Diagnostic accuracy of small intestine ultrasonography using an oral contrast agent in Crohn's disease: comparative study from the UK

Clin Radiol. 2012 Jun;67(6):553-9. doi: 10.1016/j.crad.2011.11.005. Epub 2011 Dec 31.


Aim: To evaluate the usefulness of small intestine contrast-enhanced ultrasonography (SICUS) using an oral contrast agent in routine clinical practice by assessing the level of agreement with the established techniques, small bowel follow-through (SBFT) and computed tomography (CT), and diagnostic accuracy compared with the final diagnosis in the detection of small bowel Crohn's disease (CD) and luminal complications in a regional centre.

Materials and methods: All symptomatic known or suspected cases of CD who underwent SICUS were retrospectively reviewed. The level of agreement between SICUS and SBFT, CT, histological findings, and C-reactive protein (CRP) level was assessed using kappa (κ) coefficient. Sensitivity was demonstrated using the final diagnosis as the reference standard defined by the outcome of clinical assessment, follow-up, and results of investigations other than SICUS.

Results: One hundred and forty-three patients underwent SICUS of these 79 (55%) were female. Eighty-six (60%) were known to have CD and 57 (40%) had symptoms suggestive of intestinal disease with no previous diagnosis. Forty-six (55%) of the known CD patients had had at least one previous surgical resection. The sensitivity of SICUS in detecting active small bowel CD in known CD and undiagnosed cases was 93%. The kappa coefficient was 0.88 and 0.91 with SBFT and CT, respectively. SICUS detected nine patients who had one or more small bowel strictures and six patients with a fistula all detected by SBFT or CT.

Conclusion: SICUS is not only comparable to SBFT and CT but avoids radiation exposure and should be more widely adopted in the UK as a primary diagnostic procedure and to monitor disease complications in patients with CD.

Publication types

  • Comparative Study

MeSH terms

  • Administration, Oral
  • Adult
  • C-Reactive Protein
  • Contrast Media*
  • Crohn Disease / diagnostic imaging*
  • Diagnosis, Differential
  • Female
  • Follow-Up Studies
  • Humans
  • Image Enhancement / methods
  • Intestinal Diseases / diagnostic imaging
  • Intestine, Small / diagnostic imaging*
  • Iohexol
  • Male
  • Predictive Value of Tests
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Tomography, X-Ray Computed / methods
  • Ultrasonography, Doppler / methods
  • United Kingdom


  • Contrast Media
  • Iohexol
  • C-Reactive Protein