Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients

Abstract

Background: Bowel ultrasound and magnetic resonance enterography (MRE) are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications. They assess the degree of activity, help clinicians to identify patients in need of surgery, and can be used for patient follow-up.

Aim: To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease (IBD) patients in Egypt.

Methods: The study was conducted on 40 patients with IBD. All patients were subjected to clinical assessment, laboratory investigations, bowel ultrasound, MRE, and colonoscopy up to the terminal ileum with biopsies for histopathological examination.

Results: This study was conducted on 14 patients (35%) with ulcerative colitis and 26 patients (65%) with Crohn's disease; 34 (85%) of these patients had active disease. Bowel ultrasound detected different bowel lesions with the following accuracies: ileum (85%), large bowel (70%), fistula (95%), stricture and proximal dilatation (95%) and abscesses (100%). Also, it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.

Conclusion: In comparison to MRE, bowel ultrasound is a useful, non-invasive, and feasible bedside imaging tool for the detection of inflammation, detection of complications, and follow-up of IBD patients when performed by the attending physician.

Keywords: Bowel ultrasound; Colonoscopy; Crohn's disease; Inflammatory bowel disease; Magnetic resonance enterography; Ulcerative colitis.

Figure 1

Bowel ultrasound and colonoscopy images. Bowel ultrasound demonstrates diffuse terminal ileal wall thickening likely of inflammatory nature with sonographic evidence of fistulization with mesenteric abscess formation. Stenosis which was detected during colonoscopy was seen by bowel ultrasound with proximal dilatation.

Figure 2

Magnetic resonance enterography. A: Coronal T2WI shows enteroenteric fistula at the right iliac fossa with stellate appearance of the thickened ileal loops (white arrow); B: Coronal fat-suppressed three-dimensional gradient echo postcontrast T1WI shows accentuated star-like enhancement at the right iliac fossa denoting fistulizing crohn’s disease.

Figure 3

Receiver operating characteristic curve for prediction of active disease. A: At endoscopy, aphthous ulcers mean area under the receiver operating characteristic (ROC) curve was 0.875 (P < 0.001), positive likelihood ratio infinity, and negative likelihood ratio 0.28; B: Bowel ultrasound showed stricture and lymphadenopathy mean area under the ROC curve were 0.929 (P = 0.036) and 0.898 (P = 0.01) respectively, positive likelihood ratio infinity for both, and negative likelihood ratio 0.94 and 0.71 respectively; C: Magnetic resonance enterography showed thickness and proximal dilatation mean area under the ROC curve were 0.880 (P < 0.001) and 0.904 (P = 0.033) respectively, positive likelihood ratio 1.06 and infinity respectively, and negative likelihood ratio 0.88 for both.