Introduction SICUS accurately assesses small bowel lesions in patients with Crohn’s disease (CD) without exposure to diagnostic medical radiation.1 Its role in identifying intra-abdominal complications associated with CD remains to be confirmed. The aim of this retrospective study was to compare the diagnostic sensitivity of SICUS with subsequent surgical findings.
Methods Patients with CD evaluated by SICUS who subsequently required bowel resection within 6 months were identified. Radiological findings and operation notes were collated. The accuracy and agreement of SICUS to detect the site and length of strictures, fistulae, abscesses and mucosal thickening, was compared with surgical findings and assessed by kappa (κ) coefficient statistical analysis. Stricture lengths were compared using student’s t-test. CRP and platelet count were recorded within 2 weeks of SICUS and surgery as surrogate markers of disease activity.
Results A total of 25 patients (12 male) with a mean age of 29.9 years were included in the study. Mean time from SICUS to respective bowel surgery was 91.5 days (Range 5–176). Ultrasonographic and surgical inter-rater agreement was good for the presence of strictures (κ=0.73, sensitivity and specificity both 88%), their number (κ=0.65, 95% CI: 0.31–0.96) and stricture site (κ =0.72, 95% CI: 0.44–1.00). Stricture length was 7.4 ± 1.5 cm identified at surgery vs. 5.8 ± 1.8 cm by SICUS (NS). Agreement was excellent for the presence of fistulae (κ = 0.82, sensitivity 86%, specificity 94%), location of fistula (κ=0.92, 95% CI: 0.76–1.00), presence of abscess (κ = 0.87, sensitivity 100%, specificity 95%) and its location (κ = 0.87, 95% CI: 0.63–1.00). Agreement was moderate for mucosal wall thickening (κ = 0.51, sensitivity 95%, specificity 50%). Markers of inflammation (CRP and platelet count) showed no significant difference at the time of SICUS and surgery.
Conclusion SICUS accurately identifies small bowel complications in CD and offers an alternative in the pre-operative stage of CD complications. Its wider use should be adopted.
Chatu S, Pilcher J, Saxena SK, et al. Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn’s disease: comparative study from the UK. Clin Radiol 2012 Jun;67(6):553–9
Disclosure of Interest None Declared.