Reproducibility of bowel ultrasonography in the evaluation of Crohn's disease.
BACKGROUND
Bowel ultrasonography is increasingly used in the detection and follow-up of patients with Crohn's disease, but a limitation to its further diffusion is the lack of standardisation of ultrasonography parameters.


OBJECTIVE
This study aimed to standardise the most common bowel ultrasonography parameters in order to develop an unequivocal imaging interpretation and to assess bowel ultrasonography reproducibility.


METHODS
Twenty patients with Crohn's disease were examined.


METHODS
Six ultrasonographers (mean bowel ultrasonography experience=16 years) performed the study. They chose and discussed a common assessment methodology concerning eight ultrasonography parameters: bowel wall thickness, bowel wall pattern, bowel wall blood flow, enlarged mesenteric lymph nodes, mesenteric hypertrophy, abdominal free fluid, and stenosis or fistulae at four preliminary meetings. The day of the study operators were randomised to two rooms where they independently and in turn performed ultrasonography scans. Interobserver agreement was scored by kappa statistics.


RESULTS
Excellent k values were observed for bowel wall thickness (0.72-1). k Values were poor for bowel wall pattern (-0.22-0.85) and good for bowel wall blood flow (0.53-0.89). The presence of lymph nodes was reproducible (0.56-0.90) except in one case (0.25). Concordance on free fluid was excellent (0.85-1), whereas that on mesenteric hypertrophy was generally poor (0.14-0.69). Agreement was excellent for stenosis (0.81-1) whereas that for fistula was fair in room abscesses (0.31-0.48) and very good in room B (0.87-1).


CONCLUSIONS
Bowel ultrasonography signs used in Crohn's disease can be standardised as most of them showed a fair to good reproducibility. In particular, bowel wall thickness, the most relevant parameter for Crohn's disease detection, showed an excellent reproducibility.
Fraquelli
M
M
Second Division Gastroenterology, Fondazione IRCCS Ospedale Policlinico, Mangiagalli e Regina Elena, Milan, Italy. mfraquelli@yahoo.it
Sarno
A
A
Girelli
C
C
Laudi
C
C
Buscarini
E
E
Villa
C
C
Robotti
D
D
Porta
P
P
Cammarota
T
T
Ercole
E
E
Rigazio
C
C
Senore
C
C
Pera
A
A
Malacrida
V
V
Gallo
C
C
Maconi
G
G
D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology; D019160:Endosonography / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D015994:Incidence; D007558:Italy; D008198:Lymph Nodes / Q000000981:diagnostic imaging* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011336:Probability; D015203:Reproducibility of Results; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index