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P223 Bowel damage in Crohn’s disease: direct comparison of ultrasonography– and magnetic resonance–based Lemann index

N. Imperatore*1, A. Rispo1, A. Testa1, P. Mainenti2, G. D. De Palma1, M. Rea1, O.M. Nardone1, G. Luglio1, P. Gervetti1, M. L. Taranto1, F. Castiglione1

1University ‘Federico II’ of Naples, Department of Clinical Medicine and Surgery, Naples, Italy, 2University ‘Federico II’ of Naples, Naples, Italy

Background

The Lemann Index (LI) was developed to assess bowel damage (BD) in Crohn’s disease (CD). LI should be evaluated by using magnetic resonance (MR) or CT enterography in association with endoscopy. Our aim was to investigate the concordance between ultrasonography-based LI (US-LI) and MR-based LI (MR-LI).

Methods

We retrospectively evaluated all consecutive CD patients referred to our IBD unit from February to September 2015. All patients had undergone ileo-colonoscopy, US, and MR within 1 month. The US/MR diagnosis of CD and the assessment of extension/complications were performed in accordance with the current literature. US-LI and MR-LI were calculated for each patient by scoring: previous surgery, location, extension, and intestinal complications (Figure 1). Further, we evaluated the association between LI and CD duration (months) and Harvey–Bradshaw index (HBI) and other relevant clinical features. Further, in accordance with recent literature, a LI > 4.8 was considered indicative of BD. Statistical analysis included student t, ANOVA, Chi-square, Cohen’s k coefficient and Spearman’s r test. All differences were considered significant when p < 0.05.

Results

Finally, 30 CD patients were enrolled. Regarding CD location, 36% showed ileal disease (L1), 10% had an isolated colonic CD (L2), and 64% had an ileocolonic disease (L3). Moreover, 20% of patients presented a non-complicated behaviour (B1); 47% had almost one stricture (B2), and the remaining 33% shown a penetrating CD (B3). Perianal CD was observed in 23% of subjects, whereas 43% had undergone previous surgery. Mean HBI was 12.7+6. When calculating BD, mean US-LI and MR-LI were 6.44 (95% CI 3.6–9.2) and 6.9 (95% CI 4.2–9.7), respectively (k = 0.90; p < 0.001), with 16 patients (53%) showing a LI indicative of underlying BD. No significant correlation was evident between LI and HBI (p = 0.9), whereas a significant correlation was found between both US-LI and RM-LI and CD duration (p = 0.01).

Conclusion

US-LI shows high concordance with MR-LI and could be considered a good option for assessing BD in CD by using a highly available and relatively inexpensive procedure. Our data confirm the low accuracy of the current clinical activity indices in assessing BD in CD.