A reliability study - strong inter-observer agreement of an expert panel for intestinal ultrasound in ulcerative colitis

Floris De Voogd, Rune Wilkens, Krisztina Gecse, Mariangela Allocca, Kerri Novak, Cathy Lu, Geert D'Haens, Christian Maaser

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23 Citations (Scopus)


BACKGROUND: Intestinal ultrasound [IUS] is a promising and non-invasive cross-sectional imaging modality in the diagnosis and monitoring of ulcerative colitis [UC]. Unlike endoscopy, where standardized scoring for evaluation of disease activity is widely used, scoring for UC with IUS is currently unavailable. Therefore, we conducted a study to assess the reliability of IUS in UC among expert sonographists in order to identify robust parameters. METHODS: Thirty patients with both clinically active [25] and quiescent [five] UC were included. Six expert sonographers first agreed upon key IUS parameters and grading, including bowel wall thickness [BWT], colour Doppler signal [CDS], inflammatory fat [i-fat], loss of bowel wall stratification [BWS], loss of haustrations and presence of lymph nodes. Thirty video-recorded cases were blindly reviewed. RESULTS: Inter-observer agreement was almost perfect for BWT (intra-class correlation coefficient [ICC]: 0.96) and substantial for CDS [κ = 0.63]. Agreement was moderate for presence of lymph nodes [κ = 0.41] and fair for presence of i-fat [κ = 0.36], BWS [κ = 0.24] and loss of haustrations [κ = 0.26]. Furthermore, there was substantial agreement for presence of disease activity on IUS [κ = 0.77] and almost perfect agreement for disease severity [ICC: 0.93]. Most individual parameters showed a strong association with IUS disease activity as measured by the six readers. CONCLUSION: IUS is a reliable imaging modality to assess disease activity and severity in UC. Important individual parameters such as BWT and CDS are reliable and could be incorporated in a future UC scoring index. Standardized acquisition and assessment of UC utilizing IUS with established reliability is important to expand the use of IUS globally.

Original languageEnglish
Pages (from-to)1284-1290
Number of pages7
JournalJournal of Crohn's & colitis
Issue number8
Early online date9 Jan 2021
Publication statusPublished - 1 Aug 2021


  • Intestinal ultrasound
  • inter-observer agreement
  • reliability
  • ulcerative colitis

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