Abdominal Ultrasonography with Color Doppler Analysis in the Assessment of Ileal Crohn’s Disease: Comparison with Magnetic Resonance Enterography

Abstract

Background/Aims: Consistently defining disease activity remains a critical challenge in the follow-up of patients with Crohn’s disease (CD). We investigated the potential applicability of abdominal ultrasonography with color Doppler (USCD) analysis for the detection of morphological alterations and inflammatory activity in CD. Methods: Forty-three patients with CD ileitis/ ileocolitis were evaluated using USCD analysis with measurements obtained on the terminal ileum and right colon. Sonogra-phic parameters included wall thickening, stricture, hyperemia, presence of intra-abdominal mass, and fistulas. Patients were evaluated for the clinical activity (Harvey-Bradshaw Index [HBI]), fecal calprotectin (FC) and C-reactive protein (CRP). The USCD performance was assessed using magnetic resonance enterography (MRE) as a criterion standard. Results: Most mea-surements obtained with USCD matched the data generated with MRE; however, the agreement improved in clinically active patients where sensitivity, positive predictive value, and accuracy were >80%, considering wall thickening and hyperemia. Com-plications such as intestinal wall thickening, stricture formation, and hyperemia, were detected in the USCD analysis with mod-erate agreement with MRE. The best agreement with the USCD analysis was obtained in regard to FC, where the sensitivity, positive predictive value, and accuracy were >70%. The overall performance of USCD was superior to that of HBI, FC and CRP levels, particularly when considering thickening, stricture, and hyperemia parameters. Conclusions: USCD represents a practi-cal noninvasive and low-cost tool for evaluating patients with ileal or ileocolonic disease, particularly in clinically active CD. Therefore, USCD might become a useful asset in the follow-up of patients with CD. (Intest Res 2019;17:227-236)