Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients

Table 1 Magnetic resonance enterography imaging protocol

Imaging sequence and plane	TR/TE	Slice thickness (mm)	Gap	Field of view (mm)	Matrix
Coronal T2 SSFSE	1200/115	6	1	375 × 375	268 × 234
Coronal SSFP	3.2/1.56	6	0	375 × 375	252 × 233
Axial T2WI	1200/115	7	1	375 × 336	268 × 208
Axial DWI	2743/65	7	1	375 × 302	124 × 100
3D-THRIVE	4/1.9	-	0	410 × 377	196 × 178
Axial post contrast fat-suppressed gradient-echo T1WI	3.8/1.8	-	0	375 × 314	196 × 157
Coronal post contrast fat-suppressed gradient-echo T1WI	4/1.9	-	0	410 × 314	196 × 178

TR: Repetition time; TE: Echo time; SSFSE: Single-shot fast spin-echo; SSFP: Single-shot free precision; 3D: Three dimensional.

Table 2 Demographic characteristics, laboratory and colonscopic findings of the total 40 studied cases

Demographic characteristics, laboratory and colonscopic findings	n
Age (yr)	33.50 ± 8.19
Gender (male/female)	16/24
Symptoms
Diarrhea	14 (35%)
Diarrhea and bleeding	10 (25%)
Bleeding	4 (10%)
Abdominal pain	36 (90%)
Total leukocyte count (103/cmm)	7.32 ± 2.22
Hemoglobin (g/dL)	11.22 ± 1.86
Total bilirubin (mg/dL)	0.97 ± 0.14
Alanine aminotransferase (IU/L)	25.75 ± 10.49
Total protein (g/dL)	7.16 ± 0.73
Albumin (g/dL)	3.76 ± 0.44
Blood urea nitrogen (mg/dL)	22.10 ± 9.86
Creatinine (mg/dL)	0.87 ± 0.22
Serum sodium (mmol/L)	136.65 ± 6.19
Serum Potassium (mmol/L)	3.96 ± 0.55
C-reactive protein (mg/L)	28 (6–55)
Erythrocyte sedimentation rate (mm/h)	45 (31.5–60)
Colonscopic findings
Opacity of mucosa	28 (70%)
Excess exudate	24 (60%)
Cobble stone	26 (65%)
Bleeding on touch	20 (50%)
Aphthous ulcers	30 (75%)
Diffuse ulceration	20 (50%)
Pseudopolyps	20 (50%)
Polyps	30 (75%)
Site of involvement
Rectum	4 (10%)
Pancolitis	4 (10%)
Descending colon	4 (10%)
Rectum and sigmoid colon	10 (25%)
Ileum	18 (45%)
Type of disease
Ulcerative colitis	14 (35%)
Crohn's disease	26 (65%)
Activity
Remission	6 (15%)
Activity	34 (85%)

Data are mean ± standard deviation, n (%) and median (inter-quartile range).

Table 3 The diagnostic characteristics of the bowel ultrasound in the detection of small intestinal and large bowel disease and its correlation to disease activity index

	Bowel ultrasound					Disease activity index
	Sensitivity	Specificity	PPV	NPV	Accuracy	Remission	Activity	P value
Large bowel	37.5%	91.7%	75%	68.8%	0.700	0 (0)	8 (23.5%)	0.184
Ileum	93.8%	50%	88.2%	66.7%	0.850	6 (100%)	28 (82.4%)	0.264
Thickness (> 3 mm)	83.3%	50%	41.7%	87.5%	0.600	4 (66.7%)	20 (58.8%)	0.718
Extent	33.3%	85.7%	50%	75%	0.700	0 (0)	8 (23.5%)	0.184
Mesenteric lymphadenopathy	16.7%	71.4%	20%	66.7%	0.550	0 (0)	10 (29.4%)	0.125
Fistula	85.7%	100%	100%	92.9%	0.950	0 (0)	12 (35.3%)	0.082
Stricture and proximal dilatation	100%	94.4%	66.7%	100%	0.950	0 (0)	6 (17.6%)	0.264
Abscess	100%	100%	100%	100%	0.1	0 (0)	6 (17.6%)	0.264

Data are n (%). PPV: Positive predictive value; NPV: Negative predictive value

Table 4 Comparison between bowel ultrasound, magnetic resonance enterography and colonoscopy as regards the detection of disease activity and remission

Activity	Colonoscopy	Bowel ultrasound	MRE	P value
Remission	6 (15%)	6 (15%)	6 (15%)	1.000
Activity	34 (85%)	34 (85%)	34 (85%)	1.000

Data are n (%). MRE: Magnetic resonance enterography.

Table 5 Comparison between clinical symptoms and imaging techniques; bowel ultrasound and magnetic resonance enterography

	Abdominal pain			P value	Bleeding per rectum			P value	Diarrhea		P value
	No, n (%)	Yes, n (%)			No, n (%)	Yes, n (%)			No, n (%)	Yes, n (%)
Bowel ultrasound
Large bowel	0 (0)	8 (22.2%)		0.292	8 (25.0%)	0 (0)		0.114	2 (10.0%)	6 (30.0%)	0.114
Ileum	4 (100.0%)	30 (83.3%)		0.376	26 (81.2%)	8 (100.0%)		0.184	18 (90.0%)	16 (80.0%)	0.376
Thickness (> 3 mm)	4 (100.0%)	20 (55.6%)		0.085	18 (56.2%)	6 (75.0%)		0.333	14 (70.0%)	10 (50.0%)	0.197
Extent	0 (0)	8 (22.2%)		0.292	8 (25.0%)	0 (0)		0.114	2 (10.0%)	6 (30.0%)	0.114
Lymphadenopathy	0 (0)	10 (27.8%)		0.224	8 (25.0%)	2 (25.0%)		1.000	4 (20.0%)	6 (30.0%)	0.465
Fistula	0 (0)	12 (33.3%)		0.168	8 (25.0%)	4 (50.0%)		0.168	4 (20.0%)	8 (40.0%)	0.168
Stricture and proximal dilatation	0 (0)	2 (5.6%)		0.629	0 (0)	2 (25.0%)		0.004	0 (0)	2 (10.0%)	0.147
Abscess	2 (50.0%)	6 (16.7%)		0.114	6 (18.8%)	2 (25.0%)		0.693	6 (30.0%)	2 (10.0%)	0.114
MRE
Large bowel	0 (0)	16 (44.4%)		0.085	14 (43.8%)	2 (25.0%)		0.333	6 (30.0%)	10 (50.0%)	0.197
Ileum	4 (100.0%)	28 (77.8%)		0.292	24 (75.0%)	8 (100.0%)		0.114	16 (80.0%)	16 (80.0%)	1.000
Thickness (> 3 mm)	2 (50.0%)	10 (27.8%)		0.358	10 (31.2%)	2 (25.0%)		0.730	6 (30.0%)	6 (30.0%)	1.000
Extent	0 (0)	12 (33.3%)		0.168	10 (31.2%)	2 (25.0%)		0.730	2 (10.0%)	10 (50.0%)	0.006
Lymphadenopathy	0 (0)	12 (33.3%)		0.168	8 (25.0%)	4 (50.0%)		0.168	8 (40.0%)	4 (20.0%)	0.168
Fistula	0 (0)	14 (38.9%)		0.122	10 (31.2%)	4 (50.0%)		0.320	6 (30.0%)	8 (40.0%)	0.507
Stricture and proximal dilatation	0 (0)	4 (11.1%)		0.482	4 (12.5%)	0 (0)		0.292	2 (10.0%)	2 (10.0%)	1.000
Abscess	0 (0)	6 (16.7%)		0.376	6 (18.8%)	0 (0)		0.184	2 (10.0%)	4 (20.0%)	0.376

MRE: Magnetic resonance enterography.