Bowel wall thickness measured by ultrasound as a marker of Crohn's disease activity in children

doi:10.1016/S0140-6736(00)02092-4

The Lancet

Volume 355, Issue 9211, 8 April 2000, Pages 1239-1240

https://doi.org/10.1016/S0140-6736(00)02092-4 Get rights and content

Summary

Non-invasive procedures are desirable for assessing disease activity in the follow-up of children with Crohn's disease. We show that bowel wall thickness measured by ultrasound is related to clinical and histological assessment of disease activity and could represent an easy method for monitoring the intestinal inflammatory process in Crohn's disease.

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Intestinal ultrasound and shear wave elastography have gained increasing interest because of their promising results in the assessment of inflammatory bowel disease. The aim of this study was to find an ultrasonographic score to replace invasive endoscopic procedures for the management of these patients. The score includes ultrasound parameters that correlate well with clinical severity scales and inflammatory markers: bowel wall thickness, the Limberg score, disease extension and acoustic radiation force impulse measurements. The score proved to be well correlated with the Harvey Bradshaw Index, the Mayo score, C-reactive protein and fecal calprotectin. For Crohn's disease, a cutoff value of 8 points could identify active disease with 81.81% sensitivity and 83% specificity, while for ulcerative colitis, a cutoff value of 7 points could discriminate between remission and relapse with 86.85% sensitivity and 94% specificity. In conclusion, our ultrasonographic score can differentiate relapse from remission in inflammatory bowel disease.
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Technological improvements and growing sonographers’ expertise boost the role of intestinal ultrasound (IUS) in assessing patients with inflammatory bowel diseases (IBD). Non-invasiveness, low cost and good reproducibility make IUS attractive.
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For detecting IBD, particularly Crohn’s disease, the IUS parameters — above all the evidence of a thickened bowel wall (BWT) — show very good diagnostic accuracy similar to that of MRI or CT scan.
The standard IUS parameters are not accurate enough to detect inflammatory activity, but intravenous contrast-enhanced US (CEUS) is highly accurate in ruling active inflammation out. However, its routinely use remains limited in clinical practice and its parameters need standardization.
IUS is accurate in detecting IBD main complications: in particular, fistulae and abscesses. As to stenosis the recent introduction of IUS-based elastographic techniques allows to differentiate prevalently inflammatory from highly fibrotic strictures.
IUS proves valid also for monitoring IBD patients. In particular, the evidence of transmural healing, defined as BWT normalization, has got an important prognostic meaning, as associated with better long-term clinical outcomes. Post-surgery CD recurrence can be suggested by early IUS assessment.
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Citation Excerpt :
In adults, the bowel is generally considered to be thickened when wall diameter exceeds 3 mm [4]. Fewer studies have focused on children but different wall thickness values have been suggested as a threshold for positive diagnosis (from 1.5 mm to 3 mm for the terminal ileum and 2 mm for the colon [21] and >2.5 mm in the terminal ileum and >3 mm in the colon proximal to the rectum [22]. In acute IBD the individual bowel wall layers become hypertrophied and ill-defined, although the gut signature is usually maintained, whereas in chronic IBD the inflamed bowel wall layers become increasingly fibrosed and normal mural stratification is lost [23].
Ultrasound has long been favoured as first line when imaging children, primarily due to it being a non-invasive, relatively low cost, easily accessible modality. The many advantages of ultrasound evaluation in paediatric inflammatory bowel disease (IBD) vastly outweighs its limitations in both initial assessment and long term follow up. High frequency ultrasound provides excellent spatial resolution, and Doppler evaluation and compression sonography aids in providing real-time dynamic assessment in IBD where other modalities cannot. This paper outlines our ultrasound technique to maximise image quality and diagnostic accuracy, describes the imaging findings in paediatric IBD, and explores the advantages and limitations that ultrasound offers. We aim to illustrate to the reader that ultrasound is an invaluable imaging tool and should be the first line modality when imaging IBD in the paediatric patient.
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Intestinal Ultrasound for the Pediatric Gastroenterologist: A Guide for Inflammatory Bowel Disease Monitoring in Children: Expert Consensus on Behalf of the International Bowel Ultrasound Group (IBUS) Pediatric Committee
2023, Journal of Pediatric Gastroenterology and Nutrition

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Research LettersBowel wall thickness measured by ultrasound as a marker of Crohn's disease activity in children

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J Pediatr

Gastroenterology

Research Letters
Bowel wall thickness measured by ultrasound as a marker of Crohn's disease activity in children