Bowel Ultrasound Imaging, Protocol and Findings

  • Astrid-Jane Greenup
  • Kerri L. NovakEmail author


Objective measurement of disease activity in inflammatory bowel disease (IBD) is important to guide targeted therapy. Noninvasive approaches are gaining clinical traction given patient preference and need for cost containment. Ultrasound of the large and small bowel is increasingly recognized as an accurate, non-radiation-based, cost-effective modality useful in both diagnosis and follow-up in IBD. Intestinal ultrasound (IUS) is easily repeated, allowing for serial assessment to evaluate response to therapy, post-operative course and evolution of complications, particularly in Crohn’s disease. Mounting evidence suggesting sonographic response accurately reflects therapeutic efficacy and thus may provide useful insight regarding clinical outcome. It exhibits similar performance in the detection of inflammation associated with Crohn’s disease to both computed tomography (CT) and magnetic resonance (MR). Intestinal US may also provide a noninvasive surrogate to ileocolonoscopy, accurately depicting disease activity and mucosal healing, with better illustration of luminal and extra-luminal disease and complications. Intestinal US may also play a role in depicting the activity, extent of disease as well as risk of surgery in ulcerative colitis. The application of IUS is particularly useful in children with IBD, where risks of radiation are important, while there is a need for anaesthesia for endoscopic examination. To date, however, IUS has remained somewhat underutilized globally, given perceived limitations in inter-rater variability, standardized assessment and anatomic resolution. This however is starting to change: the use of IUS has moved beyond the limited domain of diagnostic imaging specialists and radiologists as it is incorporated into routine clinical assessment at the bedside and now being performed by non-radiologist gastroenterologists. Here, the benefits to patients go well beyond safety, with immediate clinical impact, facilitated through objectively informed clinical decision-making and better patient education and engagement, allowing for optimal patient participation and partnership in the clinical management of this complex, chronic disease.


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Liverpool Hospital, University of New South WalesSydneyAustralia
  2. 2.University of CalgaryCalgaryCanada

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