An award-winning study demonstrated that small intestinal contrast ultrasound (SICUS) can accurately identify the extent and activity of small-bowel Crohn’s disease (SB CD) when compared to cross-sectional imaging by magnetic resonance/computed tomography enterography (MRE/CTE).

The research, presented by Partha Pal, MD, of the Asian Institute of Gastroenterology
 in Hyderabad, Telangana, India, won the ACG Outstanding Research Award in the IBD Category.

The investigators noted that MRE and CTE are well established as superior imaging modalities for the assessment of SB CD. However, they pointed out, the role of SICUS in assessing disease activity needs more study. In their study, adult patients with known SB CD underwent SICUS prior to CTE (n=75) or MRE (n=39) to compare the accuracy of SICUS for detecting SB disease presence, extent, maximum bowel wall thickness (BWT), length of involvement, and complications (strictures, fistulas), and its impact on management to that of MRE/CTE.

In the assessment of 111 patients (median age 35 years, 56% male) SICUS showed sensitivity/specificity of 95.2%/100%; positive predictive value (PPV) of 100%; negative predictive value (NPV) of 58.3%; and accuracy of 95.5% for detecting SB CD. For disease extent, SICUS had sensitivity/specificity of 87.4%/87.5%, PPV 98.9%, NPV 35%, and accuracy 87.4%. Its sensitivity/specificity for detecting strictures were 76.5% (58.8% with IUS alone)/98.3%, PPV 97.5%, NPV 83.1%, and accuracy 88.3%; for fistulas, 80%/99%, PPV 80%, NPV 99%, and accuracy 98.2%.

SICUS correlated strongly with cross-sectional imaging for BWT (Spearman’s R=0.723, p< 0.001) and length of involvement (R=0.834, p< 0.001). Missed lesions were primarily in proximal and mid-small bowel. Overall, management changed in 17% of patients (n=19) after CTE/MRE.

The researchers concluded that SICUS accurately identifies the activity, extent, and complications, of small-bowel Crohn’s disease, with limited impact on management decisions compared to cross-sectional imaging. It is particularly beneficial for detecting strictures in the small bowel, they found. Cross-sectional imaging remains valuable for proximal and mid-small bowel involvement. (Clinicaltrials.gov: NCT06125678).

Reference:

Pal P, Mateen MA, Pooja K, et al. 2 - Correlation and assessment of small bowel lesions using cross-sectional imaging techniques vs small intestinal contrast ultrasonography in known Crohn’s disease (CACTUS-CD trial): a paired, validating study (nct06125678). Presented at: American College of Gastroenterology. October 28, 2024. Philadelphia, Pennsylvania.