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Carter D, Albshesh A, Shimon C, Segal B, Yershov A, Kopylov U, Meyers A, Brzezinski RY, Ben Horin S, Hoffer O. Automatized Detection of Crohn's Disease in Intestinal Ultrasound Using Convolutional Neural Network. Inflamm Bowel Dis 2023; 29:1901-1906. [PMID: 36794834 DOI: 10.1093/ibd/izad014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Indexed: 02/17/2023]
Abstract
INTRODUCTION The use of intestinal ultrasound (IUS) for the diagnosis and follow-up of inflammatory bowel disease is steadily growing. Although access to educational platforms of IUS is feasible, novice ultrasound operators lack experience in performing and interpreting IUS. An artificial intelligence (AI)-based operator supporting system that automatically detects bowel wall inflammation may simplify the use of IUS by less experienced operators. Our aim was to develop and validate an artificial intelligence module that can distinguish bowel wall thickening (a surrogate of bowel inflammation) from normal bowel images of IUS. METHODS We used a self-collected image data set to develop and validate a convolutional neural network module that can distinguish bowel wall thickening >3 mm (a surrogate of bowel inflammation) from normal bowel images of IUS. RESULTS The data set consisted of 1008 images, distributed uniformly (50% normal images, 50% abnormal images). Execution of the training phase and the classification phase was performed using 805 and 203 images, respectively. The overall accuracy, sensitivity, and specificity for detection of bowel wall thickening were 90.1%, 86.4%, and 94%, respectively. The network exhibited an average area under the ROC curve of 0.9777 for this task. CONCLUSIONS We developed a machine-learning module based on a pretrained convolutional neural network that is highly accurate in the recognition of bowel wall thickening on intestinal ultrasound images in Crohn's disease. Incorporation of convolutional neural network to IUS may facilitate the use of IUS by inexperienced operators and allow automatized detection of bowel inflammation and standardization of IUS imaging interpretation.
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Affiliation(s)
- Dan Carter
- Institute of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmed Albshesh
- Institute of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Carmi Shimon
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Batel Segal
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Alex Yershov
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Uri Kopylov
- Institute of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adele Meyers
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Rafael Y Brzezinski
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
| | - Shomron Ben Horin
- Institute of Gastroenterology, Chaim Sheba Medical Center, Ramat Gan, Israel
- Sackler faculty of medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oshrit Hoffer
- School of Electrical Engineering, Afeka Tel Aviv Academic College of Engineering, Tel Aviv, Israel
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Kamel S, Sakr M, Hamed W, Eltabbakh M, Askar S, Bassuny A, Hussein R, Elbaz A. Comparative study between bowel ultrasound and magnetic resonance enterography among Egyptian inflammatory bowel disease patients. World J Gastroenterol 2020; 26:5884-5895. [PMID: 33132642 PMCID: PMC7579751 DOI: 10.3748/wjg.v26.i38.5884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/11/2020] [Accepted: 09/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bowel ultrasound and magnetic resonance enterography (MRE) are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications. They assess the degree of activity, help clinicians to identify patients in need of surgery, and can be used for patient follow-up.
AIM To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease (IBD) patients in Egypt.
METHODS The study was conducted on 40 patients with IBD. All patients were subjected to clinical assessment, laboratory investigations, bowel ultrasound, MRE, and colonoscopy up to the terminal ileum with biopsies for histopathological examination.
RESULTS This study was conducted on 14 patients (35%) with ulcerative colitis and 26 patients (65%) with Crohn's disease; 34 (85%) of these patients had active disease. Bowel ultrasound detected different bowel lesions with the following accuracies: ileum (85%), large bowel (70%), fistula (95%), stricture and proximal dilatation (95%) and abscesses (100%). Also, it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.
CONCLUSION In comparison to MRE, bowel ultrasound is a useful, non-invasive, and feasible bedside imaging tool for the detection of inflammation, detection of complications, and follow-up of IBD patients when performed by the attending physician.
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Affiliation(s)
- Shimaa Kamel
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed Sakr
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Waleed Hamed
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Mohamed Eltabbakh
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Safaa Askar
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Ahmed Bassuny
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
| | - Rasha Hussein
- Department of Radiology, Ain Shams University and MR Unit of Misr Radiology Center, Cairo 11566, Egypt
| | - Ahmed Elbaz
- Department of Tropical Medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
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Omotehara S, Nishida M, Kinoshita K, Onishi R, Onodera A, Suya M, Hasegawa T, Mitsumori D, Katsurada T, Teshima T. Validation of US evaluation of ulcerative colitis activity. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1537-1544. [PMID: 30987912 DOI: 10.1016/j.ultrasmedbio.2019.02.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 02/23/2019] [Accepted: 02/26/2019] [Indexed: 06/09/2023]
Abstract
This study was aimed at validating the inter-rater grading agreement for assessing disease activity in patients with established ulcerative colitis (UC) using transabdominal ultrasonography (US) versus colonoscopy (CS). Fifty-seven patients underwent US and CS at four facilities. UC disease activity was assessed using the original US grading system and CS Matts classification. Initially, the US and CS grades were assessed at each examining facility, and still images and movie clips were re-assessed at the central facility. Grading agreement between the examining and central facilities was evaluated. Grading agreement for US and CS were 0.75 and 0.72 in all segments and 0.82 and 0.70 in the maximum grade of each patient, respectively (all p < 0.001). US grading agreement was "almost perfect" for the maximum grade and "moderate" to "substantial" for other assessments. The inter-rater US grading agreement was good and not inferior to that of CS for evaluating UC disease activity.
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Affiliation(s)
- Satomi Omotehara
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan; Diagnostic Center for Sonography, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Mutsumi Nishida
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan; Diagnostic Center for Sonography, Hokkaido University Hospital, Kita-ku, Sapporo, Japan.
| | - Kenji Kinoshita
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Reizo Onishi
- Department of Gastroenterology and Hepatology, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Aki Onodera
- Department of Clinical Laboratory, Tomakomai City Hospital, Shimizutyou, Tomakomai, Japan
| | - Mitsuhisa Suya
- Department of Clinical Laboratory, Sapporo Higashi Tokushukai Hospital, Higashi-ku, Sapporo, Japan
| | - Toru Hasegawa
- Department of Clinical Laboratory, Ohguro Gastroenterological Hospital, Kita-ku, Sapporo, Japan
| | - Daiki Mitsumori
- Department of Clinical Laboratory, NTT East Japan Sapporo Hospital, Chuou-ku, Sapporo, Japan
| | - Takehiko Katsurada
- Division of Endoscopy, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
| | - Takanori Teshima
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Japan
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da Silva Moraes AC, de Freitas Moraes G, de Araújo ALE, Luiz RR, Elia C, Carneiro AJ, de Souza HSP. Abdominal ultrasonography with color Doppler analysis in the assessment of ileal Crohn's disease: comparison with magnetic resonance enterography. Intest Res 2019; 17:227-236. [PMID: 30962408 PMCID: PMC6505095 DOI: 10.5217/ir.2018.00124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 03/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background/Aims Consistently defining disease activity remains a critical challenge in the follow-up of patients with Crohn’s disease (CD). We investigated the potential applicability of abdominal ultrasonography with color Doppler (USCD) analysis for the detection of morphological alterations and inflammatory activity in CD. Methods Forty-three patients with CD ileitis/ileocolitis were evaluated using USCD analysis with measurements obtained on the terminal ileum and right colon. Sonographic parameters included wall thickening, stricture, hyperemia, presence of intra-abdominal mass, and fistulas. Patients were evaluated for the clinical activity (Harvey-Bradshaw Index [HBI]), fecal calprotectin (FC) and C-reactive protein (CRP). The USCD performance was assessed using magnetic resonance enterography (MRE) as a criterion standard. Results Most measurements obtained with USCD matched the data generated with MRE; however, the agreement improved in clinically active patients where sensitivity, positive predictive value, and accuracy were >80%, considering wall thickening and hyperemia. Complications such as intestinal wall thickening, stricture formation, and hyperemia, were detected in the USCD analysis with moderate agreement with MRE. The best agreement with the USCD analysis was obtained in regard to FC, where the sensitivity, positive predictive value, and accuracy were >70%. The overall performance of USCD was superior to that of HBI, FC and CRP levels, particularly when considering thickening, stricture, and hyperemia parameters. Conclusions USCD represents a practical noninvasive and low-cost tool for evaluating patients with ileal or ileocolonic disease, particularly in clinically active CD. Therefore, USCD might become a useful asset in the follow-up of patients with CD.
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Affiliation(s)
- Antonio Carlos da Silva Moraes
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Antonio Luis Eiras de Araújo
- Serviço de Radiologia, Departamento de Radiologia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronir Raggio Luiz
- Instituto de Estudos de Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Celeste Elia
- D'Or Institute for Research and Education, Rio de Janeiro, Brazil
| | - Antonio Jose Carneiro
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Heitor Siffert Pereira de Souza
- Serviço de Gastroenterologia, Departamento de Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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Usefulness of contrast-enhanced ultrasound (CEUS) in Inflammatory Bowel Disease (IBD). Dig Liver Dis 2018; 50:761-767. [PMID: 29705029 DOI: 10.1016/j.dld.2018.03.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022]
Abstract
Intestinal ultrasonography has emerged as a cheap, non-invasive and readily accessible modality for the assessment of a number of gastroenterological diseases. Over the last decade, particularly due to the widespread use of biological agents in Inflammatory Bowel Disease (IBD), guidelines regarding management and follow-up advise more regular disease assessment and surveillance in order to guide treatment adjustments, and provide more personalised care. Given the young age of the majority of patients with IBD the availability of an alternative modality to harmful radiation or the risks of endoscopy for this indication offers an appealing advantage. Intestinal ultrasonography has been shown to be as sensitive and specific for detecting IBD as both computed tomography and magnetic resonance enterography, and endoscopic evaluation. More recent developments in the technology of ultrasonography equipment and the use of intravenous contrast agents (contrast enhanced ultrasonography, known as CEUS), have significantly increased the ability to both detect disease location, determine the disease activity and also potentially the difference between fibrotic and inflammatory segments. This review focusses specifically on the value of CEUS for the diagnosis of both Crohn's disease and Ulcerative Colitis, in determining disease activity, extraintestinal complications, determination of fibrosis as well as its more recent use in assessing and predicting response to biological and immunosuppressive therapies.
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Kucharzik T, Kannengiesser K, Petersen F. The use of ultrasound in inflammatory bowel disease. Ann Gastroenterol 2016; 30:135-144. [PMID: 28243033 PMCID: PMC5320025 DOI: 10.20524/aog.2016.0105] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 10/18/2016] [Indexed: 02/07/2023] Open
Abstract
Imaging in inflammatory bowel disease (IBD) plays a pivotal role in the primary diagnosis, as well as during the management of patients with known IBD. The evolution of ultrasound equipment and the growing expertise of examiners have both enhanced the role of intestinal ultrasound in the assessment of the gastrointestinal tract in IBD patients. Intestinal ultrasound has been shown to have high sensitivity and specificity, as well as high positive and negative predictive value, in the detection or exclusion of intestinal inflammatory activity in IBD. The obvious advantages of intestinal ultrasound over other imaging modalities include non-invasiveness, rapid availability and low costs. This review summarizes the current developments in the use of intestinal ultrasound for the detection of IBD and its complications, and discusses its use in the management of patients with IBD. Indications for the use of intestinal ultrasound in daily practice are presented, expanded by new developments such as contrast-enhanced ultrasonography and elastography.
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Affiliation(s)
- Torsten Kucharzik
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Germany
| | - Klaus Kannengiesser
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Germany
| | - Frauke Petersen
- Department of Gastroenterology, Lüneburg Hospital, University of Hamburg, Germany
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Kucharzik T. [Current strategies in diagnosis and treatment of IBD]. MMW Fortschr Med 2016; 158:74-82. [PMID: 27822845 DOI: 10.1007/s15006-016-8234-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Torsten Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Bögelstraße 1, D-21339, Lüneburg, Deutschland.
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