Skip to main content
Top
Published in: European Radiology 1/2014

01-01-2014 | Gastrointestinal

Ultrasound as a diagnostic tool in detecting active Crohn’s disease: a meta-analysis of prospective studies

Authors: Jianning Dong, Honggang Wang, Jie Zhao, Weiming Zhu, Liang Zhang, Jianfeng Gong, Yi Li, Lili Gu, Jieshou Li

Published in: European Radiology | Issue 1/2014

Login to get access

Abstract

Objectives

To evaluate the diagnostic accuracy of ultrasound in assessing active Crohn’s disease (CD) in adults.

Methods

We systematically searched PubMed, EMBASE, Web of Science and the Cochrane Library for prospective studies in which ultrasound was performed to evaluate active CD in adults from January 1993 to April 2013. Pooled sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR−) and diagnostic odds ratios (DORs) in a per-patient-based analysis were estimated. Additionally, the area under the receiver-operating characteristic (ROC) curve was calculated to measure the diagnostic accuracy of ultrasound in patients with known or suspected CD.

Results

Fifteen studies involving 1,558 patients were included in this meta-analysis. Overall, the pooled sensitivity (0.88) and LR- (0.14) were not heterogeneous, whereas the pooled specificity (0.97, I2 = 72.9 %) and LR + (15.10, I2 = 71.8 %) were. The DOR of ultrasound for assessing active CD was 121.70, with significant heterogeneity (I2 = 63.3 %). A symmetrical summary ROC curve was plotted showing that the area under the curve was 0.94, indicating good diagnostic accuracy. Meta-regression and subgroup analysis showed that the disease location may be a major cause of heterogeneity.

Conclusions

This meta-analysis suggests that ultrasound has high diagnostic accuracy in detecting active CD in adults, especially for small bowel CD.

Key Points

• Ultrasound can detect active Crohn’s disease (CD).
• A meta-analysis of ultrasound for detecting active CD was carried out.
• This revealed that ultrasound has high diagnostic accuracy for detecting CD.
Literature
2.
go back to reference Fletcher JG, Fidler JL, Bruining DH, Huprich JE (2011) New concepts in intestinal imaging for inflammatory bowel diseases. Gastroenterology 140:1795–1806PubMedCrossRef Fletcher JG, Fidler JL, Bruining DH, Huprich JE (2011) New concepts in intestinal imaging for inflammatory bowel diseases. Gastroenterology 140:1795–1806PubMedCrossRef
3.
go back to reference Parente F, Greco S, Molteni M, Anderloni A, Maconi G, Bianchi PG (2004) Modern imaging of Crohn’s disease using bowel ultrasound. Inflamm Bowel Dis 10:452–461PubMedCrossRef Parente F, Greco S, Molteni M, Anderloni A, Maconi G, Bianchi PG (2004) Modern imaging of Crohn’s disease using bowel ultrasound. Inflamm Bowel Dis 10:452–461PubMedCrossRef
5.
go back to reference Al-Hawary M, Zimmermann EM (2012) A new look at Crohn’s disease novel imaging techniques. Curr Opin Gastroenterol 28:334–340PubMed Al-Hawary M, Zimmermann EM (2012) A new look at Crohn’s disease novel imaging techniques. Curr Opin Gastroenterol 28:334–340PubMed
6.
go back to reference Drews BH, Barth TF, Hänle MM, Akinli AS, Mason RA, Muche R, Thiel R, Pauls S, Klaus J, von Boyen G, Kratzer W (2009) Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn’s disease. Eur Radiol 19:1379–1386PubMedCrossRef Drews BH, Barth TF, Hänle MM, Akinli AS, Mason RA, Muche R, Thiel R, Pauls S, Klaus J, von Boyen G, Kratzer W (2009) Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn’s disease. Eur Radiol 19:1379–1386PubMedCrossRef
7.
go back to reference Calabrese E, La Seta F, Buccellato A, Virdone R, Pallotta N, Corazziari E, Cottone M (2005) Crohn’s disease: a comparative prospective study of transabdominal ultrasonography, small intestine contrast ultrasonography, and small bowel enema. Inflamm Bowel Dis 11:139–145PubMedCrossRef Calabrese E, La Seta F, Buccellato A, Virdone R, Pallotta N, Corazziari E, Cottone M (2005) Crohn’s disease: a comparative prospective study of transabdominal ultrasonography, small intestine contrast ultrasonography, and small bowel enema. Inflamm Bowel Dis 11:139–145PubMedCrossRef
8.
go back to reference Rispo A, Imbriaco M, Celentano L, Cozzolino A, Camera L, Mainenti PP, Manguso F, Sabbatini F, D’Amico P, Castiglione F (2005) Noninvasive diagnosis of small bowel Crohn’s disease: combined use of bowel sonography and tc-99m-hmpao leukocyte scintigraphy. Inflamm Bowel Dis 11:376–382PubMedCrossRef Rispo A, Imbriaco M, Celentano L, Cozzolino A, Camera L, Mainenti PP, Manguso F, Sabbatini F, D’Amico P, Castiglione F (2005) Noninvasive diagnosis of small bowel Crohn’s disease: combined use of bowel sonography and tc-99m-hmpao leukocyte scintigraphy. Inflamm Bowel Dis 11:376–382PubMedCrossRef
9.
go back to reference Rispo A, Bucci L, Pesce G, Sabbatini F, de Palma GD, Grassia R, Compagna A, Testa A, Castiglione F (2006) Bowel sonography for the diagnosis and grading of postsurgical recurrence of Crohn’s disease. Inflamm Bowel Dis 12:486–490PubMedCrossRef Rispo A, Bucci L, Pesce G, Sabbatini F, de Palma GD, Grassia R, Compagna A, Testa A, Castiglione F (2006) Bowel sonography for the diagnosis and grading of postsurgical recurrence of Crohn’s disease. Inflamm Bowel Dis 12:486–490PubMedCrossRef
10.
go back to reference Castiglione F, Bucci L, Pesce G, De Palma GD, Camera L, Cipolletta F, Testa A, Diaferia M, Rispo A (2008) Oral contrast-enhanced sonography for the diagnosis and grading of postsurgical recurrence of Crohn’s disease. Inflamm Bowel Dis 14:1240–1245PubMedCrossRef Castiglione F, Bucci L, Pesce G, De Palma GD, Camera L, Cipolletta F, Testa A, Diaferia M, Rispo A (2008) Oral contrast-enhanced sonography for the diagnosis and grading of postsurgical recurrence of Crohn’s disease. Inflamm Bowel Dis 14:1240–1245PubMedCrossRef
11.
go back to reference Migaleddu V, Scanu AM, Quaia E, Rocca PC, Dore MP, Scanu D, Azzali L, Virgilio G (2009) Contrast-enhanced ultrasonographic evaluation of inflammatory activity in Crohn’s disease. Gastroenterology 137:43–52PubMedCrossRef Migaleddu V, Scanu AM, Quaia E, Rocca PC, Dore MP, Scanu D, Azzali L, Virgilio G (2009) Contrast-enhanced ultrasonographic evaluation of inflammatory activity in Crohn’s disease. Gastroenterology 137:43–52PubMedCrossRef
12.
go back to reference Paredes JM, Ripolles T, Cortes X, Reyes MD, Lopez A, Martinez MJ, Moreno-Osset E (2010) Non-invasive diagnosis and grading of postsurgical endoscopic recurrence in Crohn’s disease: usefulness of abdominal ultrasonography and (99m)tc-hexamethylpropylene amineoxime-labelled leucocyte scintigraphy. J Crohns Colitis 4:537–545PubMedCrossRef Paredes JM, Ripolles T, Cortes X, Reyes MD, Lopez A, Martinez MJ, Moreno-Osset E (2010) Non-invasive diagnosis and grading of postsurgical endoscopic recurrence in Crohn’s disease: usefulness of abdominal ultrasonography and (99m)tc-hexamethylpropylene amineoxime-labelled leucocyte scintigraphy. J Crohns Colitis 4:537–545PubMedCrossRef
13.
go back to reference Castiglione F, Mainenti PP, De Palma GD, Testa A, Bucci L, Pesce G, Camera L, Diaferia M, Rea M, Caporaso N, Salvatore M, Rispo A (2013) Noninvasive diagnosis of small bowel Crohn’s disease: direct comparison of bowel sonography and magnetic resonance enterography. Inflamm Bowel Dis 19:991–998PubMedCrossRef Castiglione F, Mainenti PP, De Palma GD, Testa A, Bucci L, Pesce G, Camera L, Diaferia M, Rea M, Caporaso N, Salvatore M, Rispo A (2013) Noninvasive diagnosis of small bowel Crohn’s disease: direct comparison of bowel sonography and magnetic resonance enterography. Inflamm Bowel Dis 19:991–998PubMedCrossRef
14.
go back to reference Fraquelli M, Colli A, Casazza G, Paggi S, Colucci A, Massironi S, Duca P, Conte D (2005) Role of us in detection of Crohn disease: meta-analysis. Radiology 236:95–101PubMedCrossRef Fraquelli M, Colli A, Casazza G, Paggi S, Colucci A, Massironi S, Duca P, Conte D (2005) Role of us in detection of Crohn disease: meta-analysis. Radiology 236:95–101PubMedCrossRef
15.
go back to reference Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCentralPubMedCrossRef Whiting P, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 3:25PubMedCentralPubMedCrossRef
16.
17.
go back to reference Sheridan MB, Nicholson DA, Martin DF (1993) Transabdominal ultrasonography as the primary investigation in patients with suspected Crohn’s disease or recurrence: a prospective study. Clin Radiol 48:402–404PubMedCrossRef Sheridan MB, Nicholson DA, Martin DF (1993) Transabdominal ultrasonography as the primary investigation in patients with suspected Crohn’s disease or recurrence: a prospective study. Clin Radiol 48:402–404PubMedCrossRef
18.
go back to reference Limberg B, Osswald B (1994) Diagnosis and differential diagnosis of ulcerative colitis and Crohn’s disease by hydrocolonic sonography. Am J Gastroenterol 89:1051–1057PubMed Limberg B, Osswald B (1994) Diagnosis and differential diagnosis of ulcerative colitis and Crohn’s disease by hydrocolonic sonography. Am J Gastroenterol 89:1051–1057PubMed
19.
go back to reference Solvig J, Ekberg O, Lindgren S, Floren CH, Nilsson P (1995) Ultrasound examination of the small bowel: comparison with enteroclysis in patients with Crohn disease. Abdom Imaging 20:323–326PubMedCrossRef Solvig J, Ekberg O, Lindgren S, Floren CH, Nilsson P (1995) Ultrasound examination of the small bowel: comparison with enteroclysis in patients with Crohn disease. Abdom Imaging 20:323–326PubMedCrossRef
20.
go back to reference Andreoli A, Cerro P, Falasco G, Giglio LA, Prantera C (1998) Role of ultrasonography in the diagnosis of postsurgical recurrence of Crohn’s disease. Am J Gastroenterol 93:1117–1121PubMedCrossRef Andreoli A, Cerro P, Falasco G, Giglio LA, Prantera C (1998) Role of ultrasonography in the diagnosis of postsurgical recurrence of Crohn’s disease. Am J Gastroenterol 93:1117–1121PubMedCrossRef
21.
go back to reference Tarjan Z, Toth G, Gyorke T, Mester A, Karlinger K, Mako EK (2000) Ultrasound in Crohn’s disease of the small bowel. Eur J Radiol 35:176–182PubMedCrossRef Tarjan Z, Toth G, Gyorke T, Mester A, Karlinger K, Mako EK (2000) Ultrasound in Crohn’s disease of the small bowel. Eur J Radiol 35:176–182PubMedCrossRef
22.
go back to reference Astegiano M, Bresso F, Cammarota T, Sarno A, Robotti D, Demarchi B, Sostegni R, Macchiarella V, Pera A, Rizzetto M (2001) Abdominal pain and bowel dysfunction: diagnostic role of intestinal ultrasound. Eur J Gastroenterol Hepatol 13:927–931PubMedCrossRef Astegiano M, Bresso F, Cammarota T, Sarno A, Robotti D, Demarchi B, Sostegni R, Macchiarella V, Pera A, Rizzetto M (2001) Abdominal pain and bowel dysfunction: diagnostic role of intestinal ultrasound. Eur J Gastroenterol Hepatol 13:927–931PubMedCrossRef
23.
go back to reference Cittadini G, Giasotto V, Garlaschi G, de Cicco E, Gallo A, Cittadini G (2001) Transabdominal ultrasonography of the small bowel after oral administration of a non-absorbable anechoic solution: comparison with barium enteroclysis. Clin Radiol 56:225–230PubMedCrossRef Cittadini G, Giasotto V, Garlaschi G, de Cicco E, Gallo A, Cittadini G (2001) Transabdominal ultrasonography of the small bowel after oral administration of a non-absorbable anechoic solution: comparison with barium enteroclysis. Clin Radiol 56:225–230PubMedCrossRef
24.
go back to reference Miao YM, Koh DM, Amin Z, Healy JC, Chinn RJ, Zeegen R, Westaby D (2002) Ultrasound and magnetic resonance imaging assessment of active bowel segments in Crohn’s disease. Clin Radiol 57:913–918PubMedCrossRef Miao YM, Koh DM, Amin Z, Healy JC, Chinn RJ, Zeegen R, Westaby D (2002) Ultrasound and magnetic resonance imaging assessment of active bowel segments in Crohn’s disease. Clin Radiol 57:913–918PubMedCrossRef
25.
go back to reference Horsthuis K, Bipat S, Bennink RJ, Stoker J (2008) Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 247:64–79PubMedCrossRef Horsthuis K, Bipat S, Bennink RJ, Stoker J (2008) Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology 247:64–79PubMedCrossRef
26.
go back to reference Hara AK, Leighton JA, Heigh RI, Sharma VK, Silva AC, De Petris G, Hentz JG, Fleischer DE (2006) Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology 238:128–134PubMedCrossRef Hara AK, Leighton JA, Heigh RI, Sharma VK, Silva AC, De Petris G, Hentz JG, Fleischer DE (2006) Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology 238:128–134PubMedCrossRef
27.
go back to reference Migaleddu V, Quaia E, Scano D, Virgilio G (2008) Inflammatory activity in Crohn disease: ultrasound findings. Abdom Imaging 33:589–597PubMedCrossRef Migaleddu V, Quaia E, Scano D, Virgilio G (2008) Inflammatory activity in Crohn disease: ultrasound findings. Abdom Imaging 33:589–597PubMedCrossRef
28.
go back to reference Jensen MD, Ormstrup T, Vagn-Hansen C, Ostergaard L, Rafaelsen SR (2011) Interobserver and intermodality agreement for detection of small bowel Crohn’s disease with MR enterography and CT enterography. Inflamm Bowel Dis 17:1081–1088PubMedCrossRef Jensen MD, Ormstrup T, Vagn-Hansen C, Ostergaard L, Rafaelsen SR (2011) Interobserver and intermodality agreement for detection of small bowel Crohn’s disease with MR enterography and CT enterography. Inflamm Bowel Dis 17:1081–1088PubMedCrossRef
29.
go back to reference Menys A, Atkinson D, Odille F, Ahmed A, Novelli M, Rodriguez-Justo M, Proctor I, Punwani S, Halligan S, Taylor SA (2012) Quantified terminal ileal motility during MR enterography as a potential biomarker of Crohn’s disease activity: a preliminary study. Eur Radiol 22:2494–2501PubMedCrossRef Menys A, Atkinson D, Odille F, Ahmed A, Novelli M, Rodriguez-Justo M, Proctor I, Punwani S, Halligan S, Taylor SA (2012) Quantified terminal ileal motility during MR enterography as a potential biomarker of Crohn’s disease activity: a preliminary study. Eur Radiol 22:2494–2501PubMedCrossRef
Metadata
Title
Ultrasound as a diagnostic tool in detecting active Crohn’s disease: a meta-analysis of prospective studies
Authors
Jianning Dong
Honggang Wang
Jie Zhao
Weiming Zhu
Liang Zhang
Jianfeng Gong
Yi Li
Lili Gu
Jieshou Li
Publication date
01-01-2014
Publisher
Springer Berlin Heidelberg
Published in
European Radiology / Issue 1/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI
https://doi.org/10.1007/s00330-013-2973-0

Other articles of this Issue 1/2014

European Radiology 1/2014 Go to the issue