{
  "abstract": "Small-bowel ultrasound (USS) is increasingly used in paediatric inflammatory bowel disease (IBD) owing to its safety, accessibility, and ability to provide real-time assessment. Magnetic resonance enterography (MRE) remains the reference standard for non-invasive evaluation of small-bowel inflammation because it enables assessment of transmural disease and detection of complications(1). However, comparative paediatric performance data remain limited, particularly regarding segment-specific accuracy and the identification of complications.To evaluate the real-world diagnostic accuracy and concordance of small-bowel USS compared with MRE for detecting small-bowel inflammation, segmental disease distribution, and complications in a paediatric cohort at a tertiary gastroenterology centre.A retrospective review was conducted of 66 children who underwent USS followed by MRE between 2020 and 2025. Demographic and clinical variables, including age, sex, and suspected and confirmed IBD phenotype, were collected. Imaging reports were coded as positive or negative for (1) terminal ileum (TI) involvement, (2) other small-bowel involvement, and (3) complications (stricture, fistula, abscess). MRE served as the reference standard. Diagnostic accuracy measures with 95% confidence intervals (CIs), concordance rates, and Cohen’s κ were calculated.Sixty-six children were included (25 female, 41 males; median age 13 years). Fifty were investigated for suspected new Crohn’s disease, of these, 45 were subsequently confirmed to have Crohn’s disease, 2 ulcerative colitis, 2 had non-IBD diagnoses and 1 IBD-unclassified. 13 children underwent imaging for reassessment of known Crohn’s disease and 3 for known ulcerative colitis. The mean waiting times between USS and MRE for new diagnoses was 206 days.USS demonstrated a sensitivity of 63.6% (95% CI 46.6–77.8) and specificity of 90.9% (95% CI 76.4–96.9) for detecting small-bowel inflammation, with a positive predictive value of 87.5% and a negative predictive value of 71.4%. Overall concordance with MRE was 77% (51/66), and Cohen’s κ was 0.55, indicating moderate agreement.Discordance occurred in 15/66 (23%) cases, predominantly due to USS-negative/MRE-positive findings (12/15). Most USS under-detection was attributable to limited acoustic windows. Agreement was higher for Terminal ileal disease than for proximal or deep small-bowel involvement. USS detected few complications compared with MRE, consistent with the latter’s superior ability to assess transmural and extraintestinal disease.In this paediatric cohort, USS showed high specificity and moderate sensitivity relative to MRE, with moderate overall concordance. Most discordant findings reflected technical rather than biological factors, with paediatric body habitus influencing acoustic windows and the sensitivity of ultrasound for small bowel disease detection. USS was less effective than MRE in delineating L4(proximal small bowel) and B2(structuring) disease. The long waiting times for MRE supports the use of USS as a pragmatic first-line cross-sectional imaging modality in paediatric IBD pathways, while emphasising the continued need for MRE when clinical suspicion of small-bowel disease persists despite a negative ultrasound.References van Rheenen PF, Aloi M, Assa A, et al. The medical management of paediatric Crohn’s disease: an ECCO–ESPGHAN guideline update. J Crohns Colitis. 2021;15(2):171–194.Bruining DH, Zimmermann EM, Loftus EV Jr, Sandborn WJ, Sauer CG, Strong SA, et al. Consensus recommendations for evaluation, interpretation, and utilisation of diagnostic imaging in paediatric Crohn’s disease. J Pediatr Gastroenterol Nutr. 2018;66(3):403–17.Kucharzik T, Koulaouzidis A, Mallant M, Armbruster M, Karstensen JG, Maconi G, et al. Use of intestinal ultrasound for monitoring paediatric inflammatory bowel disease: an international expert survey. J Crohns Colitis. 2021;15(7):1134–42.Aloi M, Pacifico L, Passariello R, Tromba V, Di Nardo G, Catalano C, et al. Magnetic resonance enterography, bowel ultrasound and capsule endoscopy in children with suspected Crohn’s disease. Aliment Pharmacol Ther. 2015;41(10):1054–62.Rimola J, Ordás I, Rodriguez S, García-Bosch O, Aceituno M, Llach J, et al. Magnetic resonance enterography identifies transmural inflammation and complications in Crohn’s disease. Gut. 2009;58(8):1113–20.Puylaert CAJ, Tielbeek JAW, Bipat S, Stoker J. Ultrasound of the bowel in paediatric inflammatory bowel disease: systematic review and meta-regression. Eur Radiol. 2017;27(9):3969–82.Di Nardo G, Aloi M, Oliva S, Ferrari F, Mallardo S, Casciani E, et al. Ultrasonography in paediatric Crohn’s disease: diagnostic accuracy and prediction of disease course. Clin Gastroenterol Hepatol. 2010;8(2):146–52.",
  "authors": [
    {
      "affiliations": [
        "Nottingham University Hospital"
      ],
      "name": "Abhishek Menon"
    },
    {
      "affiliations": [
        "Nottingham University Hospital"
      ],
      "name": "Sabrinathan Loganathan"
    },
    {
      "affiliations": [
        "Nottingham University Hospital"
      ],
      "name": "Zafar Zaidi"
    },
    {
      "affiliations": [
        "Nottingham University Hospital"
      ],
      "name": "Kathryn Allan"
    },
    {
      "affiliations": [
        "Nottingham University Hospital"
      ],
      "name": "Sian Kirkham"
    },
    {
      "affiliations": [
        "Nottingham University Hospital"
      ],
      "name": "David Devadason"
    }
  ],
  "title": "LBA11 Diagnostic concordance between small-bowel ultrasound and magnetic resonance enterography in paediatric inflammatory bowel disease: a retrospective study at a tertiary paediatric gastroenterology unit in the United Kingdom",
  "uid": "12a86035-5b46-587d-a492-aeec90c97959"
}