Comparative Accuracy of Bowel Ultrasound Versus Magnetic Resonance Enterography in Combination With Colonoscopy in Assessing Crohn's Disease and Guiding Clinical Decision-making

Research output: Contribution to journalArticle

Abstract

Background: The comparative accuracy of bowel ultrasound [US] versus magnetic resonance enterography [MRE] in combination with colonoscopy [CS] in assessing Crohn's disease [CD] and influencing the decision-making process is unknown. Methods: Consecutive ileo-colonic CD patients seen in a tertiary referral centre were prospectively assessed by MRE, CS, and bowel US, within 1 week. Sensitivity, specificity, accuracy, positive predictive value [PPV], and negative predictive value [NPV] of bowel US in assessing localisation, enhancement [presence of vascularisation at Power Doppler], active disease [presence of ulcers at colonoscopy], strictures, fistulas, and abscesses were calculated using CS + MRE findings together as a reference standard. Two blinded inflammatory bowel disease [IBD] specialists reviewed MRE and bowel US findings and were asked to decide the therapeutic strategy [continue versus change therapy]. Kappa agreement with clinical decision was calculated. Results: Sixty CD patients [36 with endoscopic disease activity, 28 with complications] were enrolled. For localisation, sensitivity, specificity, accuracy, PPV, and NPV of bowel US were 88%, 96%, 91%, 96%, and 85%, respectively; for enhancement, 87%, 92%, 89%, 93%, and 86%; for activity, 92%, 100%, 96%, 100%, and 94%; for strictures, 75%, 86%, 81%, 78%, and 83%; for fistulas, 100%, 98%, 98%, 66%, and 100%; for abscesses, 100%, 96%, 96%, 33%, and 100%. The concordance of management of CD patients based on bowel US or MRE findings, alone, compared with clinical decision, was 0.768 and 0.767, respectively [p <0.001]. The concordance between bowel US and MRE on management of CD patients was 0.800 [p <0.001]. Conclusions: Bowel US is very accurate in assessing CD and is a non-invasive, easy-to-use tool to manage CD patients in clinical practice.

Original languageEnglish
Pages (from-to)1280-1287
Number of pages8
JournalJournal of Crohn's & colitis
Volume12
Issue number11
DOIs
Publication statusPublished - Nov 15 2018

Fingerprint

Colonoscopy
Crohn Disease
Magnetic Resonance Spectroscopy
Abscess
Fistula
Pathologic Constriction
Colonic Diseases
Sensitivity and Specificity
Clinical Decision-Making
Inflammatory Bowel Diseases
Tertiary Care Centers
Ulcer
Decision Making
Therapeutics

ASJC Scopus subject areas

  • Gastroenterology

Cite this

@article{9e251533e34b4d889d06c9d77087098f,
title = "Comparative Accuracy of Bowel Ultrasound Versus Magnetic Resonance Enterography in Combination With Colonoscopy in Assessing Crohn's Disease and Guiding Clinical Decision-making",
abstract = "Background: The comparative accuracy of bowel ultrasound [US] versus magnetic resonance enterography [MRE] in combination with colonoscopy [CS] in assessing Crohn's disease [CD] and influencing the decision-making process is unknown. Methods: Consecutive ileo-colonic CD patients seen in a tertiary referral centre were prospectively assessed by MRE, CS, and bowel US, within 1 week. Sensitivity, specificity, accuracy, positive predictive value [PPV], and negative predictive value [NPV] of bowel US in assessing localisation, enhancement [presence of vascularisation at Power Doppler], active disease [presence of ulcers at colonoscopy], strictures, fistulas, and abscesses were calculated using CS + MRE findings together as a reference standard. Two blinded inflammatory bowel disease [IBD] specialists reviewed MRE and bowel US findings and were asked to decide the therapeutic strategy [continue versus change therapy]. Kappa agreement with clinical decision was calculated. Results: Sixty CD patients [36 with endoscopic disease activity, 28 with complications] were enrolled. For localisation, sensitivity, specificity, accuracy, PPV, and NPV of bowel US were 88{\%}, 96{\%}, 91{\%}, 96{\%}, and 85{\%}, respectively; for enhancement, 87{\%}, 92{\%}, 89{\%}, 93{\%}, and 86{\%}; for activity, 92{\%}, 100{\%}, 96{\%}, 100{\%}, and 94{\%}; for strictures, 75{\%}, 86{\%}, 81{\%}, 78{\%}, and 83{\%}; for fistulas, 100{\%}, 98{\%}, 98{\%}, 66{\%}, and 100{\%}; for abscesses, 100{\%}, 96{\%}, 96{\%}, 33{\%}, and 100{\%}. The concordance of management of CD patients based on bowel US or MRE findings, alone, compared with clinical decision, was 0.768 and 0.767, respectively [p <0.001]. The concordance between bowel US and MRE on management of CD patients was 0.800 [p <0.001]. Conclusions: Bowel US is very accurate in assessing CD and is a non-invasive, easy-to-use tool to manage CD patients in clinical practice.",
author = "Mariangela Allocca and Gionata Fiorino and Cristiana Bonifacio and Federica Furfaro and Daniela Gilardi and Marjorie Argollo and Laurent Peyrin-Biroulet and Silvio Danese",
year = "2018",
month = "11",
day = "15",
doi = "10.1093/ecco-jcc/jjy093",
language = "English",
volume = "12",
pages = "1280--1287",
journal = "Journal of Crohn's and Colitis",
issn = "1873-9946",
publisher = "Oxford University Press",
number = "11",

}

TY - JOUR

T1 - Comparative Accuracy of Bowel Ultrasound Versus Magnetic Resonance Enterography in Combination With Colonoscopy in Assessing Crohn's Disease and Guiding Clinical Decision-making

AU - Allocca, Mariangela

AU - Fiorino, Gionata

AU - Bonifacio, Cristiana

AU - Furfaro, Federica

AU - Gilardi, Daniela

AU - Argollo, Marjorie

AU - Peyrin-Biroulet, Laurent

AU - Danese, Silvio

PY - 2018/11/15

Y1 - 2018/11/15

N2 - Background: The comparative accuracy of bowel ultrasound [US] versus magnetic resonance enterography [MRE] in combination with colonoscopy [CS] in assessing Crohn's disease [CD] and influencing the decision-making process is unknown. Methods: Consecutive ileo-colonic CD patients seen in a tertiary referral centre were prospectively assessed by MRE, CS, and bowel US, within 1 week. Sensitivity, specificity, accuracy, positive predictive value [PPV], and negative predictive value [NPV] of bowel US in assessing localisation, enhancement [presence of vascularisation at Power Doppler], active disease [presence of ulcers at colonoscopy], strictures, fistulas, and abscesses were calculated using CS + MRE findings together as a reference standard. Two blinded inflammatory bowel disease [IBD] specialists reviewed MRE and bowel US findings and were asked to decide the therapeutic strategy [continue versus change therapy]. Kappa agreement with clinical decision was calculated. Results: Sixty CD patients [36 with endoscopic disease activity, 28 with complications] were enrolled. For localisation, sensitivity, specificity, accuracy, PPV, and NPV of bowel US were 88%, 96%, 91%, 96%, and 85%, respectively; for enhancement, 87%, 92%, 89%, 93%, and 86%; for activity, 92%, 100%, 96%, 100%, and 94%; for strictures, 75%, 86%, 81%, 78%, and 83%; for fistulas, 100%, 98%, 98%, 66%, and 100%; for abscesses, 100%, 96%, 96%, 33%, and 100%. The concordance of management of CD patients based on bowel US or MRE findings, alone, compared with clinical decision, was 0.768 and 0.767, respectively [p <0.001]. The concordance between bowel US and MRE on management of CD patients was 0.800 [p <0.001]. Conclusions: Bowel US is very accurate in assessing CD and is a non-invasive, easy-to-use tool to manage CD patients in clinical practice.

AB - Background: The comparative accuracy of bowel ultrasound [US] versus magnetic resonance enterography [MRE] in combination with colonoscopy [CS] in assessing Crohn's disease [CD] and influencing the decision-making process is unknown. Methods: Consecutive ileo-colonic CD patients seen in a tertiary referral centre were prospectively assessed by MRE, CS, and bowel US, within 1 week. Sensitivity, specificity, accuracy, positive predictive value [PPV], and negative predictive value [NPV] of bowel US in assessing localisation, enhancement [presence of vascularisation at Power Doppler], active disease [presence of ulcers at colonoscopy], strictures, fistulas, and abscesses were calculated using CS + MRE findings together as a reference standard. Two blinded inflammatory bowel disease [IBD] specialists reviewed MRE and bowel US findings and were asked to decide the therapeutic strategy [continue versus change therapy]. Kappa agreement with clinical decision was calculated. Results: Sixty CD patients [36 with endoscopic disease activity, 28 with complications] were enrolled. For localisation, sensitivity, specificity, accuracy, PPV, and NPV of bowel US were 88%, 96%, 91%, 96%, and 85%, respectively; for enhancement, 87%, 92%, 89%, 93%, and 86%; for activity, 92%, 100%, 96%, 100%, and 94%; for strictures, 75%, 86%, 81%, 78%, and 83%; for fistulas, 100%, 98%, 98%, 66%, and 100%; for abscesses, 100%, 96%, 96%, 33%, and 100%. The concordance of management of CD patients based on bowel US or MRE findings, alone, compared with clinical decision, was 0.768 and 0.767, respectively [p <0.001]. The concordance between bowel US and MRE on management of CD patients was 0.800 [p <0.001]. Conclusions: Bowel US is very accurate in assessing CD and is a non-invasive, easy-to-use tool to manage CD patients in clinical practice.

UR - http://www.scopus.com/inward/record.url?scp=85052509048&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052509048&partnerID=8YFLogxK

U2 - 10.1093/ecco-jcc/jjy093

DO - 10.1093/ecco-jcc/jjy093

M3 - Article

C2 - 29982361

AN - SCOPUS:85052509048

VL - 12

SP - 1280

EP - 1287

JO - Journal of Crohn's and Colitis

JF - Journal of Crohn's and Colitis

SN - 1873-9946

IS - 11

ER -