Usefulness of transabdominal ultrasonography for assessing ulcerative colitis: a prospective, multicenter study

  • Kenji KinoshitaEmail author
  • Takehiko Katsurada
  • Mutsumi Nishida
  • Satomi Omotehara
  • Reizo Onishi
  • Katsuhiro Mabe
  • Aki Onodera
  • Mami Sato
  • Kazunori Eto
  • Mitsutoshi Suya
  • Atsuo Maemoto
  • Toru Hasegawa
  • Junji Yamamoto
  • Daiki Mitsumori
  • Shinji Yoshii
  • Kota Ono
  • Naoya Sakamoto
Original Article—Alimentary Tract



Transabdominal ultrasonography (US) has been reported to be a useful tool for evaluating ulcerative colitis (UC) although with less well-established data than for Crohn’s disease. This prospective multicenter study aimed to establish the usefulness of US compared with colonoscopy (CS) for assessing disease extent and activity of UC.


Altogether, 173 patients with UC were prospectively enrolled, among whom 156 were eligible for this study. All patients underwent US and CS within 2 days at five facilities. We divided the colon into six segments and examined each segment and the rectum using US and CS. US severity was graded 1–4 regarding bowel wall thickness, stratification, and ulceration. CS severity was also graded 1–4 according to Matts’ endoscopic classification. Concordance between US and CS grades for all colonic segments was analyzed using kappa statistics. US and CS findings were also compared with the clinical disease activity index (CAI) and histological grade using Spearman's correlation coefficient.


There was moderate concordance between US and CS grades in all colonic segments (weighted κ = 0.55, p < 0.001). Concordance was rated moderate for each colonic segment but only slight for the rectum. The US grade was significantly correlated with the CAI score (r = 0.40, p < 0.001) and histological grade (r = 0.35, p < 0.001).


This prospective multicenter study showed moderate concordance between US and CS for assessing the disease activity of UC. Hence, US may be used more generally for evaluating UC in daily clinical practice.


Ulcerative colitis Transabdominal ultrasonography Colonoscopy 



The authors would like to thank all the endoscopists and sonographers who participated in this study. This manuscript has been proofread by Edanz Group (



Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest associated with this manuscript.


  1. 1.
    Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med. 2011;365:1713–25.CrossRefGoogle Scholar
  2. 2.
    Ordás I, Eckmann L, Talamini M, et al. Ulcerative colitis. Lancet. 2012;380:1606–19.CrossRefGoogle Scholar
  3. 3.
    Dignass A, Lindsay JO, Sturm A, et al. Second European evidence-based consensus on the diagnosis and management of ulcerative colitis part 2: current management. J Crohns Colitis. 2012;6:991–1030.CrossRefGoogle Scholar
  4. 4.
    Damore LJ II, Rantis PC, Vernava AM III, et al. Colonoscopic perforations. Etiology, diagnosis, and management. Dis Colon Rectum. 1996;39:1308–14.CrossRefGoogle Scholar
  5. 5.
    Levin TR, Conell C, Shapiro JA, et al. Complications of screening flexible sigmoidoscopy. Gastroenterology. 2002;123:1786–92.CrossRefGoogle Scholar
  6. 6.
    Peloquin JM, Pardi DS, Sandborn WJ, et al. Diagnostic ionizing radiation exposure in a population-based cohort of patients with inflammatory bowel disease. Am J Gastroenterol. 2008;103:2015–22.CrossRefGoogle Scholar
  7. 7.
    Jaffe TA, Gaca AM, Delaney S, et al. Radiation doses from small-bowel follow-through and abdominopelvic MDCT in Crohn's disease. Am J Roentgenol. 2007;189:1015–22.CrossRefGoogle Scholar
  8. 8.
    Ajaj WM, Lauenstein TC, Pelster G, et al. Magnetic resonance colonography for the detection of inflammatory diseases of the large bowel: quantifying the inflammatory activity. Gut. 2005;54:257–63.CrossRefGoogle Scholar
  9. 9.
    Ordas I, Rimola J, Garcia-Bosch O, et al. Diagnostic accuracy of magnetic resonance colonography for the evaluation of disease activity and severity in ulcerative colitis: a prospective study. Gut. 2013;62:1566–72.CrossRefGoogle Scholar
  10. 10.
    Horsthuis K, Bipat S, Bennink RJ, et al. Inflammatory bowel disease diagnosed with US, MR, scintigraphy, and CT: meta-analysis of prospective studies. Radiology. 2008;247:64–79.CrossRefGoogle Scholar
  11. 11.
    Hata J, Haruma K, Suenaga K, et al. Ultrasonographic assessment of inflammatory bowel disease. Am J Gastroenterol. 1992;87:443–7.Google Scholar
  12. 12.
    Parente F, Greco S, Molteni M, et al. Imaging inflammatory bowel disease using bowel ultrasound. Eur J Gastroenterol Hepatol. 2005;17:283–91.CrossRefGoogle Scholar
  13. 13.
    Calabrese E, Maaser C, Zorzi F, et al. Bowel ultrasonography in the management of Crohn's disease. A review with recommendations of an international panel of experts. Inflamm Bowel Dis. 2016;22:1168–83.CrossRefGoogle Scholar
  14. 14.
    Migaleddu V, Quaia E, Scano D, et al. Inflammatory activity in Crohn disease: ultrasound findings. Abdom Imaging. 2008;33:589–97.CrossRefGoogle Scholar
  15. 15.
    Fraquelli M, Sarno A, Girelli C, et al. Reproducibility of bowel ultrasonography in the evaluation of Crohn's disease. Dig Liver Dis. 2008;40:860–6.CrossRefGoogle Scholar
  16. 16.
    Parente F, Maconi G, Bollani S, et al. Bowel ultrasound in assessment of Crohn's disease and detection of related small bowel strictures: a prospective comparative study versus X-ray and intraoperative findings. Gut. 2002;50:490–5.CrossRefGoogle Scholar
  17. 17.
    Parente F, Greco S, Molteni M, et al. Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn's disease. A prospective comparison with conventional ultrasound, X-ray studies, and ileocolonoscopy. Gut. 2004;53:1652–7.CrossRefGoogle Scholar
  18. 18.
    Dietrich CF. Significance of abdominal ultrasound in inflammatory bowel disease. Dig Dis. 2009;27:482–93.CrossRefGoogle Scholar
  19. 19.
    Martinez MJ, Ripolles T, Paredes JM, et al. Assessment of the extension and the inflammatory activity in Crohn's disease: comparison of ultrasound and MRI. Abdom Imaging. 2009;34:141–8.CrossRefGoogle Scholar
  20. 20.
    Civitelli F, Di Nardo G, Oliva S, et al. Ultrasonography of the colon in pediatric ulcerative colitis: a prospective, blind, comparative study with colonoscopy. J Pediatr. 2014;165(78–84):e2.Google Scholar
  21. 21.
    Parente F, Molteni M, Marino B, et al. Are colonoscopy and bowel ultrasound useful for assessing response to short-term therapy and predicting disease outcome of moderate-to-severe forms of ulcerative colitis? A prospective study. Am J Gastroenterol. 2010;105:1150–7.CrossRefGoogle Scholar
  22. 22.
    Parente F, Molteni M, Marino B, et al. Bowel ultrasound and mucosal healing in ulcerative colitis. Dig Dis. 2009;27:285–90.CrossRefGoogle Scholar
  23. 23.
    Antonelli E, Giuliano V, Casella G, et al. Ultrasonographic assessment of colonic wall in moderate-severe ulcerative colitis: comparison with endoscopic findings. Dig Liver Dis. 2011;43:703–6.CrossRefGoogle Scholar
  24. 24.
    Maconi G, Ardizzone S, Parente F, et al. Ultrasonography in the evaluation of extension, activity, and follow-up of ulcerative colitis. Scand J Gastroenterol. 1999;34:1103–7.CrossRefGoogle Scholar
  25. 25.
    Rachmilewitz D. Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: a randomised trial. BMJ. 1989;298:82–6.CrossRefGoogle Scholar
  26. 26.
    Satsangi J, Silverberg MS, Vermeire S, et al. The Montreal classification of inflammatory bowel disease: controversies, consensus, and implications. Gut. 2006;55:749–53.CrossRefGoogle Scholar
  27. 27.
    Hata J, Haruma K, Yamanaka H, et al. Ultrasonographic evaluation of the bowel wall in inflammatory bowel disease: comparison of in vivo and in vitro studies. Abdom Imaging. 1994;19:395–9.CrossRefGoogle Scholar
  28. 28.
    Wada T, Nishida M, Kudo Y, et al. Comparison between transabdominal ultrasound and colonoscopy in evaluating disease activity of ulcerative colitis (in Japanese). Jpn J Med Ultrasound Technol. 2015;40:141–9.Google Scholar
  29. 29.
    Matts SG. The value of rectal biopsy in the diagnosis of ulcerative colitis. Q J Med. 1961;30:393–407.Google Scholar
  30. 30.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefGoogle Scholar
  31. 31.
    Maconi G. Ultrasonography in the evaluation of extension, activity, and follow-up of ulcerative colitis. Scand J Gastroenterol. 2009;34:1103–7.CrossRefGoogle Scholar
  32. 32.
    Arienti V, Campieri M, Boriani L, et al. Management of severe ulcerative colitis with the help of high resolution ultrasonography. Am J Gastroenterol. 1996;91:2163–9.Google Scholar
  33. 33.
    Pascu M, Roznowski AB, Muller HP, et al. Clinical relevance of transabdominal ultrasonography and magnetic resonance imaging in patients with inflammatory bowel disease of the terminal ileum and large bowel. Inflamm Bowel Dis. 2004;10:373–82.CrossRefGoogle Scholar
  34. 34.
    Bremner AR, Griffiths M, Argent JD, et al. Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study. Pediatr Radiol. 2006;36:947–53.CrossRefGoogle Scholar
  35. 35.
    Girlich C, Schacherer D, Jung EM, et al. Comparison between quantitative assessment of bowel wall vascularization by contrast-enhanced ultrasound and results of histopathological scoring in ulcerative colitis. Int J Colorectal Dis. 2012;27:193–8.CrossRefGoogle Scholar
  36. 36.
    Socaciu M, Ciobanu L, Diaconu B, et al. Non-invasive assessment of inflammation and treatment response in patients with Crohn's disease and ulcerative colitis using contrast-enhanced ultrasonography quantification. J Gastrointest Liver Dis. 2015;24:457–65.Google Scholar
  37. 37.
    Haber HP, Busch A, Ziebach R, et al. Ultrasonographic findings correspond to clinical, endoscopic, and histologic findings in inflammatory bowel disease and other enterocolitides. Journal of ultrasound in medicine. J Ultrasound Med. 2002;21:375–82.CrossRefGoogle Scholar
  38. 38.
    Romanini L, Passamonti M, Navarria M, et al. Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease. Eur J Radiol. 2014;83:1317–23.CrossRefGoogle Scholar
  39. 39.
    Baert F, Moortgat L, Van Assche G, et al. Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn's disease. Gastroenterology. 2010;138:463–8 (quiz e10–1).CrossRefGoogle Scholar
  40. 40.
    Bryant RV, Burger DC, Delo J, et al. Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut. 2016;65:408–14.CrossRefGoogle Scholar
  41. 41.
    Walsh A, Palmer R, Travis S. Mucosal healing as a target of therapy for colonic inflammatory bowel disease and methods to score disease activity. Gastrointest Endosc Clin N A. 2014;24:367–78.CrossRefGoogle Scholar
  42. 42.
    Mosli MH, Feagan BG, Sandborn WJ, et al. Histologic evaluation of ulcerative colitis: a systematic review of disease activity indices. Inflamm Bowel Dis. 2014;20:564–75.CrossRefGoogle Scholar
  43. 43.
    Parente F, Greco S, Molteni M, et al. Role of early ultrasound in detecting inflammatory intestinal disorders and identifying their anatomical location within the bowel. Aliment Pharmacol Ther. 2003;18:1009–16.CrossRefGoogle Scholar
  44. 44.
    Mak WY, Buisson A, Andersen MJ Jr, et al. Fecal calprotectin in assessing endoscopic and histological remission in patients with ulcerative colitis. Dig Dis Sci. 2018;63:1294–301.CrossRefGoogle Scholar
  45. 45.
    Kopylov U, Rosenfeld G, Bressler B, et al. Clinical utility of fecal biomarkers for the diagnosis and management of inflammatory bowel disease. Inflamm Bowel Dis. 2014;20:742–56.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Kenji Kinoshita
    • 1
    Email author
  • Takehiko Katsurada
    • 1
  • Mutsumi Nishida
    • 2
    • 3
  • Satomi Omotehara
    • 2
    • 3
  • Reizo Onishi
    • 1
  • Katsuhiro Mabe
    • 4
  • Aki Onodera
    • 5
  • Mami Sato
    • 5
  • Kazunori Eto
    • 6
  • Mitsutoshi Suya
    • 7
  • Atsuo Maemoto
    • 8
  • Toru Hasegawa
    • 9
  • Junji Yamamoto
    • 10
  • Daiki Mitsumori
    • 11
  • Shinji Yoshii
    • 12
  • Kota Ono
    • 13
  • Naoya Sakamoto
    • 1
  1. 1.Department of Gastroenterology and HepatologyHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Division of Laboratory and Transfusion MedicineHokkaido University HospitalSapporoJapan
  3. 3.Diagnostic Center for SonographyHokkaido University HospitalSapporoJapan
  4. 4.Department of GastroenterologyNational Hospital Organization Hakodate HospitalHakodateJapan
  5. 5.Department of Clinical LaboratoryTomakomai City HospitalTomakomaiJapan
  6. 6.Department of GastroenterologyTomakomai City HospitalTomakomaiJapan
  7. 7.Department of Clinical LaboratorySapporo Higashi Tokushukai HospitalSapporoJapan
  8. 8.Inflammatory Bowel Disease CenterSapporo Higashi Tokushukai HospitalSapporoJapan
  9. 9.Department of Clinical LaboratoryOhguro Gastroenterological HospitalSapporoJapan
  10. 10.Ohguro Gastroenterological HospitalSapporoJapan
  11. 11.Department of Clinical LaboratorySapporo Medical Center NTT ECSapporoJapan
  12. 12.Department of GastroenterologySapporo Medical Center NTT ECSapporoJapan
  13. 13.Clinical Research and Medical Innovation CenterHokkaido University HospitalSapporoJapan

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