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P190. Small intestine contrast ultrasonography (SICUS) and CT-enteroclysis in the assessment of Crohn's disease lesions


E. Calabrese1, F. Zorzi1, S. Onali1, E. Stasi1, S. Prencipe1, G. Condino1, F. Pallone1, L. Biancone1

1University of Rome Tor Vergata, GI Unit, Medicine, Rome, Italy



Background: CT enteroclysis (CTE) is an imaging technique with the highest diagnostic accuracy for the detection of intestinal involvement of Crohn's disease (CD) including extramural complications. Several studies demonstrated that Small intestine contrast ultrasonography (SICUS) has emerged as a valuable and radiation-free technique in the detection of intestinal damage in CD. Our aim was to evaluate the diagnostic accuracy of SICUS for location, disease extent and complications in CD using CTE as gold standard.

Methods: Between January 2007 and September 2011, CD pts who underwent SICUS and CTE in a 6‑month interval were retrospectively identified. A total of 53 pts were included (30 males; median age 42; disease duration: median 156 mos; CD behavior: non-penetrating in 37 pts, penetrating in 16 pts; CD location: ileo-colonic in 20 pts, ileal in 28 pts, jejuno-ileal in 3 pts, colonic disease in pts 2; previous ileocolonic resection in 17 pts). SICUS was performed after PEG ingestion (375 mL). CTE was performed using 1500 mL of PEG administrated using an 8F naso-jejunal catheter and administration of intravenous iodinated contrast material using a 64-slice multi detector. Disease location in terms of bowel wall thickness (>3 mm) and lesion extent (cm), presence of complications (stenosis, pre-stenostic dilation, abscess, fistula) were considered using CTE as gold standard. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and diagnostic accuracy were calculated. Correlation (Spearman's test: r) between SICUS and CTE in the small bowel CD was calculated for maximum wall thickness and disease extent.

Results: Sensitivity, specificity, PPV, NPV and diagnostic accuracy of SICUS are shown in Table 1. SICUS and CTE showed a high correlations for bowel wall thickness (r = 0.796) and disease extent (r = 0.888) (p = 0.0001 for both).

Table 1
 Sensitivity (%)Specificity (%)PPV (%)NPV (%)Accuracy (%)
Location     
 Jejunum100100100100100
 Ileum97.866.695.88094.3
 Colon84.2979491.692.4
Stenosis94.7809285.790.5
Pre-stenotic dilation8566.660.78873.5
Abscess71.410010095.896.2
Fistula72.795.2809390.5

Conclusions: SICUS showed a high sensitivity, specificity and accuracy in the assessment of CD lesion and complications compared to CTE. SICUS may represent an alternative, radiation-free imaging modality for detection and monitoring of CD.