Abstract
Abstract Background The advantages of intestinal ultrasound (IUS) over magnetic resonance enterography (MRE) include wide availability, low cost, and the possibility of being point-of-care. We here aimed to compare the performance of IUS with MRE for assessing disease activity and complications in Crohn’s disease (CD). Methods Prospective longitudinal study of CD patients starting anti-TNF therapy. IUS and MRE were performed at baseline (W0) and after 1 year of infliximab therapy (W54). Bowel wall thickness (BWT) of the most affected segment (MAS) was measured in both exams (average of 4 measurements) and compared. Transmural response (TR) was defined as a reduction in 25% of BWT. All MRE were centrally reviewed by a blinded radiologist. Results We included 48 CD patients (48% male; median age 31 years, IQR 26-44). Ileum was the most commonly affected segment in 63% of the patients. At baseline the agreement between the two methods to select the most affected segment was moderate (k=0.581, p<0.001). At W54, 50% of patients had TR in IUS and 40% in MRE. After 1 year of therapy there was a significant decrease in median BWT in both methods (IUS: 4.88mm vs 3.22mm, MRE: 8.21mm vs 4.91mm, both p<0.001). We found a significant association between the two methods in detecting intestinal complications (stricturing or penetrating disease) on both timepoints (W0: 31.25% vs 21.73%; p<0.001; W54: 17.78% vs 20.83% ; p=0.004), and also a significant moderate to high correlation between BWT measured by IUS and MRE on both timepoints (W0:r=0.34, p=0.02; W54:r=0.58; p<0.001). The correlation was higher when the MAS was the ileum (W0 and W54: r=0.65, p<0.001). Conclusion We found a moderate to good agreement in the selection of MAS between IUS and MRE. There was also a moderate correlation between BWT measurements and detection of complications between the two methods, which increased when the MAS was the ileum. Our results suggest that IUS, a readily available and inexpensive tool, is accurate to evaluate disease activity and treatment response, particularly in patients with ileal disease.
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