ORIGINAL ARTICLE Small Intestine Contrast Ultrasonography (SICUS) for the Detection of Small Bowel Complications in Crohn’s Disease: A Prospective Comparative Study Versus Intraoperative Findings Nadia Pallotta, MD, PhD,* Giuseppina Vincoli, MD,* Chiara Montesani, MD, † Piero Chirletti, MD, ‡ Annamaria Pronio, MD, † Roberto Caronna, MD, ‡ Barbara Ciccantelli, MD,* Erminia Romeo, MD, § Adriana Marcheggiano, MD,* and Enrico Corazziari, MD* Background: In Crohn’s disease (CD) patients, small intestine contrast ultrasonography (SICUS) accurately assesses small bowel lesions. Its diagnostic role is not known in the assessment of intraabdominal CD complications. The aim was to assess the value of SICUS to detect intesti- nal complications in patients with CD. Methods: Forty-nine CD patients (21 female, mean age 37.7 years; range 12–78 years) underwent resective bowel surgery and were included in this study. The accuracy of SICUS to preoperatively detect number, site, and length of strictures, fistulas, and abscesses was compared with surgical and pathological findings by kappa statistics. Results: SICUS identified at least one stricture in 39/40 and excluded it in 9/9 (97.5% sensitivity, 100% specificity, k ¼ 0.93); two or more stric- tures in 9/12 (75% sensitivity, 100% specificity, k ¼ 0.78). The agreement by k-statistics between SICUS and surgery in identifying proximal and distal small intestine site of stricture was 1 and 0.92, respectively. The extension of strictures was 6.8 6 5.4 cm at surgery, 6.6 6 5.4 cm at SICUS (NS). Fistulas were correctly identified in 27/28 patients and excluded in 19/21 patients (96% sensitivity, 90.5% specificity, k ¼ 0.88). Intraabdominal abscesses were correctly detected in 10/10 patients and excluded in 37/39 patients (100% sensitivity, 95% specificity, k ¼ 0.89). Conclusions: SICUS is an accurate method for the detection of small intestinal complications in CD. Noninvasive SICUS is valuable as a pri- mary investigative method for evaluating and planning proper treatment in patients with severe CD of the small bowel. (Inflamm Bowel Dis 2012;18:74–84) Key Words: Crohn’s disease, small intestine, morphology, pathology, ultrasonography, SICUS C ontrast radiology, computed tomography (CT), magnetic resonance imaging (MRI), and transabdomi- nal ultrasound (TUS) are widely and variably utilized for the diagnosis of Crohn’s disease (CD) lesions of the small bowel (SB) and of strictures, fistulas, and abscesses that often complicate the lifelong course of CD. Contrast radiol- ogy has for a long time been the only diagnostic tool to detect SB stenoses but it has been shown to be inaccurate to detect fistulas and abscesses 1–7 because of poor assessment of transmural and extramural extension of disease, and it is not indicated in patients with symptoms of acute obstruction. TUS proved to be valuable in detecting SB CD strictures and abscesses, whereas its sensitivity in detecting entero-en- teric fistulas is still debated. 8–12 Furthermore, TUS does not properly assess degree, localization, and length of strictures. MRI is valuable to detect abscesses, 13,14 but is limited to identify low-grade strictures 15 and to discriminate them from muscular bowel wall contractions; finally, its accuracy in the detection of fistulas is not yet fully established. 16 CT is use- ful for the detection of not-deep abscesses 12,17 but its diag- nostic accuracy for CD strictures and fistulas is low when compared with surgical findings. 12,17,18 Furthermore, since with the medical use of x-rays it is a significant (the second after natural terrestrial) source of radiation, 19 radiological exposure should be minimized, particularly in young and child-bearing age female patients and in those who may require repetitive follow-up assessments. In order to plan appropriate treatments for CD, accurate diagnostic tools are needed to detect and characterize these complications. 20,21 Surgery remains an important component of treatment of CD and an accurate Received for publication December 28, 2010; Accepted January 17, 2011. From the *Dipt. Medicina Interna e Specialita ` Mediche Universita `‘‘Sapienza,’’ Rome Italy; and † Dipt. General Surgery ‘‘P. Stefanini,’’ Universita `‘‘Sapienza,’’ Rome, Italy, ‡ Dipt. Scienze Chirurgiche Francesco Durante, Universita ` ‘‘Sapienza,’’ Rome, Italy, § Ospedale Bambino Gesu `, Dipt. Medico Chirurgico di Epato-Gastroenterologia e Nutrizione, Rome, Italy. Reprints: Enrico Corazziari, MD, Dipt. di Medicina Interna e Specialita ` Mediche, Universita ` ‘‘Sapienza,’’ Policlinico ‘‘Umberto I,’’ V.le del Policlinico, 155-00161 Rome, Italy (e-mail: enrico.corazziari@uniroma1.it) Copyright V C 2011 Crohn’s & Colitis Foundation of America, Inc. DOI 10.1002/ibd.21678 Published online 21 March 2011 in Wiley Online Library (wileyonlinelibrary.com). Inflamm Bowel Dis  Volume 18, Number 1, January 2012 74