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TOPLINE
Intestinal ultrasound (IUS) showed high accuracy in the detection of disease activity among children with small bowel Crohn's disease (CD) in the terminal and proximal ileum compared with magnetic resonance enterography (MRE). A bowel wall thickness (BWT) of 2.4 and 2.0 mm served as the optimal cutoff values for detecting disease activity in the terminal and proximal ileum, respectively.
METHODOLOGY
- Researchers conducted a prospective study to evaluate the diagnostic accuracy of IUS, compared with MRE, for identifying small bowel disease activity in children with CD.
- They included 78 children with CD (median age, 15 years; 49% girls) from a tertiary care centre in Amsterdam between 2019 and 2024 who underwent IUS and MRE scans within a week.
- MRE was conducted during routine care and was used as the reference. On the basis of MRE findings, mild inflammation was identified in 44 bowel segments, and moderate-to-severe inflammation was reported in 37 bowel segments.
- Certified ultrasonographers performed IUS without access to patients' clinical status and MRE findings. BWT was measured in the terminal ileum, ileum, and jejunum, along with other parameters such as colour Doppler signal, BW layer stratification, peristalsis, and mesenteric fat proliferation.
- Receiver operating characteristic curve analysis was used to determine the optimal thresholds for BWT and IUS scores, and the diagnostic accuracy of BWT, IUS scores, and other parameters was estimated.
TAKEAWAY
- For IUS BWT, the area under the curve (AUC) demonstrated excellent performance for detecting disease activity in the terminal ileum (0.91; 95% CI, 0.84-0.98) and very good performance for detecting disease activity in the proximal ileum (0.80; 95% CI, 0.66-0.94).
- For the jejunum, the AUC demonstrated moderate performance in identifying disease activity using IUS BWT (0.69; 95% CI, 0.52-0.86).
- For detecting disease activity, the optimal BWT cutoff values were 2.4 mm in the terminal ileum (sensitivity, 87.0%; specificity, 84.4%) and 2.0 mm in the proximal ileum (sensitivity, 76.0%; specificity, 92.5%). An accurate BWT cutoff value could not be established for the jejunum.
- No significant differences in BWT were observed between children aged 10-14 years and those aged 15-19 years across all bowel segments and levels of disease activity.
IN PRACTICE
"[The] results show that IUS is an accurate tool to non‐invasively assess disease activity in the TI [terminal ileum] and ileum and suggests it is less accurate for the jejunum," the authors wrote.
"Our findings support the integration of IUS as a first‐line diagnostic tool, with BWT as the most important IUS parameter," they added.
SOURCE
This study was led by Johanna M.B.W. Vos, Amsterdam University Medical Centre, Emma Children's Hospital, Amsterdam, Netherlands. It was published online on September 29, 2026, in the Journal of Pediatric Gastroenterology and Nutrition.
LIMITATIONS
The use of a standardised method to determine the proximal small bowel may have hindered IUS performance in the jejunum and ileum. The study only assessed the utility of B‐mode IUS.
DISCLOSURES
This study did not receive any specific funding. Two authors declared receiving grants, consultancy fees, honoraria, and/or travel support from various pharmaceutical, biotechnology, and diagnostic companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
