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01-04-2016 | Original Article

Prospective cohort study of ultrasound-ultrasound and ultrasound-MR enterography agreement in the evaluation of pediatric small bowel Crohn disease

Authors: Jonathan R. Dillman, Ethan A. Smith, Ramon Sanchez, Michael A. DiPietro, Soudabeh Fazeli Dehkordy, Jeremy Adler, Vera DeMatos-Maillard, Shokoufeh Khalatbari, Matthew S. Davenport

Published in: Pediatric Radiology | Issue 4/2016

Abstract

Background

There is a paucity of published literature describing ultrasound (US)-US and US-MR enterography (MRE) inter-radiologist agreement in pediatric small bowel Crohn disease.

Objective

To prospectively assess US-US and US-MRE inter-radiologist agreement in pediatric small bowel Crohn disease.

Materials and methods

Institutional Review Board approval and informed consent/assent were obtained for this HIPAA-compliant prospective cohort study of children with newly diagnosed distal small bowel Crohn disease (July 2012 to December 2014). Enrolled subjects (n = 29) underwent two small bowel US examinations performed by blinded independent radiologists both before and at multiple time points after initiation of medical therapy (231 unique US examinations, in total); 134 US examinations were associated with concurrent MRE. The MRE examination was interpreted by a third blinded radiologist. The following was documented on each examination: involved length of ileum (cm); maximum bowel wall thickness (mm); amount of bowel wall and mesenteric Doppler signal, and presence of stricture, penetrating disease and/or abscess. Inter-radiologist agreement was assessed with single-measure, three-way, mixed-model intra-class correlation coefficients (ICC) and prevalence-adjusted, bias-adjusted kappa statistics (κ). Numbers in brackets are 95% confidence intervals.

Results

Ultrasound-US agreement was moderate for involved length (ICC: 0.41 [0.35-0.49]); substantial for maximum bowel wall thickness (ICC: 0.67 [0.64-0.70]); moderate for bowel wall Doppler signal (ICC: 0.53 [0.48-0.59]); slight for mesenteric Doppler signal (ICC: 0.25 [0.18-0.42]), and moderate to almost perfect for stricture (κ: 0.54), penetrating disease (κ: 0.80), and abscess (κ: 0.96). US-MRE agreement was moderate for involved length (ICC: 0.42 [0.37-0.49]); substantial for maximum bowel wall thickness (ICC: 0.66 [0.65-0.69]), and substantial to almost perfect for stricture (κ: 0.61), penetrating disease (κ: 0.72) and abscess (κ: 0.88).

Conclusion

Ultrasound-US agreement was similar to US-MRE agreement for assessing pediatric small bowel Crohn disease. Discrepancies in US-US and US-MRE reporting question the utility of US as an accurate, reproducible radiologic biomarker for assessing response to medical therapy and disease-related complications.

Day AS, Ledder O, Leach ST et al (2012) Crohn’s and colitis in children and adolescents. World J Gastroenterol 18:5862–5869CrossRefPubMedPubMedCentral

Kelsen J, Baldassano RN (2008) Inflammatory bowel disease: the difference between children and adults. Inflamm Bowel Dis 14:S9–11PubMed

Benchimol EI, Mack DR, Nguyen GC et al (2014) Incidence, outcomes, and health services burden of very early onset inflammatory bowel disease. Gastroenterology 147, 813.e807, quiz e814-805CrossRef

Malaty HM, Fan X, Opekun AR et al (2010) Rising incidence of inflammatory bowel disease among children: a 12-year study. J Pediatr Gastroenterol Nutr 50:27–31CrossRefPubMed

Malmborg P, Grahnquist L, Lindholm J et al (2013) Increasing incidence of paediatric inflammatory bowel disease in northern Stockholm County, 2002–2007. J Pediatr Gastroenterol Nutr 57:29–34CrossRefPubMed

Martin-de-Carpi J, Rodriguez A, Ramos E et al (2014) The complete picture of changing pediatric inflammatory bowel disease incidence in Spain in 25 years (1985–2009): the EXPERIENCE registry. J Crohns Colitis 8:763–769CrossRefPubMed

Petritsch W, Fuchs S, Berghold A et al (2013) Incidence of inflammatory bowel disease in the province of Styria, Austria, from 1997 to 2007: a population-based study. J Crohns Colitis 7:58–69CrossRefPubMed

Anupindi SA, Podberesky DJ, Towbin AJ et al (2015) Pediatric inflammatory bowel disease: imaging issues with targeted solutions. Abdom Imaging. doi:10.1007/s00261-015-0423-y PubMed

Dillman JR, Adler J, Zimmermann EM et al (2010) CT enterography of pediatric Crohn disease. Pediatr Radiol 40:97–105CrossRefPubMed

10.

Hammer MR, Podberesky DJ, Dillman JR (2013) Multidetector computed tomographic and magnetic resonance enterography in children: state of the art. Radiol Clin N Am 51:615–636CrossRefPubMed

11.

Towbin AJ, Sullivan J, Denson LA et al (2013) CT and MR enterography in children and adolescents with inflammatory bowel disease. Radiographics 33:1843–1860CrossRefPubMed

12.

Alison M, Kheniche A, Azoulay R et al (2007) Ultrasonography of Crohn disease in children. Pediatr Radiol 37:1071–1082CrossRefPubMed

13.

Bremner AR, Griffiths M, Argent JD et al (2006) Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study. Pediatr Radiol 36:947–953CrossRefPubMed

14.

Epifanio M, Baldisserotto M, Spolidoro JV et al (2008) Grey-scale and colour Doppler sonography in the evaluation of children with suspected bowel inflammation: correlation with colonoscopy and histological findings. Clin Radiol 63:968–978CrossRefPubMed

15.

Faure C, Belarbi N, Mougenot JF et al (1997) Ultrasonographic assessment of inflammatory bowel disease in children: comparison with ileocolonoscopy. J Pediatr 130:147–151CrossRefPubMed

16.

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 355:1239–1240CrossRefPubMed

17.

Pallotta N, Vincoli G, Montesani C et al (2012) Small intestine contrast ultrasonography (SICUS) for the detection of small bowel complications in crohn’s disease: a prospective comparative study versus intraoperative findings. Inflamm Bowel Dis 18:74–84CrossRefPubMed

18.

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 39:524–528CrossRefPubMed

19.

Spalinger J, Patriquin H, Miron MC et al (2000) Doppler US in patients with crohn disease: vessel density in the diseased bowel reflects disease activity. Radiology 217:787–791CrossRefPubMed

20.

Sturm EJ, Cobben LP, Meijssen MA et al (2004) Detection of ileocecal Crohn’s disease using ultrasound as the primary imaging modality. Eur Radiol 14:778–782CrossRefPubMed

21.

Tarjan Z, Toth G, Gyorke T et al (2000) Ultrasound in Crohn’s disease of the small bowel. Eur J Radiol 35:176–182CrossRefPubMed

22.

Casciani E, De Vincentiis C, Polettini E et al (2014) Imaging of the small bowel: Crohn’s disease in paediatric patients. World J Radiol 6:313–328CrossRefPubMedPubMedCentral

23.

Duigenan S, Gee MS (2012) Imaging of pediatric patients with inflammatory bowel disease. AJR Am J Roentgenol 199:907–915CrossRefPubMed

24.

Barkmeier DT, Dillman JR, Al-Hawary M et al (2015) MR enterography-histology comparison in resected pediatric small bowel Crohn disease strictures: can imaging predict fibrosis? Pediatr Radiol. doi:10.1007/s00247-015-3506-6

25.

Byrt T, Bishop J, Carlin JB (1993) Bias, prevalence and kappa. J Clin Epidemiol 46:423–429CrossRefPubMed

26.

Fraquelli M, Sarno A, Girelli C et al (2008) Reproducibility of bowel ultrasonography in the evaluation of Crohn’s disease. Dig Liver Dis 40:860–866CrossRefPubMed

27.

Martinez MJ, Ripolles T, Paredes JM et al (2009) Assessment of the extension and the inflammatory activity in Crohn’s disease: comparison of ultrasound and MRI. Abdom Imaging 34:141–148CrossRefPubMed

28.

Castiglione F, Mainenti PP, De Palma GD et al (2013) Noninvasive diagnosis of small bowel Crohn’s disease: direct comparison of bowel sonography and magnetic resonance enterography. Inflamm Bowel Dis 19:991–998CrossRefPubMed

Title: Prospective cohort study of ultrasound-ultrasound and ultrasound-MR enterography agreement in the evaluation of pediatric small bowel Crohn disease
Authors: Jonathan R. Dillman
Ethan A. Smith
Ramon Sanchez
Michael A. DiPietro
Soudabeh Fazeli Dehkordy
Jeremy Adler
Vera DeMatos-Maillard
Shokoufeh Khalatbari
Matthew S. Davenport
Publication date: 01-04-2016
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Radiology / Issue 4/2016
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI: https://doi.org/10.1007/s00247-015-3517-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prospective cohort study of ultrasound-ultrasound and ultrasound-MR enterography agreement in the evaluation of pediatric small bowel Crohn disease

Abstract

Background

Objective

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Objective

Materials and methods

Results

Conclusion

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