Impact of high-resolution transabdominal ultrasound in the diagnosis of complications of Crohn's disease.
OBJECTIVE
Crohn's disease is associated with intestinal complications such as strictures, fistulas and abscesses. As the management of the patients is influenced by the presence or absence of complication, sensitive diagnostic modalities to detect these complications are needed. The aim of this prospective study was to evaluate the diagnostic accuracy of high-resolution transabdominal ultrasound in the diagnosis of complications of Crohn's disease.


METHODS
From April 2003 to July 2009, 58 patients (31 women, 27 men; mean age 36.3 years, range 13-86 years) with known Crohn's disease were included in the study and investigated with high-resolution transabdominal ultrasound. The diagnosis of Crohn's disease was based on clinical, endoscopic, histological, radiological and operative findings. Patients with other forms of enteritis (e.g. infectious) were excluded from the study. Twenty of the 58 patients were investigated on a second occasion with other symptoms than at the first admission. The time duration between the two ultrasound investigations was at least 3 months. Consequently, a total of 78 ultrasound investigations were done in 58 patients. With respect to their clinical symptoms, all patients were further investigated within 2 weeks after ultrasound with magnetic resonance imaging, and/or computed tomography, and/or enteroclysis, and/or endoscopy with biopsy. Together with clinical data (Crohn's disease activity index) and surgical findings these investigations were used as reference procedure.


RESULTS
The sensitivity, specificity, positive predictive and negative predictive values of ultrasound were as follows: 0.86, 0.90, 0.83 and 0.92 for stenoses; 0.78, 0.95, 0.86, and 0.91 for fistulas; 0.90, 0.99, 0.90 and 0.99 for abscesses, respectively.


CONCLUSIONS
High-resolution transabdominal ultrasound done by experienced examiners has an excellent diagnostic accuracy in the diagnosis of complications in patients with Crohn's disease. Thus, it can be recommended as one of the primary investigative procedures for evaluation of Crohn's disease.
Department of Internal Medicine, AMEOS Hospital St. Salvator, Halberstadt, Germany.
Holger
H
Neye
Daniel
D
Ensberg
Peter
P
Rauh
Ulrich
U
Peitz
Klaus
K
Mönkemüller
Gerhard
G
Treiber
Sabine
S
Klauck
Peter
P
Malfertheiner
Steffen
S
Rickes
D018784:Abdominal Abscess / Q000000981:diagnostic imaging* / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003424:Crohn Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007412:Intestinal Fistula / Q000000981:diagnostic imaging* / Q000209:etiology; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult