Inflammatory Bowel Disease Diagnosed with US, MR, Scintigraphy, and CT: Meta-analysis of Prospective Studies

Purpose: To compare, by performing a meta-analysis, the accuracies of ultrasonography (US), magnetic resonance (MR) imaging, scintigraphy, computed tomography (CT), and positron emission tomography (PET) in the diagnosis of inflammatory bowel disease (IBD).

Materials and Methods: MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched for studies on the accuracy of US, MR imaging, scintigraphy, CT, and PET, as compared with a predefined reference standard, in the diagnosis of IBD. Sensitivity and specificity estimates were calculated on per-patient and per-bowel-segment bases by using a bivariate random-effects model.

Results: Thirty-three studies, from a search that yielded 1406 articles, were included in the final analysis. Mean sensitivity estimates for the diagnosis of IBD on a per-patient basis were high and not significantly different among the imaging modalities (89.7%, 93.0%, 87.8%, and 84.3% for US, MR imaging, scintigraphy, and CT, respectively). Mean per-patient specificity estimates were 95.6% for US, 92.8% for MR imaging, 84.5% for scintigraphy, and 95.1% for CT; the only significant difference in values was that between scintigraphy and US (P = .009). Mean per-bowel-segment sensitivity estimates were lower: 73.5% for US, 70.4% for MR imaging, 77.3% for scintigraphy, and 67.4% for CT. Mean per-bowel-segment specificity estimates were 92.9% for US, 94.0% for MR imaging, 90.3% for scintigraphy, and 90.2% for CT. CT proved to be significantly less sensitive and specific compared with scintigraphy (P = .006) and MR imaging (P = .037)

Conclusion: No significant differences in diagnostic accuracy among the imaging techniques were observed. Because patients with IBD often need frequent reevaluation of disease status, use of a diagnostic modality that does not involve the use of ionizing radiation is preferable.

Supplemental material:

© RSNA, 2008


  • 1 FriedmanS, Blumberg RS. Inflammatory bowel disease. In: Harrison's principles of internal medicine. 16th ed. New York, NY: McGraw-Hill, 2005. Google Scholar
  • 2 HommesDW, van Deventer SJ. Endoscopy in inflammatory bowel diseases. Gastroenterology2004;126(6):1561–1573. Crossref, MedlineGoogle Scholar
  • 3 StangeEF, Travis SP, Vermeire S, et al. European evidence based consensus on the diagnosis and management of Crohn's disease: definitions and diagnosis. Gut2006;55(suppl 1):i1–i15. Crossref, MedlineGoogle Scholar
  • 4 MaglinteDD. Small bowel imaging: a rapidly changing field and a challenge to radiology. Eur Radiol2006;16(5):967–971. Crossref, MedlineGoogle Scholar
  • 5 FlorieJ, Horsthuis K, Hommes DW, et al. Magnetic resonance imaging compared with ileocolonoscopy in evaluating disease severity in Crohn's disease. Clin Gastroenterol Hepatol2005;3(12):1221–1228. Crossref, MedlineGoogle Scholar
  • 6 LaghiA, Borrelli O, Paolantonio P, et al. Contrast enhanced magnetic resonance imaging of the terminal ileum in children with Crohn's disease. Gut2003;52(3):393–397. Crossref, MedlineGoogle Scholar
  • 7 ShoenutJP, Semelka RC, Silverman R, Yaffe CS, Micflikier AB. Magnetic resonance imaging in inflammatory bowel disease. J Clin Gastroenterol1993;17(1):73–78. Crossref, MedlineGoogle Scholar
  • 8 ShoenutJP, Semelka RC, Magro CM, Silverman R, Yaffe CS, Micflikier AB. Comparison of magnetic resonance imaging and endoscopy in distinguishing the type and severity of inflammatory bowel disease. J Clin Gastroenterol1994;19(1):31–35. Crossref, MedlineGoogle Scholar
  • 9 OchsenkuhnT, Herrmann K, Schoenberg SO, Reiser MF, Goke B, Sackmann M. Crohn disease of the small bowel proximal to the terminal ileum: detection by MR-enteroclysis. Scand J Gastroenterol2004;39(10):953–960. Crossref, MedlineGoogle Scholar
  • 10 PallottaN, Tomei E, Viscido A, et al. Small intestine contrast ultrasonography: an alternative to radiology in the assessment of small bowel disease. Inflamm Bowel Dis2005;11(2):146–153. Crossref, MedlineGoogle Scholar
  • 11 SchreyerAG, Rath HC, Kikinis R, et al. Comparison of magnetic resonance imaging colonography with conventional colonoscopy for the assessment of intestinal inflammation in patients with inflammatory bowel disease: a feasibility study. Gut2005;54(2):250–256. Crossref, MedlineGoogle Scholar
  • 12 SchreyerAG, Gölder S, Scheibl K, et al. Dark lumen magnetic resonance enteroclysis in combination with MRI colonography for whole bowel assessment in patients with Crohn's disease: first clinical experience. Inflamm Bowel Dis2005;11(4):388–394. Crossref, MedlineGoogle Scholar
  • 13 MolnárT, Papós M, Gyulai C, et al. Clinical value of technetium-99m-HMPAO-labeled leukocyte scintigraphy and spiral computed tomography in active Crohn's disease. Am J Gastroenterol2001;96(5):1517–1521. Crossref, MedlineGoogle Scholar
  • 14 AburanoT, Saito Y, Shuke N, et al. Tc-99m leukocyte imaging for evaluating disease severity and monitoring treatment response in ulcerative colitis: comparison with colonoscopy. Clin Nucl Med1998;23(8):509–513. Crossref, MedlineGoogle Scholar
  • 15 StåhlbergD, Veress B, Måre K, et al. Leukocyte migration in acute colonic inflammatory bowel disease: comparison of histological assessment and Tc-99m-HMPAO labeled leukocyte scan. Am J Gastroenterol1997;92(2):283–288. MedlineGoogle Scholar
  • 16 GibsonP, Lichtenstein M, Salehi N, Hebbard G, Andrews J. Value of positive technetium-99m leucocyte scans in predicting intestinal inflammation. Gut1991;32(12):1502–1507. Crossref, MedlineGoogle Scholar
  • 17 CucchiaraS, Celentano L, de Magistris TM, Montisci A, Iula VD, Fecarotta S. Colonoscopy and technetium-99m white cell scan in children with suspected inflammatory bowel disease. J Pediatr1999;135(6):727–732. Crossref, MedlineGoogle Scholar
  • 18 PradelJA, David XR, Taourel P, Djafari M, Veyrac M, Bruel JM. Sonographic assessment of the normal and abnormal bowel wall in nondiverticular ileitis and colitis. Abdom Imaging1997;22(2):167–172. Crossref, MedlineGoogle Scholar
  • 19 FraquelliM, Colli A, Casazza G, et al. Role of US in detection of Crohn disease: meta-analysis. Radiology2005;236(1):95–101. LinkGoogle Scholar
  • 20 WhitingP, Rutjes AW, Reitsma JB, Bossuyt PM, Kleijnen J. The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol2003;3:25. Google Scholar
  • 21 WhitingPF, Weswood ME, Rutjes AW, Reitsma JB, Bossuyt PN, Kleijnen J. Evaluation of QUADAS, a tool for the quality assessment of diagnostic accuracy studies. BMC Med Res Methodol2006;6:9. Google Scholar
  • 22 SheridanMB, Nicholson DA, Martin DF. Transabdominal ultrasonography as the primary investigation in patients with suspected Crohn's disease or recurrence: a prospective study. Clin Radiol1993;48(6):402–404. Crossref, MedlineGoogle Scholar
  • 23 AndreoliA, Cerro P, Falasco G, Giglio LA, Prantera C. Role of ultrasonography in the diagnosis of postsurgical recurrence of Crohn's disease. Am J Gastroenterol1998;93(7):1117–1121. Crossref, MedlineGoogle Scholar
  • 24 ReimundJM, Jung-Chaigneau E, Chamouard P, Wittersheim C, Duclos B, Baumann R. Diagnostic value of high-resolution sonography in the diagnosis of Crohn's disease and ulcerative colitis [in French]. Gastroenterol Clin Biol1999;23(6-7):740–746. MedlineGoogle Scholar
  • 25 CalabreseE, La Seta F, Buccellato A, et al. Crohn's disease: a comparative prospective study of transabdominal ultrasonography, small intestine contrast ultrasonography, and small bowel enema. Inflamm Bowel Dis2005;11(2):139–145. Crossref, MedlineGoogle Scholar
  • 26 SolvigJ, Ekberg O, Lindgren S, Florén CH, Nilsson P. Ultrasound examination of the small bowel: comparison with enteroclysis in patients with Crohn disease. Abdom Imaging1995;20(4):323–326. Crossref, MedlineGoogle Scholar
  • 27 LimbergB, Osswald B. Diagnosis and differential diagnosis of ulcerative colitis and Crohn's disease by hydrocolonic sonography. Am J Gastroenterol1994;89(7):1051–1057. MedlineGoogle Scholar
  • 28 TarjánZ, Tóth G, Györke T, Mester A, Karlinger K, Makó EK. Ultrasound in Crohn's disease of the small bowel. Eur J Radiol 2000;35(3):176–182. Crossref, MedlineGoogle Scholar
  • 29 RispoA, Imbriaco M, Celentano L, et al. Noninvasive diagnosis of small bowel Crohn's disease: combined use of bowel sonography and Tc-99m-HMPAO leukocyte scintigraphy. Inflamm Bowel Dis2005;11(4):376–382. Crossref, MedlineGoogle Scholar
  • 30 MiaoYM, Koh DM, Amin Z, et al. Ultrasound and magnetic resonance imaging assessment of active bowel segments in Crohn's disease. Clin Radiol2002;57(10):913–918. Crossref, MedlineGoogle Scholar
  • 31 NeyeH, Voderholzer W, Rickes S, Weber J, Wermke W, Lochs H. Evaluation of criteria for the activity of Crohn's disease by power Doppler sonography. Dig Dis2004;22(1):67–72. Crossref, MedlineGoogle Scholar
  • 32 KohDM, Miao Y, Chinn RJ, et al. MR imaging evaluation of the activity of Crohn's disease. AJR Am J Roentgenol2001;177(6):1325–1332. Crossref, MedlineGoogle Scholar
  • 33 RieberA, Aschoff A, Nussle K, et al. MRI in the diagnosis of small bowel disease: use of positive and negative oral contrast media in combination with enteroclysis. Eur Radiol2000;10(9):1377–1382. Crossref, MedlineGoogle Scholar
  • 34 DarbariA, Sena L, Argani P, Oliva-Hemker JM, Thompson R, Cuffari C. Gadolinium-enhanced magnetic resonance imaging: a useful radiological tool in diagnosing pediatric IBD. Inflamm Bowel Dis2004;10(2):67–72. Crossref, MedlineGoogle Scholar
  • 35 AjajWM, Lauenstein TC, Pelster G, et al. Magnetic resonance colonography for the detection of inflammatory diseases of the large bowel: quantifying the inflammatory activity. Gut2005;54(2):257–263. Crossref, MedlineGoogle Scholar
  • 36 LowRN, Francis IR, Politoske D, Bennett M. Crohn's disease evaluation: comparison of contrast-enhanced MR imaging and single-phase helical CT scanning. J Magn Reson Imaging2000;11(2):127–135. Crossref, MedlineGoogle Scholar
  • 37 MiddletonSJ, Li D, Wharton S, Reynolds PD, Wraight EP, Hunter JO. Validation of 99Tcm-HMPAO leucocyte scintigraphy in ulcerative colitis by comparison with histology. Br J Radiol1995;68(814):1061–1066. Crossref, MedlineGoogle Scholar
  • 38 PaposM, Nagy F, Narai G, et al. Anti-granulocyte immunoscintigraphy and [99mTc]hexamethylpropyleneamine-oxime-labeled leukocyte scintigraphy in inflammatory bowel disease. Dig Dis Sci1996;41(2):412–420. Crossref, MedlineGoogle Scholar
  • 39 KolkmanJJ, Falke TH, Roos JC, et al. Computed tomography and granulocyte scintigraphy in active inflammatory bowel disease: comparison with endoscopy and operative findings. Dig Dis Sci1996;41(4):641–650. Crossref, MedlineGoogle Scholar
  • 40 HeresbachD, Bretagne JF, Raoul JL, et al. Indium scanning in assessment of acute Crohn's disease: a prospective study of sensitivity and correlation with severity of mucosal damage. Dig Dis Sci1993;38(9):1601–1607. Crossref, MedlineGoogle Scholar
  • 41 DhôteR, Beades E, Le Dinh T, et al. Scintigraphy using leukocytes marked with 99m-Tc-HMPAO in Crohn's disease [in French]. Acta Gastroenterol Belg1995;58(5-6):353–363. MedlineGoogle Scholar
  • 42 HassanC, Cerro P, Zullo A, Spina C, Morini S. Computed tomography enteroclysis in comparison with ileoscopy in patients with Crohn's disease. Int J Colorectal Dis2003;18(2):121–125. Crossref, MedlineGoogle Scholar
  • 43 MazzeoS, Caramella D, Battolla L, et al. Crohn disease of the small bowel: spiral CT evaluation after oral hyperhydration with isotonic solution. J Comput Assist Tomogr2001;25(4):612–616. Crossref, MedlineGoogle Scholar
  • 44 JamiesonDH, Shipman PJ, Israel DM, Jacobson K. Comparison of multidetector CT and barium studies of the small bowel: inflammatory bowel disease in children. AJR Am J Roentgenol2003;180(5):1211–1216. Crossref, MedlineGoogle Scholar
  • 45 WoldPB, Fletcher JG, Johnson CD, Sandborn WJ. Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy—feasibility study. Radiology2003;229(1):275–281. LinkGoogle Scholar
  • 46 SaverymuttuSH, Camilleri M, Rees H, Lavender JP, Hodgson HJ, Chadwick VS. Indium 111-granulocyte scanning in the assessment of disease extent and disease activity in inflammatory bowel disease: a comparison with colonoscopy, histology, and fecal indium 111-granulocyte excretion. Gastroenterology1986;90(5 pt 1):1121–1128. Crossref, MedlineGoogle Scholar
  • 47 MaccioniF, Colaiacomo MC, Parlanti S. Ulcerative colitis: value of MR imaging. Abdom Imaging2005;30(5):584–592. Crossref, MedlineGoogle Scholar
  • 48 SunB, Rajan E, Cheng S, et al. Diagnostic yield and therapeutic impact of double-balloon enteroscopy in a large cohort of patients with obscure gastrointestinal bleeding. Am J Gastroenterol2006;101(9):2011–2015. Crossref, MedlineGoogle Scholar
  • 49 MönkemüllerK, Weigt J, Treiber G, et al. Diagnostic and therapeutic impact of double-balloon enteroscopy. Endoscopy2006;38(1):67–72. Crossref, MedlineGoogle Scholar
  • 50 TriesterSL, Leighton JA, Leontiadis GI, et al. A meta-analysis of the yield of capsule endoscopy compared to other diagnostic modalities in patients with non-stricturing small bowel Crohn's disease. Am J Gastroenterol2006;101(5):954–964. Crossref, MedlineGoogle Scholar
  • 51 HaraAK, Leighton JA, Heigh RI, et al. Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology2006;238(1):128–134. LinkGoogle Scholar
  • 52 LowRN, Francis IR. MR imaging of the gastrointestinal tract with i.v., gadolinium and diluted barium oral contrast media compared with unenhanced MR imaging and CT. AJR Am J Roentgenol1997;169(4):1051–1059. Crossref, MedlineGoogle Scholar
  • 53 MarcosHB, Semelka RC. Evaluation of Crohn's disease using half-Fourier RARE and gadolinium-enhanced SGE sequences: initial results. Magn Res Imaging2000;18(3):263–268. Crossref, MedlineGoogle Scholar
  • 54 AjajW, Goehde SC, Schneemann H, Ruehm SG, Debatin JF, Lauenstein TC. Dose optimization of mannitol solution for small bowel distension in MRI. J Magn Reson Imaging2004;20(4):648–653. Crossref, MedlineGoogle Scholar
  • 55 GourtsoyiannisNC, Papanikolaou N. Magnetic resonance enteroclysis. Semin Ultrasound CT MR2005;26(4):237–246. Crossref, MedlineGoogle Scholar
  • 56 SchreyerAG, Geissler A, Albrich H, et al. Abdominal MRI after enteroclysis or with oral contrast in patients with suspected or proven Crohn's disease. Clin Gastroenterol Hepatol2004;2(6):491–497. Crossref, MedlineGoogle Scholar
  • 57 LijmerJG, Mol BW, Heisterkamp S, et al. Empirical evidence of design-related bias in studies of diagnostic tests. JAMA1999;282(11):1061–1066. Crossref, MedlineGoogle Scholar
  • 58 RutjesAW, Reitsma JB, Di Nisio M, Smidt N, van Rijn JC, Bossuyt PM. Evidence of bias and variation in diagnostic accuracy studies. CMAJ2006;174(4):469–476. Crossref, MedlineGoogle Scholar
  • 59 DeeksJJ, Macaskill P, Irwig L. The performance of tests of publication bias and other sample size effects in systematic reviews of diagnostic test accuracy was assessed. J Clin Epidemiol2005;58(9):882–893. Crossref, MedlineGoogle Scholar
  • 60 BeggCB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics1994;50(4):1088–1101. Crossref, MedlineGoogle Scholar
  • 61 EggerM, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ1997;315(7109):629–634. Crossref, MedlineGoogle Scholar
  • 62 MacaskillP, Walter SD, Irwig L. A comparison of methods to detect publication bias in meta-analysis. Stat Med 2001;20(4):641–654. Google Scholar

Article History

Published in print: 2008