title: Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study.
abstract: BACKGROUND
  Children with inflammatory bowel disease (IBD) undergo invasive and repeated investigations, including contrast radiology and endoscopy.
  
  
  OBJECTIVE
  To assess transabdominal sonography of the colon and distal ileum compared to colonoscopy and barium radiology in known or suspected IBD.
  
  
  METHODS
  A prospectively recruited cohort of 44 children (median age 12 years, range 3.5-16.5 years; 24 males) underwent transabdominal sonography prior to colonoscopy (n=33) or barium follow-through (n=25). Diagnoses were: Crohn disease (n=25), ulcerative colitis (n=12), indeterminate colitis (n=1), normal (n=6).
  
  
  RESULTS
  Bowel wall thickness (BWT) and endoscopic severity were compared in 153 colonic segments. No difference was found between normal and mildly affected segments. BWT was less in normal bowel than moderate (P<0.001) or severe (P<0.001) lesions. Where BWT was >2.9 mm, sensitivity for moderate/severe disease was 48%, specificity 93%, positive predictive value 83% (likelihood ratio 7). Barium radiology showed terminal ileum abnormality in ten patients (40%). Where ileal BWT was >2.5 mm, comparative sensitivity was 75%, specificity 92%, positive predictive value 88% (likelihood ratio 9). Superior mesenteric artery Doppler did not correlate with disease severity.
  
  
  CONCLUSIONS
  Increased BWT has good positive predictive value for moderate/severe disease in the colon proximal to the rectum (>3 mm), and terminal ileum (>2.5 mm). BWT below this cannot exclude moderate/severe mucosal lesions.
authors.affiliation: Paediatric Medical Unit, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
authors.forename: A Ronald
authors.initials: AR
authors.lastname: Bremner
authors.forename: Mark
authors.initials: M
authors.lastname: Griffiths
authors.forename: Julie D
authors.initials: JD
authors.lastname: Argent
authors.forename: Joanna J
authors.initials: JJ
authors.lastname: Fairhurst
authors.forename: R Mark
authors.initials: RM
authors.lastname: Beattie
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001466:Barium Sulfate; D002648:Child; D002675:Child, Preschool; D003113:Colonoscopy; D003287:Contrast Media; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000000981:diagnostic imaging*; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014463:Ultrasonography
chemical_list: D003287:Contrast Media; D001466:Barium Sulfate