Detecting inflammation in inflammatory bowel disease — how does ultrasound compare to magnetic resonance enterography using standardised scoring systems?
- 20 Downloads
Magnetic resonance enterography (MRE) is the current gold standard for imaging in inflammatory bowel disease, but ultrasound (US) is a potential alternative.
To determine whether US is as good as MRE for the detecting inflamed bowel, using a combined consensus score as the reference standard.
Materials and methods
We conducted a retrospective cohort study in children and adolescents <18 years with inflammatory bowel disease (IBD) at a tertiary and quaternary centre. We included children who underwent MRE and US within 4 weeks. We scored MRE using the London score and US using a score adapted from the METRIC (MR Enterography or Ultrasound in Crohn’s Disease) trial. Four gastroenterologists assessed an independent clinical consensus score. A combined consensus score using the imaging and clinical scores was agreed upon and used as the reference standard to compare MRE with US.
We included 53 children. At a whole-patient level, MRE scores were 2% higher than US scores. We used Lin coefficient to assess inter-observer variability. The repeatability of MRE scores was poor (Lin 0.6). Agreement for US scoring was substantial (Lin 0.95). There was a significant positive correlation between MRE and clinical consensus scores (Spearman’s rho = 0.598, P=0.0053) and US and clinical consensus scores (Spearman’s rho = 0.657, P=0.0016).
US detects as much clinically significant bowel disease as MRE. It is possible that MRE overestimates the presence of disease when using a scoring system. This study demonstrates the feasibility of using a clinical consensus reference standard in paediatric IBD imaging studies.
KeywordsAdolescents Children Diagnostic accuracy Inflammatory bowel disease Magnetic resonance imaging Reproducibility Ultrasound
We thank Dr. Antony Higginson, Prof. Stuart Taylor and Dr. Gauraang Bhatnagar for their permission to use the METRIC ultrasound scoring system and for their guidance when preparing the manuscript.
Compliance with ethical standards
Conflicts of interest
- 3.NHS Improvement (2017) Full unbundled HRG list 2017/18. In: The national prices and national tariff workbook. https://improvement.nhs.uk/resources/national-tariff-1719/#h2-annexes. Accessed 12 June 2017
- 12.Taylor S, Mallett S, Bhatnagar G et al (2014) METRIC (MREnterography or ulTRasound in Crohn’s disease): a study protocol for a multicentre, non-randomised, single-arm, prospective comparison study of magnetic resonance enterography and small bowel ultrasound compared to a reference standard in those aged 16 and over. BMC Gastroenterol 14:142CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Rutjes AW, Reitsma JB, Coomarasamy A et al (2007) Evaluation of diagnostic tests when there is no gold standard. A review of methods. Health Technol Assess 11:iii, ix–51Google Scholar
- 29.Tsai TL, Marine MB, Wanner MR et al (2017) Can ultrasound be used as the primary imaging in children with suspected Crohn disease? Pediatr Radiol 22:1–7Google Scholar
- 34.Santillan C, Rimola J, Levesque B et al (2016) Clinical and MR indices of inflammatory bowel disease activity. Radiological Society of North America 2016 Scientific Assembly and Annual Meeting, Nov. 27–Dec. 2, 2016, Chicago, IL archive.rsna.org/2016/16015846.html. Accessed 12 June 2017