Abstract Background Inflammatory bowel diseases (IBD) are chronic diseases that require multiple endoscopic and imaging assessments, being diseases that not only involve a multitude of medical resources but patient compliance too. Bowel ultrasonography (BUS) and computed tomography (CT) have similar sensitivities (89.7% and 84.3%) and specificities (95.6% and 95.1%) in assessing IBD patients.Current guidelines recommend BUS altogether with other cross-sectional imaging methods to diagnose, monitor IBD patients and also for detecting complications and post-surgery recurrence Methods 36 Crohn’s disease patients with established endoscopic and histologic diagnosis were included in the study. Patients with moderate and severe disease were prospectively evaluated using two cross-sectional imaging methods (CT and BUS) by two different examiners. Patients with superimposed infection or with surgical history were excluded. The BUS examination was performed using 5-12 MHz micro-convex transducer with no special preparation before, while CT examination was performed using both intra-venous and oral contrasts. Both examiners were blinded to each other’s data. Different bowel wall characteristics were noted using the two methods. A subjective overall assessment of the obtained images was noted according to each examiner. Results A moderate correlation was observed between the measurements of bowel wall thickness using BUS and CT (Spearman’s equation, r= 0.504, p<0.01). Regarding bowel wall stratification, no corrrelation was observed using the two methods. Regarding the comb sign, there was no BUS surrogate for the CT observation. Doppler signal correlated well with the presence of bowel wall stratification observed using CT ( K= 0,36, p p<0.006). A very good agreement was noticed regarding mesenteric fat densification using the two imaging techniques ( k=0,55, p p<0.00006). A low but significantly statistic inter-observer agreement was obtained when lymph nodes were searched ( k=0.28, p p<0.03). When comparing the overall assessment of the examinators, we obtained a good inter-rater agreement (k=0.58, p<0.001) between the two cross-sectional techniques. Conclusion Several BUS and CT observations do not overlap even though the general aspect is similar. This happens when analizing bowel wall stratification that should be understood and applied in clinical pactice differently. The good inter-rater agreement between the two methods prooves that both investigations are useful and should be used according to availability.
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