Magnetic resonance enterography (MRE) is the current gold standard for imaging in inflammatory bowel disease, but ultrasound (US) is a potential alternative.
To determine whether US is as good as MRE for the detecting inflamed bowel, using a combined consensus score as the reference standard.
Materials and methods
We conducted a retrospective cohort study in children and adolescents <18 years with inflammatory bowel disease (IBD) at a tertiary and quaternary centre. We included children who underwent MRE and US within 4 weeks. We scored MRE using the London score and US using a score adapted from the METRIC (MR Enterography or Ultrasound in Crohn’s Disease) trial. Four gastroenterologists assessed an independent clinical consensus score. A combined consensus score using the imaging and clinical scores was agreed upon and used as the reference standard to compare MRE with US.
We included 53 children. At a whole-patient level, MRE scores were 2% higher than US scores. We used Lin coefficient to assess inter-observer variability. The repeatability of MRE scores was poor (Lin 0.6). Agreement for US scoring was substantial (Lin 0.95). There was a significant positive correlation between MRE and clinical consensus scores (Spearman’s rho = 0.598, P=0.0053) and US and clinical consensus scores (Spearman’s rho = 0.657, P=0.0016).
US detects as much clinically significant bowel disease as MRE. It is possible that MRE overestimates the presence of disease when using a scoring system. This study demonstrates the feasibility of using a clinical consensus reference standard in paediatric IBD imaging studies.
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We thank Dr. Antony Higginson, Prof. Stuart Taylor and Dr. Gauraang Bhatnagar for their permission to use the METRIC ultrasound scoring system and for their guidance when preparing the manuscript.
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Barber, J.L., Zambrano-Perez, A., Olsen, Ø.E. et al. Detecting inflammation in inflammatory bowel disease — how does ultrasound compare to magnetic resonance enterography using standardised scoring systems?. Pediatr Radiol 48, 843–851 (2018). https://doi.org/10.1007/s00247-018-4084-1
- Diagnostic accuracy
- Inflammatory bowel disease
- Magnetic resonance imaging