Aim
To compare the diagnostic yield of small intestinal contrast ultrasonography (SICUS) with magnetic resonance enterography (MRE) in routine clinical practice in a cohort of paediatric patients investigated for Crohn’s disease (CD) attending a UK tertiary centre.
Methods and results
Patients with suspected or established CD who underwent SICUS were identified retrospectively. SICUS was compared to conventional trans-abdominal ultrasound (TUS), ileocolonoscopy (IC) and MRE. Accuracy and agreement of SICUS in detecting small bowel lesions and CD-related complications were assessed using kappa (κ) coefficient statistics. Ninety-three patients (median age 15 years, range 2–17, 49 male) underwent SICUS; 58 had suspected and 35 established CD. In suspected CD, sensitivity and specificity of SICUS in detecting CD small bowel lesions were 81.8% and 100% and for trans-abdominal ultrasound (TUS) 85.7% and 87.5%, respectively. In established CD, sensitivity and specificity of SICUS were 98.7% and 100% and TUS 80% and 100%, respectively. Agreement between SICUS and IC was substantial for the presence of lesions (κ=0.73) but fair with TUS (κ=0.31). Agreement between SICUS and IC was almost perfect for detecting strictures (κ=0.84) with a sensitivity of 100% and specificity of 97.6%. When comparing SICUS and TUS with MRE, agreement for the presence of lesions was substantial (κ=0.63) and moderate (κ=0.53) respectively. Agreement between SICUS and MRE was substantial for detecting strictures (κ=0.77) and dilatation (κ=0.68).
Conclusions
SICUS offers a radiation-free alternative for assessing paediatric small bowel CD, with diagnostic accuracy that is comparable to MRE and IC, supporting its wider use in routine practice.