Saima Batool MBBS, Abstract Co-Author: Nothing to Disclose

Aman Wadhwani BSC, Presenter: Nothing to Disclose

Kerri Novak MD, Abstract Co-Author: Research Grant, Abbott Laboratories Consultant, Abbott Laboratories Speakers Bureau, Merck KgaA

Stephanie R. Wilson MD, Abstract Co-Author: Research Grant, Lantheus Medical Imaging, Inc Research Grant, Abbott Laboratories Consultant, Lantheus Medical Imaging, Inc Equipment support, Siemens AG Equipment support, Koninklijke Philips Electronics NV

To show the equivalence of abdominal ultrasound (US) with computed tomography (CT) or magnetic resonance enterography (MRE) /CTE, as gold standard imaging (GSI), in predicting active disease and intestinal complications in patients with crohn disease (CD).

This retrospective review of 210 patients with CD compares US with temporally performed CT (n=70) or CTE (n=75)/MRE (n=65). Two independent reviewers, blinded to the final pathology, reviewed image files of all modalities for active disease predicted on the basis of wall thickness, hyperemia, and presence of mesenteric inflammatory fat. Complications were predicted based on their familiar morphologic appearances. Sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) for active disease and complications visualized with US were calculated. In each instance, the advantages and disadvantages afforded by US relative to other modalities were documented.  

In this select population, a majority presented to Emergency with acute complications. A total of 138 patients had thick bowel, inflammatory fat, and hyperemia on GSI, with agreement on US in 134 (SN 97%, SP 95.8%, PPV 98.5%, NPV 92% and ACC 96.7%). Complications were present on GSI in 118/210 patients. Cumulative US interpretation correctly diagnosed these complications in 105/118 (SN 92.1 %, SP 95.8%, PPV 96.33 %, NPV 91.0% and ACC 93.8%). Although fistulae and strictured segments were shown with equivalence between modalities (n=84), US has an advantage to suggest incomplete mechanical bowel obstruction on the basis of dysfunctional peristalsis and fixed bowel angulations. Localized perforations with phlegmons were more confidentially identified with US although deep positioned abscess with large quantities of gas may be shown with superiority on CT scan. MR was superior for prediction of bowel wall edema and mucosal ulceration although the difference in determination of active disease between US and MR was inconsequential.  

In our study US showed equivalent ability to predict active disease and a wide range of clinical complications, equal to and at times superior to that of either CT or CTE/MRE.

US is a real-time  method for diagnosis of CD and associated complications. Scanning patients for followup or at the time of acute clinical exacerbation is effective with this radiation free modality

Batool, S, Wadhwani, A, Novak, K, Wilson, S, Does Abdominal Ultrasound Show Equivalence to Computed Tomography  and Magnetic Resonance Enterography in Predicting Active Crohn Disease and Complications?  .  Radiological Society of North America 2013 Scientific Assembly and Annual Meeting, December 1 - December 6, 2013 ,Chicago IL. http://archive.rsna.org/2013/13021919.html