TY - JOUR

T1 - Expert consensus on optimal acquisition and development of the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS)

T2 - a reliability and inter-rater variability study on intestinal ultrasonography in Crohn's Disease

AU - Novak, Kerri L

AU - Nylund, Kim

AU - Maaser, Christian

AU - Petersen, Frauke

AU - Kucharzik, Torsten

AU - Lu, Cathy

AU - Allocca, Mariangela

AU - Maconi, Giovanni

AU - de Voogd, Floris

AU - Christensen, Britt

AU - Vaughan, Rose

AU - Palmela, Carolina

AU - Carter, Dan

AU - Wilkens, Rune

N1 - © The Author(s) 2020. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.

PY - 2021

Y1 - 2021

N2 - BACKGROUND AND AIMS: Intestinal ultrasound (IUS) is an accurate, patient-centered monitoring tool that objectively evaluates Crohn's disease (CD) activity. However, no current, widely accepted, reproducible activity index exists to facilitate consistent IUS identification of inflammatory activity. The aim of this study is to identify key parameters of CD inflammation on IUS, evaluate their reliability and develop an IUS index reflecting segmental activity.METHODS: There were 3 phases: 1) expert consensus Delphi method to derive measures of IUS activity; 2) an initial, multi-expert case acquisition and expert-interpretation of 20 blinded cases to measure inter-rater reliability for individual measures; 3) refinement of case acquisition and interpretation by 12 international experts, with 30 blinded case reads with reliability assessment and development of a segmental activity score.RESULTS: Delphi Consensus: Eleven experts representing 7 countries identified four key parameters including (1) bowel wall thickness (BWT) (2) bowel wall stratification (3) hyperemia of the wall [color Doppler imaging] and (4) inflammatory mesenteric fat. Blind Read: Each variable exhibited moderate to substantial reliability. Optimal, standardized image and cineloop acquisition were established. Second Blind Read and score development: intra-class correlation coefficient (ICC) for BWT was almost perfect 0.96 (0.94-0.98). All 4 parameters correlated with the global disease activity assessment and were included in the final International Bowel Ultrasound Segmental Activity Score with almost perfect ICC [0.97 (0.95-0.99, p<0.001)].CONCLUSIONS: Using expert consensus and standardized approaches, identification of key activity measurements on IUS has been achieved and a segmental activity score has been proposed, demonstrating excellent reliability.

AB - BACKGROUND AND AIMS: Intestinal ultrasound (IUS) is an accurate, patient-centered monitoring tool that objectively evaluates Crohn's disease (CD) activity. However, no current, widely accepted, reproducible activity index exists to facilitate consistent IUS identification of inflammatory activity. The aim of this study is to identify key parameters of CD inflammation on IUS, evaluate their reliability and develop an IUS index reflecting segmental activity.METHODS: There were 3 phases: 1) expert consensus Delphi method to derive measures of IUS activity; 2) an initial, multi-expert case acquisition and expert-interpretation of 20 blinded cases to measure inter-rater reliability for individual measures; 3) refinement of case acquisition and interpretation by 12 international experts, with 30 blinded case reads with reliability assessment and development of a segmental activity score.RESULTS: Delphi Consensus: Eleven experts representing 7 countries identified four key parameters including (1) bowel wall thickness (BWT) (2) bowel wall stratification (3) hyperemia of the wall [color Doppler imaging] and (4) inflammatory mesenteric fat. Blind Read: Each variable exhibited moderate to substantial reliability. Optimal, standardized image and cineloop acquisition were established. Second Blind Read and score development: intra-class correlation coefficient (ICC) for BWT was almost perfect 0.96 (0.94-0.98). All 4 parameters correlated with the global disease activity assessment and were included in the final International Bowel Ultrasound Segmental Activity Score with almost perfect ICC [0.97 (0.95-0.99, p<0.001)].CONCLUSIONS: Using expert consensus and standardized approaches, identification of key activity measurements on IUS has been achieved and a segmental activity score has been proposed, demonstrating excellent reliability.

U2 - 10.1093/ecco-jcc/jjaa216

DO - 10.1093/ecco-jcc/jjaa216

M3 - Journal article

C2 - 33098642

JO - Journal of Crohn's and Colitis

JF - Journal of Crohn's and Colitis

SN - 1873-9946

ER -