Could ultrasound alone substitute MR imaging in evaluation of Crohn’s disease complications?

Crohn’s disease is a chronic disease that causes remitting and relapsing inflammatory episodes in the transmural part of the gastrointestinal system. It usually affects young people. The study sought to establish whether ultrasound can visualize important/useful diagnostic features and complications of the disease in the same way that MR enterography (MRE) can. The study is a prospective cohort of 133 patients of various disease stages (active and in remission) who had previously been seen by a gastroenterologist. All patients underwent abdominal and pelvic ultrasound examinations, with each of the five intestine segments checked independently for thickening and active inflammation. Complications of fistulas, abscesses, and stenosis were evaluated. Findings at MRE together with ileocolonoscopic results were deemed the standard reference. Ultrasound showed wall stenosis ranging from 5 to 12 mm, with a mean ± SD of 7.73 ± 2.30. A single loop was present in 69.2% of cases. The ileum was the most heavily involved loop portion (66.7%). In 72.9% of patients, stenosis and dilatation were present, whereas 69.7% showed active inflammation. Complications such as fistulas and abscess formation (21.2%) were identified. Ultrasound was found to be an effective tool for detecting stenosis and dilatation in the examined patients, with sensitivity of 84% and 87%, and specificity of 91% and 97%, respectively. A high accuracy of 90.9% was demonstrated for abscess formation. Ultrasound is a noninvasive method that is comparable to MRI for detecting damaged bowel segments and transmural complications such as bowel strictures, fistulas, and abscesses in Crohn’s disease patients. However, MR imaging is more comprehensive in providing detailed information about the disease's extent and activity.