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Pediatric Radiology

, Volume 36, Issue 9, pp 947–953 | Cite as

Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study

  • A. Ronald Bremner
  • Mark Griffiths
  • Julie D. Argent
  • Joanna J. Fairhurst
  • R. Mark BeattieEmail author
Original Article

Abstract

Background

Children with inflammatory bowel disease (IBD) undergo invasive and repeated investigations, including contrast radiology and endoscopy.

Objective

To assess transabdominal sonography of the colon and distal ileum compared to colonoscopy and barium radiology in known or suspected IBD.

Materials and methods

A prospectively recruited cohort of 44 children (median age 12 years, range 3.5–16.5 years; 24 males) underwent transabdominal sonography prior to colonoscopy (n=33) or barium follow-through (n=25). Diagnoses were: Crohn disease (n=25), ulcerative colitis (n=12), indeterminate colitis (n=1), normal (n=6).

Results

Bowel wall thickness (BWT) and endoscopic severity were compared in 153 colonic segments. No difference was found between normal and mildly affected segments. BWT was less in normal bowel than moderate (P<0.001) or severe (P<0.001) lesions. Where BWT was >2.9 mm, sensitivity for moderate/severe disease was 48%, specificity 93%, positive predictive value 83% (likelihood ratio 7). Barium radiology showed terminal ileum abnormality in ten patients (40%). Where ileal BWT was >2.5 mm, comparative sensitivity was 75%, specificity 92%, positive predictive value 88% (likelihood ratio 9). Superior mesenteric artery Doppler did not correlate with disease severity.

Conclusion

Increased BWT has good positive predictive value for moderate/severe disease in the colon proximal to the rectum (>3 mm), and terminal ileum (>2.5 mm). BWT below this cannot exclude moderate/severe mucosal lesions.

Keywords

Bowel Inflammation Crohn disease Ulcerative colitis Ultrasound Barium follow through Colonoscopy Children 

Notes

Acknowledgement

This work was supported by a project grant from Wessex Medical Research (Hope). Dr. A.R. Bremner was a Crohn’s in Childhood Research Association (CICRA) fellow.

References

  1. 1.
    Dinkel E, Dittrich M, Peters H, et al (1986) Real-time ultrasound in Crohn’s disease: characteristic features and clinical implications. Pediatr Radiol 16:8–12PubMedCrossRefGoogle Scholar
  2. 2.
    Gasche C, Moser G, Turetschek K, et al (1999) Transabdominal bowel sonography for the detection of intestinal complications in Crohn’s disease. Gut 44:112–117PubMedCrossRefGoogle Scholar
  3. 3.
    Ali SI, Carty HM (2000) Paediatric Crohn’s disease: a radiological review. Eur Radiol 10:1085–1094PubMedCrossRefGoogle Scholar
  4. 4.
    Hirche TO, Russler J, Schroder O, et al (2002) The value of routinely performed ultrasonography in patients with Crohn disease. Scand J Gastroenterol 37:1178–1183PubMedCrossRefGoogle Scholar
  5. 5.
    Faure C, Belarbi N, Mougenot JF, et al (1997) Ultrasonographic assessment of inflammatory bowel disease in children: comparison with ileocolonoscopy. J Pediatr 130:147–151PubMedCrossRefGoogle Scholar
  6. 6.
    Haber HP, Busch A, Ziebach R, et al (2000) Bowel wall thickness measured by ultrasound as a marker of Crohn’s disease activity in children. Lancet 355:1239–1240PubMedCrossRefGoogle Scholar
  7. 7.
    Haber HP, Busch A, Ziebach R, et al (2002) Ultrasonographic findings correspond to clinical, endoscopic, and histologic findings in inflammatory bowel disease and other enterocolitides. J Ultrasound Med 21:375–382PubMedGoogle Scholar
  8. 8.
    Baud C, Saguintaah M, Veyrac C, et al (2004) Sonographic diagnosis of colitis in children. Eur Radiol 14:2105–2119PubMedCrossRefGoogle Scholar
  9. 9.
    Ruess L, Blask AR, Bulas DI, et al (2000) Inflammatory bowel disease in children and young adults: correlation of sonographic and clinical parameters during treatment. AJR 175:79–84PubMedGoogle Scholar
  10. 10.
    Bremner AR, Pridgeon J, Fairhurst J, et al (2004) Ultrasound scanning may reduce the need for barium radiology in the assessment of small-bowel Crohn’s disease. Acta Paediatr 93:479–481PubMedCrossRefGoogle Scholar
  11. 11.
    Hyams JS, Ferry GD, Mandel FS, et al (1991) Development and validation of a pediatric Crohn’s disease activity index. J Pediatr Gastroenterol Nutr 12:439–447PubMedGoogle Scholar
  12. 12.
    Beattie RM, Nicholls SW, Domizio P, et al (1996) Endoscopic assessment of the colonic response to corticosteroids in children with ulcerative colitis. J Pediatr Gastroenterol Nutr 22:373–379PubMedCrossRefGoogle Scholar
  13. 13.
    Bude RO, Rubin JM (1999) Relationship between the resistive index and vascular compliance and resistance. Radiology 211:411–417PubMedGoogle Scholar
  14. 14.
    Quillin SP, Siegel MJ (1994) Gastrointestinal inflammation in children: color Doppler ultrasonography. J Ultrasound Med 13:751–756PubMedGoogle Scholar
  15. 15.
    Scholbach T, Herrero I, Scholbach J (2004) Dynamic color Doppler sonography of intestinal wall in patients with Crohn disease compared with healthy subjects. J Pediatr Gastroenterol Nutr 39:524–528PubMedCrossRefGoogle Scholar
  16. 16.
    Siegel MJ, Friedland JA, Hildebolt CF (1997) Bowel wall thickening in children: differentiation with US. Radiology 203:631–635PubMedGoogle Scholar
  17. 17.
    Hollerbach S, Geissler A, Schiegl H, et al (1998) The accuracy of abdominal ultrasound in the assessment of bowel disorders. Scand J Gastroenterol 33:1201–1208PubMedCrossRefGoogle Scholar
  18. 18.
    Ledermann HP, Borner N, Strunk H, et al (2000) Bowel wall thickening on transabdominal sonography. AJR 174:107–117PubMedGoogle Scholar
  19. 19.
    Rispo A, Imbriaco M, Celentano L, et al (2005) Noninvasive diagnosis of small bowel Crohn’s disease: combined use of bowel sonography and Tc-99m-HMPAO leukocyte scintigraphy. Inflamm Bowel Dis 11:376–382PubMedCrossRefGoogle Scholar
  20. 20.
    Grahnquist L, Chapman S, Hvidsten S, et al (2003) Evaluation of 99mTc-HMPAO leukocyte scintigraphy in the investigation of pediatric inflammatory bowel disease. J Pediatr 143:48–53PubMedCrossRefGoogle Scholar
  21. 21.
    Hyer W, Beattie RM, Walker-Smith JA, et al (1997) Computed tomography in chronic inflammatory bowel disease. Arch Dis Child 76:428–431PubMedCrossRefGoogle Scholar
  22. 22.
    Madsen SM, Thomsen HS, Munkholm P, et al (2002) Inflammatory bowel disease evaluated by low-field magnetic resonance imaging. Comparison with endoscopy, 99mTc-HMPAO leucocyte scintigraphy, conventional radiography and surgery. Scand J Gastroenterol 37:307–316PubMedCrossRefGoogle Scholar
  23. 23.
    Magnano G, Granata C, Barabino A, et al (2003) Polyethylene glycol and contrast-enhanced MRI of Crohn’s disease in children: preliminary experience. Pediatr Radiol 33:385–391PubMedGoogle Scholar
  24. 24.
    Potthast S, Rieber A, Von Tirpitz C, et al (2002) Ultrasound and magnetic resonance imaging in Crohn’s disease: a comparison. Eur Radiol 12:1416–1422PubMedCrossRefGoogle Scholar
  25. 25.
    Pascu M, Roznowski AB, Muller HP, et al (2004) Clinical relevance of transabdominal ultrasonography and magnetic resonance imaging in patients with inflammatory bowel disease of the terminal ileum and large bowel. Inflamm Bowel Dis 10:373–382PubMedCrossRefGoogle Scholar
  26. 26.
    Ludwig D, Wiener S, Bruning A, et al (1999) Mesenteric blood flow is related to disease activity and risk of relapse in ulcerative colitis: a prospective follow up study. Gut 45:546–552PubMedCrossRefGoogle Scholar
  27. 27.
    Rapaccini GL, Pompili M, Orefice R, et al (2004) Contrast-enhanced power doppler of the intestinal wall in the evaluation of patients with Crohn disease. Scand J Gastroenterol 39:188–194PubMedCrossRefGoogle Scholar
  28. 28.
    Yekeler E, Danalioglu A, Movasseghi B, et al (2005) Crohn disease activity evaluated by Doppler ultrasonography of the superior mesenteric artery and the affected small-bowel segments. J Ultrasound Med 24:59–65PubMedGoogle Scholar
  29. 29.
    Tarjan Z, Toth G, Gyorke T, et al (2000) Ultrasound in Crohn’s disease of the small bowel. Eur J Radiol 35:176–182PubMedCrossRefGoogle Scholar
  30. 30.
    Byrne MF, Farrell MA, Abass S, et al (2001) Assessment of Crohn’s disease activity by Doppler sonography of the superior mesenteric artery, clinical evaluation and the Crohn’s disease activity index: a prospective study. Clin Radiol 56:973–978PubMedCrossRefGoogle Scholar
  31. 31.
    Parente F, Maconi G, Bollani S, et al (2002) Bowel ultrasound in assessment of Crohn’s disease and detection of related small bowel strictures: a prospective comparative study versus x ray and intraoperative findings. Gut 50:490–495PubMedCrossRefGoogle Scholar
  32. 32.
    Kohn A, Cerro P, Milite G, et al (1999) Prospective evaluation of transabdominal bowel sonography in the diagnosis of intestinal obstruction in Crohn’s disease: comparison with plain abdominal film and small bowel enteroclysis. Inflamm Bowel Dis 5:153–157PubMedCrossRefGoogle Scholar
  33. 33.
    Maconi G, Sampietro GM, Russo A, et al (2002) The vascularity of internal fistulae in Crohn’s disease: an in vivo power Doppler ultrasonography assessment. Gut 50:496–500PubMedCrossRefGoogle Scholar
  34. 34.
    Maconi G, Carsana L, Fociani P, et al (2003) Small bowel stenosis in Crohn’s disease: clinical, biochemical and ultrasonographic evaluation of histological features. Aliment Pharmacol Ther 18:749–756PubMedCrossRefGoogle Scholar
  35. 35.
    Maconi G, Sampietro GM, Parente F, et al (2003) Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn’s disease: a prospective comparative study. Am J Gastroenterol 98:1545–1555PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • A. Ronald Bremner
    • 1
  • Mark Griffiths
    • 2
  • Julie D. Argent
    • 2
  • Joanna J. Fairhurst
    • 2
  • R. Mark Beattie
    • 1
    Email author
  1. 1.Paediatric Medical UnitSouthampton General HospitalSouthamptonUK
  2. 2.Department of Paediatric RadiologySouthampton General HospitalSouthamptonUK

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