis and disease monitoring, including treatment response. Core to successful high quality IUS employment are appropriate training and expert techniques; however, the training pathway will not be explored in this review. Given the increasing shift towards objective assessment for tight disease control, gastroenterologist-led IUS should be incorporated into the armamentarium of imaging modalities alongside radiologists, to enhance our diagnostic and monitoring toolbox. This comprehensive review aims to outline the current literature around IUS and propose the placement of IUS in a treat-to-target algorithm in IBD. Ultimately, IUS facilitates timely management decisions to optimise patient care with potential to revolutionise patient outcomes, moving towards transmural healing as the holy grail of therapy in IBD.
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Affiliation(s)
- Aysha H Al-Ani
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Rose Vaughan
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Britt Christensen
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Department of Gastroenterology, The Royal Melbourne Hospital, Melbourne, Australia
| | - Robert V Bryant
- Department of Gastroenterology, The Queen Elizabeth Hospital, Woodville, Australia
- School of Medicine, University of Adelaide, Adelaide, Australia
| | - Kerri L Novak
- Department of Gastroenterology, The University of Calgary, Alberta, Australia
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Kucharzik T, Atreya R, Bachmann O, Baumgart DC, Daebritz J, Helwig U, Janschek J, Kienle P, Langhorst J, Mudter J, Schmidt C, Schreyer AG, Vieth M, Wessling J, Maaser C. [Position paper on reporting of intestinal ultrasound findings in patients with inflammatory bowel disease]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:978-990. [PMID: 35671995 DOI: 10.1055/a-1801-0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Intestinal ultrasound is increasingly used for primary diagnosis, detection of complications and monitoring of patients with Crohn's disease and ulcerative colitis. Standardization of reporting is relevant to ensure quality of the methodology and to improve communication between different specialties. The current manuscript describes the features required for optimized reporting of intestinal ultrasound findings in inflammatory bowel disease (IBD). METHODS An expert consensus panel of gastroenterologists, radiologists, pathologists, paediatric gastroenterologists and surgeons conducted a systematic literature search. In a Delphi- process members of the Kompetenznetz Darmerkrankungen in collaboration with members of the German Society for Radiology (DRG) voted on relevant criteria for reporting of findings in intestinal ultrasound. Based on the voting results statements were agreed by expert consensus. RESULTS Clinically relevant aspects of intestinal ultrasound (IUS) findings have been defined to optimize reporting and to standardize terminology. Minimal requirements for standardized reporting are suggested. The statements focus on description of disease activity as well as on complications of IBD. Attributes of intestinal inflammation are described and illustrated by exemplary images. CONCLUSION The current manuscript provides practical recommendations on how to standardize documentation and reporting from intestinal ultrasound findings in patients with IBD.
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Affiliation(s)
- Torsten Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Lüneburg, Germany
| | - Raja Atreya
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Bachmann
- Klinik für Innere Medizin 1, Siloah St. Trudpert Klinikum, Pforzheim, Germany
| | - Daniel C Baumgart
- Division of Gastroenterology, University of Alberta, Edmonton, Canada
| | - Jan Daebritz
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Ulf Helwig
- Internistische Praxengemeinschaft Oldenburg, Oldenburg, Germany.,1. Med. Klinik, Universität Kiel, UKSH Kiel, Kiel, Germany
| | | | - Peter Kienle
- Allgemein-und Viszeralchirurgie, Theresienkrankenhaus und St. Hedwig-Klinik GmbH, Mannheim, Germany
| | - Jost Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Sozialstiftung Bamberg, Klinikum am Bruderwald, Bamberg, Germany
| | - Jonas Mudter
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Carsten Schmidt
- Medizinische Klinik II, Universitätsmedizin Marburg-Campus Fulda, Klinikum Fulda AG, Fulda, Germany
| | - Andreas G Schreyer
- Institut für diagnostische und interventionelle Radiologie, Medizinische Hochschule Brandenburg, Universitätsklinikum Brandenburg a.d. Havel, Brandenburg an der Havel, Germany
| | - Michael Vieth
- Institut für Pathologie, Klinikum Bayreuth, Friedrich-Alexander Universität Erlangen-Nürnberg, Bayreuth, Germany
| | - Johannes Wessling
- Zentrum für Radiologie, Neuroradiologie und Nuklearmedizin, Clemenshospital Münster, Münster, Germany
| | - Christian Maaser
- Ambulanzzentrum Gastroenterologie, Klinik für Geriatrie, Klinikum Lüneburg, Lüneburg, Germany
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22
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Shaban N, Hoad CL, Naim I, Alshammari M, Radford SJ, Clarke C, Marciani L, Moran G. Imaging in inflammatory bowel disease: current and future perspectives. Frontline Gastroenterol 2022; 13:e28-e34. [PMID: 35812031 PMCID: PMC9234729 DOI: 10.1136/flgastro-2022-102117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/22/2022] [Indexed: 02/04/2023] Open
Abstract
The use of cross-sectional imaging and ultrasonography has long complemented endoscopic assessment of inflammatory bowel disease (IBD). Clinical symptoms alone are often not enough to assess disease activity, so a reliance on non-invasive techniques is essential. In this paper, we aim to examine the current use of radiological modalities in aiding the management of patients with IBD. We focus on the various sections of the gastrointestinal tract and how different modalities can aid in assessing current disease state and response to treatments. We also have a look at how newer sequences in cross-sectional imaging and ultrasonography can allow for better differentiation of disease activity (ie, fibrotic vs inflammatory) as well improve evaluation of small bowel, colonic and perianal disease. Furthermore, we examine how advanced image processing has the potential to allow radiology to be a surrogate for biomarkers. An example of this is explored when reviewing the ability of MR sequences to quantify visceral fat, which potentially plays a role in determining disease activity in Crohn's disease. Lastly, we look into the expected role for artificial intelligence to be used as an adjunct to radiology to better improve IBD evaluation.
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Affiliation(s)
- Nader Shaban
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Caroline L Hoad
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham University Park Campus, Nottingham, UK
| | - Iyad Naim
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham University Park Campus, Nottingham, UK
| | - Meshari Alshammari
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham University Park Campus, Nottingham, UK
| | - Shellie Jean Radford
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham University Park Campus, Nottingham, UK
| | - Christopher Clarke
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Luca Marciani
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham University Park Campus, Nottingham, UK
| | - Gordon Moran
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, University of Nottingham University Park Campus, Nottingham, UK
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23
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Kucharzik T, Tielbeek J, Carter D, Taylor SA, Tolan D, Wilkens R, Bryant RV, Hoeffel C, De Kock I, Maaser C, Maconi G, Novak K, Rafaelsen SR, Scharitzer M, Spinelli A, Rimola J. ECCO-ESGAR Topical Review on Optimizing Reporting for Cross-Sectional Imaging in Inflammatory Bowel Disease. J Crohns Colitis 2022; 16:523-543. [PMID: 34628504 DOI: 10.1093/ecco-jcc/jjab180] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS The diagnosis and follow up of patients with inflammatory bowel disease [IBD] requires cross-sectional imaging modalities, such as intestinal ultrasound [IUS], magnetic resonance imaging [MRI] and computed tomography [CT]. The quality and homogeneity of medical reporting are crucial to ensure effective communication between specialists and to improve patient care. The current topical review addresses optimized reporting requirements for cross-sectional imaging in IBD. METHODS An expert consensus panel consisting of gastroenterologists, radiologists and surgeons convened by the ECCO in collaboration with ESGAR performed a systematic literature review covering the reporting aspects of MRI, CT, IUS, endoanal ultrasonography and transperineal ultrasonography in IBD. Practice position statements were developed utilizing a Delphi methodology incorporating two consecutive rounds. Current practice positions were set when ≥80% of the participants agreed on a recommendation. RESULTS Twenty-five practice positions were developed, establishing standard terminology for optimal reporting in cross-sectional imaging. Assessment of inflammation, complications and imaging of perianal CD are outlined. The minimum requirements of a standardized report, including a list of essential reporting items, have been defined. CONCLUSIONS This topical review offers practice recommendations to optimize and homogenize reporting in cross-sectional imaging in IBD.
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Affiliation(s)
- Torsten Kucharzik
- Department of Gastroenterology, Klinikum Lüneburg, University of Hamburg, Bögelstr. 1, 21339 Lüneburg, Germany
| | - Jeroen Tielbeek
- Department of Radiology, Spaarne Gasthuis, Boerhaavelaan 22, Haarlem, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dan Carter
- Department of Gastroenterology, Chaim Sheba Medical Center, Tel Hasomher, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Stuart A Taylor
- Centre for Medical Imaging, University College London, London, UK
| | - Damian Tolan
- Radiology Department, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, UK
| | - Rune Wilkens
- Gastrounit, Division of Medicine, Hvidovre University Hospital, Copenhagen, Denmark; Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Copenhagen, Denmark
| | - Robert V Bryant
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, South Australia
| | - Christine Hoeffel
- Department of Abdominal Radiology, CHU Reims and CRESTIC, URCA, 51100 Reims, France
| | - Isabelle De Kock
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Christian Maaser
- Outpatient Department of Gastroenterology, Department of Geriatrics, Klinikum Lüneburg, University of Hamburg, Bögelstr. 1, 21339 Lüneburg, Germany
| | - Giovanni Maconi
- Gastroenterology Unit, 'Luigi Sacco' University Hospital, Milan, Italy
| | - Kerri Novak
- Department of Radiology and Medicine, Division of Gastroenterology, University of Calgary, Alberta, Canada
| | - Søren R Rafaelsen
- Department of Radiology, University Hospital of Southern Denmark, Vejle, Denmark
| | - Martina Scharitzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Antonino Spinelli
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy.,IRCCS Humanitas Research Hospital, Division of Colon and Rectal Surgery, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Jordi Rimola
- IBD unit, Radiology Department, Hospital Clínic Barcelona, Barcelona, Catalonia, Spain
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24
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El informe radiológico en la enfermedad de Crohn. RADIOLOGIA 2022. [DOI: 10.1016/j.rx.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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25
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Radford SJ, Taylor S, Moran G. Ultrasound use to assess Crohn's disease in the UK: a survey of British Society of Gastroenterology Inflammatory Bowel Disease Group members. Frontline Gastroenterol 2022; 13:471-476. [PMID: 36250164 PMCID: PMC9555127 DOI: 10.1136/flgastro-2021-102065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Small bowel ultrasound has very good diagnostic accuracy for disease extent, presence and activity in Crohn's Disease, is well tolerated by patients and is cheaper when compared with MRI. However, uptake of ultrasound in the UK is limited. METHODS An online survey to assess the current usage of ultrasound throughout the UK was undertaken by BSG IBD group members between 9/06/2021- 25/06/2021. Responses were anonymous. RESULTS 103 responses were included in the data analysis. Responses came from 66 different NHS trusts from 14 different regions of the UK. All respondents reported that they currently have an MRI service for Crohn's disease, whereas only 31 had an ultrasound service. Average time for results to be reported for MRI scans was reported as between 4- and 6 weeks, with a range of 2 days to 28 weeks. The average time for an ultrasound to be reported was stated as 1-4 weeks, with a range of 0-8 weeks. There was disparity between the reported confidence of clinicians making clinical decisions when using ultrasound compared to MRI. Of those respondents who did not have access to an ultrasound service, 72 stated that they would be interested in developing an ultrasound service. CONCLUSION There is an appetite for the uptake of ultrasound in the UK for assessment of Crohn's disease, however, there remains a significant number of UK centres with little or no access to an ultrasound service. Further research is necessary to understand why this is the case.
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Affiliation(s)
- Shellie Jean Radford
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Gordon Moran
- Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK,NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
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26
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Gonen C, Surmelioglu A, Kochan K, Ozer S, Aslan E, Tilki M. Impact of intestinal ultrasound with a portable system in the management of Crohn's disease. Gastroenterol Rep (Oxf) 2021; 9:418-426. [PMID: 34733527 PMCID: PMC8560037 DOI: 10.1093/gastro/goaa088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/22/2020] [Accepted: 11/04/2020] [Indexed: 11/14/2022] Open
Abstract
Background Intestinal ultrasound (IUS) is a valid cross-sectional imaging technique for the evaluation of Crohn’s disease (CD). With advancements in technology, portable ultrasound systems are becoming widely available, and the inevitable change to their use by non-radiologist clinicians would be a valuable contribution to improving patient care. This study aimed to investigate the diagnostic yield of IUS examination performed by a gastroenterologist with a portable system as an adjunct imaging modality in the routine care of CD patients. Methods A total of 117 CD patients were assessed by IUS imaging. Pre- and post-IUS clinical-management decisions were recorded. The primary outcome was to evaluate the change in the patients’ clinical-management decision following the IUS examination. The diagnostic accuracy was compared against the reference decision reached via a multidisiplinary meeting after the evaluation of all patient-related data. The endoscopic disease activity was determined using the simple endoscopic score for Crohn's disease (SES-CD). Results The initial clinical-management decision was changed in 47 patients (40.2%) after the IUS examination (P = 0.001). The accuracy of patient-management decisions improved from 63.2% to 90.6% in comparison to reference decisions (P < 0.001). After IUS examination, a further 13 cases (11.1%) were identified for urgent surgical/interventional procedures. The accuracy of colonoscopic (SES-CD ≥3) assessment was shown to be comparable to that of IUS (94% vs 91%). The sensitivity for disease presence was 95% with colonoscopy and 94% with the IUS assessment. Conclusion IUS examination with the use of a portable ultrasonography system significantly improves clinical-management decisions. With further supporting data, this practice would possibly become a requirement for CD management.
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Affiliation(s)
- Can Gonen
- Department of Gastroenterology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey.,Department of Gastroenterology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ali Surmelioglu
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Koray Kochan
- Department of Gastroenterology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Serhat Ozer
- Department of Gastroenterology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Ekrem Aslan
- Department of Gastroenterology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Metin Tilki
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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27
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Radford SJ, Clarke C, Shinkins B, Leighton P, Taylor S, Moran G. Clinical utility of small bowel ultrasound assessment of Crohn's disease in adults: a systematic scoping review. Frontline Gastroenterol 2021; 13:280-286. [PMID: 35722606 PMCID: PMC9186037 DOI: 10.1136/flgastro-2021-101897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/01/2021] [Indexed: 02/04/2023] Open
Abstract
Background Ultrasound (US) is an alternative to magnetic resonance enterography, and has the potential to significantly reduce waiting times, expedite clinical decision-making and improve patient experience. Point of care US is an advantage of the US imaging modality, where same day scanning, interpretation and treatment decisions can be made. Aim To systematically scope the literature on point of care US use in small bowel Crohn's disease, generating a comprehensive list of factors relating to the current understanding of clinical utility of this imaging modality. Methods Searches included MEDLINE, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, clinicaltrial.gov,'TRIP' and Epistemonikos. Reference lists of included studies were hand searched. Search terms were searched for as both keywords and subject headings (MeSH) as appropriate. Searches were performed with the 'suggested search terms' and 'explode' selection, and restricted to 'human', 'adult' and 'English language' publications. No date limits were applied to be as inclusive as possible. Two investigators conducted abstract and full-text review. No formal quality appraisal process was undertaken; however, quality of sources was considered when reporting findings. A narrative synthesis was conducted. Results The review included 42 sources from the UK, Europe, Japan, Canada and the USA. Small bowel ultrasound (SBUS) has been shown to be as accurate in detecting the presence of small bowel Crohn's disease, is quicker, safer and more acceptable to patients, compared with magnetic resonance enterography. SBUS is used widely in central Europe and Canada but has not been embraced in the UK. Further research considering economic evaluation, clinical decision-making and exploration of perceived barriers to future implementation of SBUSs is required.
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Affiliation(s)
- Shellie Jean Radford
- NIHR Nottingham Biomedical Research Centre—Gastrointestinal and Liver Research Theme, School of Medicine, Nottingham, UK
| | - Chris Clarke
- Department of Radiology, Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - Bethany Shinkins
- University of Leeds Faculty of Medicine and Health, Leeds, West Yorkshire, UK
| | - Paul Leighton
- School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Gordon Moran
- NIHR Nottingham Biomedical Research Centre—Gastrointestinal and Liver Research Theme, School of Medicine, Nottingham, UK
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28
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Bhatnagar G, Rodriguez-Justo M, Higginson A, Bassett P, Windsor A, Cohen R, Halligan S, Taylor SA. Inflammation and fibrosis in Crohn's disease: location-matched histological correlation of small bowel ultrasound features. Abdom Radiol (NY) 2021; 46:144-155. [PMID: 32564208 PMCID: PMC7864849 DOI: 10.1007/s00261-020-02603-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the utility of mural and extramural sonographic features of Crohn's Disease as potential imaging biomarkers of inflammation and fibrosis against whole-mount histological sections. METHODS Twelve Crohn's disease patients (Mean age 35(25-69), 7 males) underwent small bowel ultrasound prior to small bowel resection. Two radiologists in consensus graded multiple parameters including mural, mucosal and submucosal thickness, submucosal/mesenteric echogenicity and clarity and mural Doppler signal in 50 selected bowel cross-sections. Matching with histological sampling sites was facilitated via scanning of the resected specimen. A histopathologist scored acute and chronic inflammation, and fibrosis (using histological scoring systems) following analysis of whole mount block sections. The association between sonographic observations and histopathological scores was examined via univariable and multivariable analysis. RESULTS In univariate analyses, bowel wall thickness (regression co-efficient and 95% CI 0.8 (0.3, 1.3) p = 0.001), mesenteric fat echogenicity (8.7(3.0, 14.5) p = 0.005), submucosal layer thickness (7.4(1.2, 13.5) p = 0.02), submucosal layer clarity (4.4(0.6, 8.2) p = 0.02) and mucosal layer thickness (4.6(1.8, 7.4) p = 0.001) were all significantly associated with acute inflammation. Mesenteric fat echogenicity (674(8.67, 52404) p = 0.009), submucosal layer thickness (79.9(2.16, 2951) p = 0.02) and mucosal layer thickness (13.6(1.54, 121) p = 0.02) were significantly associated with chronic inflammation. Submucosal layer echogenicity (p = 0.03), clarity (25.0(1.76, 356) p = 0.02) and mucosal layer thickness (53.8(3.19, 908) p = 0.006) were significantly associated with fibrosis. In multivariate analyses, wall and mucosal thickness remained significantly associated with acute inflammation (p = 0.02), mesenteric fat echogenicity with chronic inflammation (p = 0.009) and mucosal thickness (p = 0.006) with fibrosis. CONCLUSION Multiple sonographic parameters are associated with histological phenotypes in Crohn's disease although there is overlap between ultrasonic stigmata of acute inflammation, chronic inflammation and fibrosis.
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Affiliation(s)
- Gauraang Bhatnagar
- grid.83440.3b0000000121901201Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Manuel Rodriguez-Justo
- grid.439749.40000 0004 0612 2754Department of Histology, University College Hospitals, London, UK
| | - Antony Higginson
- grid.415470.30000 0004 0392 0072Department of Radiology, Queen Alexandra Hospital, Portsmouth, UK
| | | | - Alastair Windsor
- grid.439749.40000 0004 0612 2754Department of Colorectal Surgery, University College Hospitals, London, UK
| | - Richard Cohen
- grid.439749.40000 0004 0612 2754Department of Colorectal Surgery, University College Hospitals, London, UK
| | - Steve Halligan
- grid.83440.3b0000000121901201Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
| | - Stuart A. Taylor
- grid.83440.3b0000000121901201Centre for Medical Imaging, University College London, 2nd Floor Charles Bell House, 43-45 Foley Street, London, W1W 7TS UK
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