Oral 2.5% Mannitol-Enhanced SICUS for Small Bowel Inflammatory Disease: A Surgical-Validated Comparative Study with MRE

Oral 2.5% Mannitol-Enhanced SICUS for Small Bowel Inflammatory Disease: A Surgical-Validated Comparative Study with MRE | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Oral 2.5% Mannitol-Enhanced SICUS for Small Bowel Inflammatory Disease: A Surgical-Validated Comparative Study with MRE Ahuang Cai, Yu Xu, Liqin Yu, Hailan Chen, Yan Chen, Shengnan Wu, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7275932/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: This study aimed to evaluate the diagnostic value of Small Intestine Contrast Ultrasonography (SICUS) using oral 2.5% mannitol for detecting Small Bowel Inflammatory Disease (SBID), and to compare its efficacy with Magnetic Resonance Enterography (MRE). Methods: Fifty-seven patients with pathologically confirmed SBID who underwent both SICUS and MRE before surgery were retrospectively analyzed. The sensitivity, specificity, and agreement with surgical findings were calculated for each modality in detecting SBID and its complications, including strictures, fistulas, and abscesses. Results: Both SICUS and MRE achieved a detection rate of 96.5% for SBID. SICUS showed higher sensitivity than MRE in detecting strictures (87.0% vs. 83.3%) and fistulas (82.8% vs. 65.5%), with strong consistency with surgical findings (κ = 0.83 for fistulas). The sensitivity for detecting abscesses was 81.8% for both modalities. SICUS had 100% specificity in all complications. Its advantages include real-time dynamic imaging, high resolution, reduced interference from intestinal gas, and better accessibility in primary care settings. Conclusions: SICUS is a reliable, non-invasive, and cost-effective imaging method for evaluating SBID and its complications. It provides diagnostic performance comparable or superior to MRE, particularly in detecting strictures and fistulas. SICUS is especially valuable for patients requiring repeated assessments or those who cannot undergo MRE, offering a practical alternative in clinical practice. small bowel inflammatory disorders SICUS MRE mannitol diagnosis Figures Figure 1 Figure 2 1. Introduction Small Bowel Inflammatory Disease (SBID), encompassing conditions such as Crohn’s disease (CD), nonspecific enteritis, and intestinal tuberculosis, represents a common inflammatory disease of the small intestine 1 . Global epidemiologic studies have shown that the incidence of SIBD is rapidly increasing and the proportion of refractory cases is also increasing 2 .Due to the unique anatomical structure of the small intestine, characterized by its tortuous shape, rapid peristalsis, long and free lumen, and numerous folds, traditional gastrointestinal endoscopy is limited in its ability to comprehensively and accurately assess small bowel lesions 3 . SBID often present with an insidious onset and nonspecific symptoms, leading to difficulties in early diagnosis and potential delays in treatment. SBID are associated with increased surgical complications and healthcare costs, underscoring the urgent need for timely detection and effective management 4 . With advancements in medical technology, there are several diagnostic methods used to evaluate small bowel disease such as Small Bowel Endoscopy (SBE), Computed Tomography Enterograph(CTE), and Magnetic Resonance Enterography (MRE) but each method has its own advantages and limitations.As the gold standard for the diagnosis of SIBD, SBE allows biopsy of diseased tissue in the small bowel mucosa. However, SBE is an invasive test and is not recommended as a first-line test for SIBD in cases where the intestinal lumen is significantly narrowed and the small colonoscope cannot be passed through 5 .CTE can clearly visualize the intestinal wall and surrounding structures, but because most patients with SBID require long-term follow-up, the cumulative radiation dose should not be ignored 6 .Although MRE offers high soft tissue resolution, multi-directional imaging, and avoids ionizing radiation, it has several limitations. These include high equipment requirements, expensive costs, and limited accessibility in primary or community-level hospitals. Moreover, it is contraindicated in patients with ferromagnetic implants or electronic devices 7 . Therefore, it is important to explore a more accurate, efficient, convenient, and cost-effective diagnostic method for SBID.Oral 2.5% Mannitol Small Bowel Ultrasound Contrast (SICUS) is an emerging diagnostic technique that has attracted increasing attention in recent years for SBID diagnosis. By orally administering a 2.5% mannitol solution to distend the small intestine, SICUS can effectively reduce interference from intestinal gas and provide clear visualization of small bowel structure and lesions 8 . This study aims to systematically evaluate the diagnostic performance of SICUS in detecting small bowel inflammatory lesions and to compare its efficacy with magnetic resonance enterography (MRE), with the goal of offering a simpler, more accessible imaging modality for clinical diagnosis. 2. Materials and Methods 2.1 Study Design and Participants A total of 77 patients with suspected small bowel disease who underwent small bowel examination and surgical treatment at the First Affiliated Hospital of Fujian Medical University between June 2019 and October 2023 were retrospectively enrolled in this study. Inclusion criteria were as follows: (1) presence of gastrointestinal symptoms and at least one conventional gastrointestinal endoscopic examination; (2) all patients underwent SICUS with oral administration of 2.5% mannitol; (3) all patients underwent MRE with the most recent preoperative scan included for patients who had multiple examinations within six months; (4) all patients underwent surgical treatment. Exclusion criteria were as follows: (1) absence of pathological confirmation by surgical or biopsy specimens; (2) poor bowel preparation resulting in failure of SICUS to visualize the small intestine; (3) intolerance to oral mannitol; (4) severe cardiac, hepatic, or renal dysfunction.Based on the final pathological diagnosis. Finally, 57 patients with inflammatory lesions were included, while 20 patients with postoperative pathological confirmation of small bowel neoplasms were excluded. This study was approved by the Ethics Committee of the hospital (IEC-FOM-013-2.0), and informed consent was obtained from the patients or their guardians prior to the examination. 2.2 Instruments and Methods Oral 2.5% Mannitol SICUS Examination: All examinations were performed in the supine position using a GE Voluson E10 Color Doppler Ultrasound system (convex array: 3.5–10.0 MHz; linear array: 7.5–14 MHz) by two experienced physicians with intermediate or senior professional titles.Patients ingested 2.5% isotonic mannitol solution (up to 2000 mL) to achieve adequate small bowel distension. The small intestine was scanned sequentially from the duodenum to the ileocecal junction. When necessary, additional warm water was administered to ensure optimal imaging. Intestinal wall thickness, wall stratification, peristalsis, lumen narrowing, and surrounding structures (e.g., lymph nodes, fistulas, abscesses) were evaluated. Color Doppler Flow Imaging (CDFI) was used to assess vascularity. Inflammatory activity was graded using the Limberg classification 9 . MRE Examination: MRE was performed using a Siemens Magnetom Verio 3.0T MRI scanner. Patients received 1500 mL of 2.5% mannitol solution orally 1 hour prior to scanning. Ten minutes before imaging, 20 mg of hyoscine butylbromide was intramuscularly administered. MRI sequences included axial and coronal T2-weighted imaging (T2WI), T1-weighted imaging (T1WI), and diffusion-weighted imaging (DWI). For contrast-enhanced imaging, gadopentetate dimeglumine (0.1 mmol/kg) was injected intravenously at 2 mL/s. Dynamic 3D VIBE sequences were obtained at 30, 60, and 90 seconds post-injection. 2.3 Ultrasound Image Analysis Lesion Location: The duodenum, jejunum, and ileum were identified based on the anatomical location and morphology of the small intestine. The upper duodenum is connected to the stomach pylorus, and it continues into the jejunum via the ascending part, wrapping around the head of the pancreas in a "C" shape. The jejunum is mostly located in the upper left abdomen, and the ileum is mostly in the lower right abdomen. The jejunum has prominent folds and active peristalsis, while the ileum’s folds gradually diminish and disappear, with slower peristalsis. The terminal ileum is the portion of the ileum located within 20 cm of the ileocecal valve. Intestinal Wall Thickening: Three measurements were taken in both longitudinal and transverse planes, with the average value > 3 mm being considered as intestinal wall thickening 10 . Abnormal Intestinal Wall Layers: The normal ultrasound image of the intestinal wall shows the following layers from the inside out: a high echogenic interface between the lumen and the mucosa, a hypoechoic mucosal layer containing the mucosal muscle, a high echogenic submucosa, a hypoechoic muscularis propria, and a high echogenic interface between the serosal layer and surrounding tissue. A loss of these layers is considered abnormal 11 . Narrowing: SICUS shows intestinal wall thickness > 3 mm and the maximum inner diameter of the lumen 25 mm), as the diagnostic criteria for narrowing 12 – 14 . Intestinal Fistula: An abnormal passage between the intestinal lumen and mesentery, other abdominal hollow organs, the peritoneal cavity, or the skin 15 . It appears as a disruption in the continuity of the intestinal wall echo, with a hypoechoic tubular structure around the bowel wall. When containing gas, it shows strong echogenicity, and communication with the peritoneal cavity or abdominal organs indicates an enterocutaneous fistula. Abscess: An irregular mass with thick walls, mixed echogenicity (liquid or liquid-containing), often located around an intestinal fistula. Sometimes, gas shadows may be visible inside, and posterior acoustic enhancement is commonly seen. 2.4 Statistical Methods All data were analyzed using the SPSS 25.0(IBM Corp., Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.) statistical analysis software. For continuous variables, data that followed a normal distribution were expressed as the mean ± standard deviation \(\:\left(\overline{\text{X}}\pm\:\text{S}\right)\) , while data that did not follow a normal distribution were expressed as the median (interquartile range) (P25, P75). Categorical variables were expressed as percentages. The consistency analysis of SICUS in diagnosing small bowel inflammatory lesions, complications, and surgical outcomes was performed using the kappa coefficient. A kappa value of < 0.2 indicates poor consistency; 0.2–0.4 indicates fair consistency; 0.4–0.6 indicates moderate consistency; 0.6–0.8 indicates strong consistency; and 0.8–1.0 indicates very strong consistency. The diagnostic value of SICUS and MRE for SBID was compared using the McNemar test (paired chi-square test), and a P value of < 0.05 was considered statistically significant. 3. Results 3.1 Patient Characteristics A total of 57 patients with pathologically confirmed inflammatory lesions were included in this study, comprising 36 males (63.2%) and 21 females (36.8%), with a mean age of 40.0 ± 13.9 years. The main clinical manifestations were abdominal pain in 51 cases (89.5%), altered bowel habits in 14 cases (24.6%), diarrhea in 9 cases (15.8%), vomiting in 5 cases (8.8%), abdominal distension in 3 cases (5.3%), perianal lesions in 2 cases (3.5%), hematochezia in 2 cases (3.5%), fever in 2 cases (3.5%), and melena in 1 case (1.8%). ( Table 1 ) Postoperative pathological diagnoses confirmed inflammatory lesions in all 57 patients, including Crohn’s disease (CD) in 50 cases, nonspecific enteritis in 5 cases, intestinal tuberculosis in 1 case, and cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) in 1 case. Table 1 Demographic and Clinical Characteristics of SBID (N = 57) Characteristic Number of Cases (n) Percentage (%) Sex Male 36 63.2 Female 21 36.8 Age [years, ‾x ± s] - 40.0 ± 13.9 Clinical manifestations Abdominal pain 51 85.9 Altered bowel habits 14 24.6 Diarrhea 9 15.8 Vomiting 5 8.8 Abdominal distension 3 5.3 Perianal lesions 2 3.5 Hematochezia 2 3.5 Fever 2 3.5 Melena 1 1.8 3.2 SICUS Ultrasound Features of SBID The most common ultrasound finding in SBID is bowel wall thickening. However, bowel wall thickening is a nonspecific sign that can also be observed in other conditions, including infections, vasculitis, and localized ischemia. Therefore, differential diagnosis by ultrasound should also take into account factors such as the integrity of the bowel wall layers, vascular distribution, common locations, and lesion length. CD most commonly affects in the terminal ileum and right colon, characterized by segmental bowel wall thickening with a skip pattern—normal bowel segments interspersed between affected areas with well-defined boundaries. Mesenteric fat proliferation, often referred to as "fat creeping", is requently observed around inflamed areas; this proliferation extends to mesenteric edge and typically correlates with the severity of inflammation. Significant bowel wall thickening, loss of bowel wall layering, and increased blood flow grading in the bowel wall as seen on CDFI often suggest that CD is in an active phase. Complications such as stenosis, fistulas and abscesses (Fig. 1 ) may also occur. 3.3 Consistency between SICUS and Surgical Findings in the Diagnosis of SBID-Related Complications Among the 57 patients with surgically confirmed small bowel inflammatory lesions, 54 had strictures, 29 had enteric fistulas, and 11 had abscesses. SICUS demonstrated a sensitivity of 87.0% and a specificity of 100% for detecting strictures, with moderate agreement with surgical findings (κ = 0.41). For enteric fistulas—including 24 enteroenteric fistulas, 2 enterovesical fistulas, and 3 complex fistulas—SICUS achieved a sensitivity of 82.8% and specificity of 100%, showing strong agreement with surgical localization (κ = 0.83). For abscesses—4 located posterior to the ileocecal region, 5 in the right lower abdominal/pelvic mesentery, and 2 pelvic abscesses associated with enterovesical fistulas—SICUS yielded a sensitivity of 81.8% and specificity of 100%, with excellent consistency with surgical findings (κ = 0.88).(Table 2 ) Table 2 Diagnostic performance of SICUS for SBID-related complications compared with surgical findings (N = 57) Complication Intraoperative Diagnosis (n) True Positive (n) False Positive (n) False Negative (n) True Negative (n) Sensitivity (%) Specificity (%) Accuracy (%) Kappa Coefficient stenosis 54 47 0 7 3 87.0 100 87.7 0.41 fistulas 29 24 0 5 28 82.8 100 91.2 0.83 abscesses 11 9 0 2 46 81.8 100 96.5 0.88 3.4 Diagnostic Performance of SICUS in SBID and SBID-Related Complications SICUS demonstrated a positive detection rate of 96.5% (55/57) for SBID, identical to that of MRE (96.5%). In the identification of complications such as strictures, enteric fistulas, and abscesses, the sensitivity of SICUS was 87.0%, 82.8%, and 81.8%, respectively, with a specificity of 100% for all. Compared with MRE, SICUS showed higher sensitivity and accuracy in detecting small bowel inflammatory complications. However, there was no significant difference between the two modalities in the overall diagnosis of small bowel inflammatory lesions (P = 1.00).(Table 3 )༈Figure 2 ༉ Table 3 Sensitivity, specificity, and accuracy of SICUS versus MRE in detecting SBID-related complications (N = 57) Complication Intraoperative Diagnosis (n) Imaging Modality True Positive (n) False Positive (n) False Negative (n) True Negative (n) Sensitivity (%) Specificity (%) Accuracy (%) stenosis 54 SICUS 47 0 7 3 87.0 100 87.7 MRE 45 0 9 3 83.3 100 84.2 fistulas 29 SICUS 24 0 5 28 82.8 100 91.2 MRE 19 0 10 28 65.5 100 82.5 abscesses 11 SICUS 9 0 2 46 81.8 100 96.5 MRE 9 1 2 45 81.8 97.8 94.7 4. Discussion SIBD presents with a wide range of nonspecific clinical symptoms, including abdominal pain, diarrhea, gastrointestinal bleeding, bloating, and weight loss 16 . In our study, abdominal pain was the most frequently reported symptom (89.5%), followed by altered bowel habits (24.6%). Due to the limited visualization of the entire small intestine by conventional endoscopy, these nonspecific symptoms often lead to misdiagnoses or missed diagnoses. Therefore, SIBD should be considered in patients with recurrent, unexplained gastrointestinal complaints despite negative findings on routine endoscopy. In this context, oral 2.5% mannitol SICUS has demonstrated substantial diagnostic value, with a positivity rate of 96.5% in identifying SIBD. By effectively distending the small intestine and minimizing gas interference, SICUS enables clear visualization of intestinal structures and lesions 17 . It allows dynamic assessment of bowel wall morphology and peristalsis, enhancing the detection of stenotic and rigid segments—particularly during the "peak effect" phase—thus reducing false positives. In our study, SICUS showed a sensitivity of 87% for detecting stenosis, slightly outperforming MRE (83.3%). For fistulas, its real-time scanning capability enabled tracking of contrast flow 18 , resulting in a higher detection sensitivity (82.8%) compared to MRE (65.5%), with strong concordance to surgical findings (κ = 0.83). In detecting abscesses, SICUS provided a superior acoustic window due to improved bowel preparation and distension 19 , yielding diagnostic performance comparable to MRE, with no statistically significant differences (P > 0.05). In this study, both SICUS and MRE demonstrated high diagnostic performance for SIBD, each yielding a positive detection rate of 96.5%. The few missed cases may be attributed to examinations performed during remission phases. Compared to previous studies, such as Zhu et al. (88.3%) 20 , our higher diagnostic rate may be due to the surgical confirmation of cases and the advanced expertise of our gastrointestinal ultrasonography specialists 21 , 22 . In the detection of complications, SICUS showed notable advantages. For strictures, SICUS achieved a sensitivity of 87% and specificity of 100%, slightly outperforming MRE, likely due to its real-time dynamic scanning and effective intestinal distension, which enhance visualization of stiff, narrowed segments. In diagnosing fistulas, SICUS demonstrated higher sensitivity (82.8%) than MRE (65.5%) and excellent agreement with surgical findings (κ = 0.83), consistent with previous research 48,49 . For abscesses, SICUS provided comparable sensitivity to MRE (81.8%), benefiting from improved acoustic windows following bowel preparation. Overall, SICUS offers high diagnostic accuracy for SIBD and its complications and is especially advantageous for patients requiring repeated assessments or with limited access to advanced imaging modalities. SICUS demonstrated higher sensitivity than MRE in detecting complications such as strictures and fistulas, and its non-invasive, cost-effective, and easy-to-perform nature makes it especially suitable for primary healthcare settings and patients ineligible for MRE. There are several strengths and novel aspects in this study:(1)Surgical pathology was used as the gold standard, providing objective validation of imaging results.(2)The study focused on patients with confirmed and complicated SIBD, offering insights into the performance of SICUS in severe cases.(3)All SICUS examinations were performed by an experienced specialist, ensuring high image quality and diagnostic accuracy.(4)The study specifically assessed SICUS’s ability to detect complications such as strictures and fistulas. There are several limitations in this study: (1) The data were sourced from a single-center study with a small sample size, which may limit the generalizability of the findings; (2) Surgical results were used as the gold standard in this study, which may introduce selection bias and lead to overestimation of results; (3) Although the SICUS examinations were performed by two experienced physicians, inter-operator consistency was not formally evaluated.Future research should evaluate inter-operator consistency, and large-scale, multicenter studies are needed to further validate the diagnostic efficacy of SICUS. 5. Conclusions SICUS is a non-invasive, radiation-free, cost-effective, and easily repeatable small bowel examination technique that is well tolerated by patients. It can clearly demonstrate the characteristics of small bowel inflammatory lesions and their associated complications. In diagnosing SIBD and its complications, SICUS shows high sensitivity and accuracy, particularly outperforming MRE in detecting strictures and fistulas. Given its low cost and ease of implementation, SICUS can serve as an effective alternative to MRE, especially in primary healthcare settings and for patients who are unsuitable for MRE. It provides strong support for the early diagnosis and management of SIBD. Declarations Funding Statement The authors declare that financial support was received for the research and/or publication of this article. This study was supported by Fujian Medical University QiHang Fund [grant no. 2022QH1093]. Data availability statement The original contributions presented in this study are included in this article/Supplementary material, further inquiries can be directed to the corresponding author. RefeEthics statement This study was in accordance with the Ethical Standards of the Institutional Ethics Committee of First Affiliated Hospital of Fujian Medical University and with the 1964 Helsinki declaration and its later amendments or comparable Ethical Standards. Ethics batch number: IEC-FOM-013-2.0. As a purely retrospective review of medical records that did not involve any personally identifiable information, the requirement for informed consent was waived.rences Conflict of interest All authors have no conflicts of interest that are directly relevant to the content of this article. Author Contribution Ahuang Cai: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Writing – original draft. Yu Xu: Formal Analysis,Data curation, Investigation, Funding acquisition, Writing – original draft. Liqin Yu:Formal Analysis, Data curation, Investigation, Writing – original draft. Hailan Chen: Acquisition, analysis, or interpretation of data. Yan Chen: Acquisition, analysis, or interpretation of data. Shengnan Wu: Acquisition, analysis, or interpretation of data. Xuan Wang: Acquisition, analysis, or interpretation of data. Linglin Wei: Methodology, Project administration, Writing – review and editing. Xinxiu Liu: Conceptualization, Project administration, Resources, Supervision, Validation, Writing – review and editing.All authors have reviewed the manuscript. References Danese S, Fiocchi C. Ulcerative colitis. N Engl J Med. 2011;365(18):1713–1725. Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2019;16(7):453–463. Gölder SK, Schreyer AG, Endlicher E, et al. Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease. Int J Colorectal Dis. 2006;21(2):97–104. Barreiro-de Acosta M, Molero A, Artime E, et al. Epidemiological, Clinical, Patient-Reported and Economic Burden of Inflammatory Bowel Disease(Ulcerative colitis and Crohn's disease) in Spain: A Systematic Review. Adv Ther. 2023;40(5):1975–2014. Ma JJ, Wang Y, Xu XM, et al. Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: Competing or complementary?. World J Gastroenterol. 2016;22(48):10625–10630. Zakeri N, Pollok RC. Diagnostic imaging and radiation exposure in inflammatory bowel disease. World J Gastroenterol. 2016;22(7):2165–2178. Masselli G, Gualdi G. MR imaging of the small bowel. Radiology. 2012;264(2):333–348. Pallotta N, Baccini F, Corazziari E. Small intestine contrast ultrasonography. J Ultrasound Med. 2000;19(1):21–26. Nagarajan KV, Bhat N. Intestinal ultrasound in inflammatory bowel disease: New kid on the block. Indian J Gastroenterol. 2024;43(1):160–171. Fraquelli M, Colli A, Casazza G, et al. Role of US in detection of Crohn disease: meta-analysis. Radiology. 2005;236(1):95–101. Biko DM, Rosenbaum DG, Anupindi SA. Ultrasound features of pediatric Crohn disease: a guide for case interpretation. Pediatr Radiol. 2015;45(10):1557–1556. Bollegala N, Griller N, Bannerman H, Habal M, Nguyen GC. Ultrasound vs Endoscopy, Surgery, or Pathology for the Diagnosis of Small Bowel Crohn's Disease and its Complications. Inflamm Bowel Dis. 2019;25(8):1313–1338. Coelho R, Ribeiro H, Maconi G. Bowel Thickening in Crohn's Disease: Fibrosis or Inflammation? Diagnostic Ultrasound Imaging Tools. Inflamm Bowel Dis. 2017;23(1):23–34. Pallotta N, Tomei E, Viscido A, et al. Small intestine contrast ultrasonography: an alternative to radiology in the assessment of small bowel disease. Inflamm Bowel Dis. 2005;11(2):146–153. Oberhuber G, Stangl PC, Vogelsang H, Schober E, Herbst F, Gasche C. Significant association of strictures and internal fistula formation in Crohn's disease. Virchows Arch. 2000;437(3):293–297. M'Koma AE. Inflammatory Bowel Disease: Clinical Diagnosis and Pharmaceutical Management. Med Res Arch. 2023;11(1): 10.18103/mra.v11i1.3135 . Zhu C, Ma X, Xue L, et al. Small intestine contrast ultrasonography for the detection and assessment of Crohn disease: A meta-analysis. Medicine (Baltimore). 2016;95(31):e4235. Lin T, Ye Z, Hu J, Yin H. A comparison of trans-fistula contrast-enhanced endoanal ultrasound and MRI in the diagnosis of anal fistula. Ann Palliat Med. 2021;10(8):9165–9173. Mocci G, Migaleddu V, Cabras F, et al. SICUS and CEUS imaging in Crohn's disease: an update. J Ultrasound. 2017;20(1):1–9. Zhu C, Ma X, Xue L, Xu J, Li Q, Wang Y, Zhang J. Small intestine contrast ultrasonography for the detection and assessment of Crohn disease: A meta-analysis. Medicine (Baltimore). 2016;95(31):e4235. Pallotta N, Vincoli G, Montesani C, Chirletti P, Pronio A, Caronna R, Ciccantelli B, Romeo E, Marcheggiano A, Corazziari E. Small intestine contrast ultrasonography (SICUS) for the detection of small bowel complications in crohn's disease: a prospective comparative study versus intraoperative findings. Inflamm Bowel Dis. 2012;18(1):74–84. Allocca M, Fiorino G, Bonifacio C, et al. Comparative Accuracy of Bowel Ultrasound Versus Magnetic Resonance Enterography in Combination With Colonoscopy in Assessing Crohn's Disease and Guiding Clinical Decision-making. J Crohns Colitis. 2018;12(11):1280–1287. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7275932","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":496212945,"identity":"4c70ee3f-64d7-46d9-961e-d143b63fe92b","order_by":0,"name":"Ahuang Cai","email":"","orcid":"","institution":"The First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Ahuang","middleName":"","lastName":"Cai","suffix":""},{"id":496212946,"identity":"6ac16279-727c-4c9f-8658-03f7c39e54e8","order_by":1,"name":"Yu Xu","email":"","orcid":"","institution":"The First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Xu","suffix":""},{"id":496212947,"identity":"a9565388-e5dc-4193-a11d-db65c1515016","order_by":2,"name":"Liqin Yu","email":"","orcid":"","institution":"The First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Liqin","middleName":"","lastName":"Yu","suffix":""},{"id":496212948,"identity":"91009007-1369-4e7b-9dcd-b815de79386c","order_by":3,"name":"Hailan Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hailan","middleName":"","lastName":"Chen","suffix":""},{"id":496212949,"identity":"9b2ae446-d6f0-4997-8e92-0edde65fc7c0","order_by":4,"name":"Yan Chen","email":"","orcid":"","institution":"The First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Chen","suffix":""},{"id":496212954,"identity":"7b745659-fe85-4697-9807-0f9052f85bd3","order_by":5,"name":"Shengnan Wu","email":"","orcid":"","institution":"The First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shengnan","middleName":"","lastName":"Wu","suffix":""},{"id":496212957,"identity":"448f15ed-ba65-467e-81b0-2ab2a6dd0886","order_by":6,"name":"Xuan Wang","email":"","orcid":"","institution":"The First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xuan","middleName":"","lastName":"Wang","suffix":""},{"id":496212959,"identity":"d1c9e390-edd9-44a6-997a-7137d8fb9d50","order_by":7,"name":"Linglin Wei","email":"","orcid":"","institution":"The First Affiliated Hospital of Fujian Medical University","correspondingAuthor":false,"prefix":"","firstName":"Linglin","middleName":"","lastName":"Wei","suffix":""},{"id":496212960,"identity":"87b106dd-1892-42b9-a028-e43d3a1a010d","order_by":8,"name":"Xinxiu Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAu0lEQVRIiWNgGAWjYBACPhCRwMDAw8De2PjwAzFa2OBaeA43G0sQrQUMJNLbBHiI0sJ+xkzi4Y7DMgY3H7YxSDDYyek2ENLCk2NskHgmjcfgdmLbgwKGZGOzAwQdlmP4ILHNBqSl3UCC4UDiNoJa+N8YHEhsk+AxuHkQSBKlRQJmyw1GorU8KzZIbEvjkTyTCAxkAyL8ws+fvE3yZ9the77jxx8+/FBhJ0dQCxowIE35KBgFo2AUjAIcAACuiDyR7kxNTAAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital of Fujian Medical University","correspondingAuthor":true,"prefix":"","firstName":"Xinxiu","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2025-08-02 06:23:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7275932/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7275932/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88652561,"identity":"5a51f066-8c36-452c-9b38-e88dcd09aad3","added_by":"auto","created_at":"2025-08-08 17:56:08","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":249504,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eImaging Features of Small Bowel Inflammatory Complications Detected by SICUS and MRE。\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7275932/v1/050147f9b371726ac84fec67.jpg"},{"id":88652562,"identity":"a3aed5f0-ff9a-44d2-b739-7816e97d2984","added_by":"auto","created_at":"2025-08-08 17:56:08","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":203795,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eComparison of SICUS and MRE in diagnosing stenosis, fistulas, and abscesses.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7275932/v1/f992d138a7e514ee39ba5d51.jpg"},{"id":89485654,"identity":"1de52e14-762c-49ac-a33b-51570e66061a","added_by":"auto","created_at":"2025-08-20 12:47:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1340964,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7275932/v1/97375fa1-6572-4232-99fe-4bf044a2d2b9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eOral 2.5% Mannitol-Enhanced SICUS for Small Bowel Inflammatory Disease: A Surgical-Validated Comparative Study with MRE\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSmall Bowel Inflammatory Disease (SBID), encompassing conditions such as Crohn\u0026rsquo;s disease (CD), nonspecific enteritis, and intestinal tuberculosis, represents a common inflammatory disease of the small intestine\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Global epidemiologic studies have shown that the incidence of SIBD is rapidly increasing and the proportion of refractory cases is also increasing\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e.Due to the unique anatomical structure of the small intestine, characterized by its tortuous shape, rapid peristalsis, long and free lumen, and numerous folds, traditional gastrointestinal endoscopy is limited in its ability to comprehensively and accurately assess small bowel lesions\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. SBID often present with an insidious onset and nonspecific symptoms, leading to difficulties in early diagnosis and potential delays in treatment. SBID are associated with increased surgical complications and healthcare costs, underscoring the urgent need for timely detection and effective management\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eWith advancements in medical technology, there are several diagnostic methods used to evaluate small bowel disease such as Small Bowel Endoscopy (SBE), Computed Tomography Enterograph(CTE), and Magnetic Resonance Enterography (MRE) but each method has its own advantages and limitations.As the gold standard for the diagnosis of SIBD, SBE allows biopsy of diseased tissue in the small bowel mucosa. However, SBE is an invasive test and is not recommended as a first-line test for SIBD in cases where the intestinal lumen is significantly narrowed and the small colonoscope cannot be passed through\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.CTE can clearly visualize the intestinal wall and surrounding structures, but because most patients with SBID require long-term follow-up, the cumulative radiation dose should not be ignored\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.Although MRE offers high soft tissue resolution, multi-directional imaging, and avoids ionizing radiation, it has several limitations. These include high equipment requirements, expensive costs, and limited accessibility in primary or community-level hospitals. Moreover, it is contraindicated in patients with ferromagnetic implants or electronic devices\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Therefore, it is important to explore a more accurate, efficient, convenient, and cost-effective diagnostic method for SBID.Oral 2.5% Mannitol Small Bowel Ultrasound Contrast (SICUS) is an emerging diagnostic technique that has attracted increasing attention in recent years for SBID diagnosis. By orally administering a 2.5% mannitol solution to distend the small intestine, SICUS can effectively reduce interference from intestinal gas and provide clear visualization of small bowel structure and lesions\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThis study aims to systematically evaluate the diagnostic performance of SICUS in detecting small bowel inflammatory lesions and to compare its efficacy with magnetic resonance enterography (MRE), with the goal of offering a simpler, more accessible imaging modality for clinical diagnosis.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003e2.1 Study Design and Participants\u003c/h2\u003e\nA total of 77 patients with suspected small bowel disease who underwent small bowel examination and surgical treatment at the First Affiliated Hospital of Fujian Medical University between June 2019 and October 2023 were retrospectively enrolled in this study. Inclusion criteria were as follows: (1) presence of gastrointestinal symptoms and at least one conventional gastrointestinal endoscopic examination; (2) all patients underwent SICUS with oral administration of 2.5% mannitol; (3) all patients underwent MRE with the most recent preoperative scan included for patients who had multiple examinations within six months; (4) all patients underwent surgical treatment. Exclusion criteria were as follows: (1) absence of pathological confirmation by surgical or biopsy specimens; (2) poor bowel preparation resulting in failure of SICUS to visualize the small intestine; (3) intolerance to oral mannitol; (4) severe cardiac, hepatic, or renal dysfunction.Based on the final pathological diagnosis. Finally, 57 patients with inflammatory lesions were included, while 20 patients with postoperative pathological confirmation of small bowel neoplasms were excluded. This study was approved by the Ethics Committee of the hospital (IEC-FOM-013-2.0), and informed consent was obtained from the patients or their guardians prior to the examination.\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e2.2 Instruments and Methods\u003c/h2\u003e\n\u003cp\u003eOral 2.5% Mannitol SICUS Examination: All examinations were performed in the supine position using a GE Voluson E10 Color Doppler Ultrasound system (convex array: 3.5\u0026ndash;10.0 MHz; linear array: 7.5\u0026ndash;14 MHz) by two experienced physicians with intermediate or senior professional titles.Patients ingested 2.5% isotonic mannitol solution (up to 2000 mL) to achieve adequate small bowel distension. The small intestine was scanned sequentially from the duodenum to the ileocecal junction. When necessary, additional warm water was administered to ensure optimal imaging. Intestinal wall thickness, wall stratification, peristalsis, lumen narrowing, and surrounding structures (e.g., lymph nodes, fistulas, abscesses) were evaluated. Color Doppler Flow Imaging (CDFI) was used to assess vascularity. Inflammatory activity was graded using the Limberg classification\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eMRE Examination: MRE was performed using a Siemens Magnetom Verio 3.0T MRI scanner. Patients received 1500 mL of 2.5% mannitol solution orally 1 hour prior to scanning. Ten minutes before imaging, 20 mg of hyoscine butylbromide was intramuscularly administered. MRI sequences included axial and coronal T2-weighted imaging (T2WI), T1-weighted imaging (T1WI), and diffusion-weighted imaging (DWI). For contrast-enhanced imaging, gadopentetate dimeglumine (0.1 mmol/kg) was injected intravenously at 2 mL/s. Dynamic 3D VIBE sequences were obtained at 30, 60, and 90 seconds post-injection.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003e2.3 Ultrasound Image Analysis\u003c/h2\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eLesion Location: The duodenum, jejunum, and ileum were identified based on the anatomical location and morphology of the small intestine. The upper duodenum is connected to the stomach pylorus, and it continues into the jejunum via the ascending part, wrapping around the head of the pancreas in a \"C\" shape. The jejunum is mostly located in the upper left abdomen, and the ileum is mostly in the lower right abdomen. The jejunum has prominent folds and active peristalsis, while the ileum\u0026rsquo;s folds gradually diminish and disappear, with slower peristalsis. The terminal ileum is the portion of the ileum located within 20 cm of the ileocecal valve.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eIntestinal Wall Thickening: Three measurements were taken in both longitudinal and transverse planes, with the average value\u0026thinsp;\u0026gt;\u0026thinsp;3 mm being considered as intestinal wall thickening\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAbnormal Intestinal Wall Layers: The normal ultrasound image of the intestinal wall shows the following layers from the inside out: a high echogenic interface between the lumen and the mucosa, a hypoechoic mucosal layer containing the mucosal muscle, a high echogenic submucosa, a hypoechoic muscularis propria, and a high echogenic interface between the serosal layer and surrounding tissue. A loss of these layers is considered abnormal\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eNarrowing: SICUS shows intestinal wall thickness\u0026thinsp;\u0026gt;\u0026thinsp;3 mm and the maximum inner diameter of the lumen\u0026thinsp;\u0026lt;\u0026thinsp;10 mm, with or without proximal intestinal dilation (\u0026gt;\u0026thinsp;25 mm), as the diagnostic criteria for narrowing\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eIntestinal Fistula: An abnormal passage between the intestinal lumen and mesentery, other abdominal hollow organs, the peritoneal cavity, or the skin\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. It appears as a disruption in the continuity of the intestinal wall echo, with a hypoechoic tubular structure around the bowel wall. When containing gas, it shows strong echogenicity, and communication with the peritoneal cavity or abdominal organs indicates an enterocutaneous fistula.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eAbscess: An irregular mass with thick walls, mixed echogenicity (liquid or liquid-containing), often located around an intestinal fistula. Sometimes, gas shadows may be visible inside, and posterior acoustic enhancement is commonly seen.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003e2.4 Statistical Methods\u003c/h2\u003e\n\u003cp\u003eAll data were analyzed using the SPSS 25.0(IBM Corp., Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.) statistical analysis software. For continuous variables, data that followed a normal distribution were expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\left(\\overline{\\text{X}}\\pm\\:\\text{S}\\right)\\)\u003c/span\u003e\u003c/span\u003e, while data that did not follow a normal distribution were expressed as the median (interquartile range) (P25, P75). Categorical variables were expressed as percentages. The consistency analysis of SICUS in diagnosing small bowel inflammatory lesions, complications, and surgical outcomes was performed using the kappa coefficient. A kappa value of \u0026lt;\u0026thinsp;0.2 indicates poor consistency; 0.2\u0026ndash;0.4 indicates fair consistency; 0.4\u0026ndash;0.6 indicates moderate consistency; 0.6\u0026ndash;0.8 indicates strong consistency; and 0.8\u0026ndash;1.0 indicates very strong consistency. The diagnostic value of SICUS and MRE for SBID was compared using the McNemar test (paired chi-square test), and a P value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Patient Characteristics\u003c/h2\u003e\u003cp\u003eA total of 57 patients with pathologically confirmed inflammatory lesions were included in this study, comprising 36 males (63.2%) and 21 females (36.8%), with a mean age of 40.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9 years. The main clinical manifestations were abdominal pain in 51 cases (89.5%), altered bowel habits in 14 cases (24.6%), diarrhea in 9 cases (15.8%), vomiting in 5 cases (8.8%), abdominal distension in 3 cases (5.3%), perianal lesions in 2 cases (3.5%), hematochezia in 2 cases (3.5%), fever in 2 cases (3.5%), and melena in 1 case (1.8%).\u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003ePostoperative pathological diagnoses confirmed inflammatory lesions in all 57 patients, including Crohn\u0026rsquo;s disease (CD) in 50 cases, nonspecific enteritis in 5 cases, intestinal tuberculosis in 1 case, and cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) in 1 case.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDemographic and Clinical Characteristics of SBID (N\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCharacteristic\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNumber of Cases (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e63.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge [years, \u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s]\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e-\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40.0\u0026thinsp;\u0026plusmn;\u0026thinsp;13.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eClinical manifestations\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal pain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e85.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAltered bowel habits\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDiarrhea\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVomiting\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbdominal distension\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerianal lesions\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHematochezia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFever\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMelena\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.2 SICUS Ultrasound Features of SBID\u003c/h2\u003e\u003cp\u003eThe most common ultrasound finding in SBID is bowel wall thickening. However, bowel wall thickening is a nonspecific sign that can also be observed in other conditions, including infections, vasculitis, and localized ischemia. Therefore, differential diagnosis by ultrasound should also take into account factors such as the integrity of the bowel wall layers, vascular distribution, common locations, and lesion length. CD most commonly affects in the terminal ileum and right colon, characterized by segmental bowel wall thickening with a skip pattern\u0026mdash;normal bowel segments interspersed between affected areas with well-defined boundaries. Mesenteric fat proliferation, often referred to as \"fat creeping\", is requently observed around inflamed areas; this proliferation extends to mesenteric edge and typically correlates with the severity of inflammation. Significant bowel wall thickening, loss of bowel wall layering, and increased blood flow grading in the bowel wall as seen on CDFI often suggest that CD is in an active phase. Complications such as stenosis, fistulas and abscesses (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e1\u003c/span\u003e) may also occur.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.3 Consistency between SICUS and Surgical Findings in the Diagnosis of SBID-Related Complications\u003c/h2\u003e\u003cp\u003eAmong the 57 patients with surgically confirmed small bowel inflammatory lesions, 54 had strictures, 29 had enteric fistulas, and 11 had abscesses. SICUS demonstrated a sensitivity of 87.0% and a specificity of 100% for detecting strictures, with moderate agreement with surgical findings (κ\u0026thinsp;=\u0026thinsp;0.41). For enteric fistulas\u0026mdash;including 24 enteroenteric fistulas, 2 enterovesical fistulas, and 3 complex fistulas\u0026mdash;SICUS achieved a sensitivity of 82.8% and specificity of 100%, showing strong agreement with surgical localization (κ\u0026thinsp;=\u0026thinsp;0.83). For abscesses\u0026mdash;4 located posterior to the ileocecal region, 5 in the right lower abdominal/pelvic mesentery, and 2 pelvic abscesses associated with enterovesical fistulas\u0026mdash;SICUS yielded a sensitivity of 81.8% and specificity of 100%, with excellent consistency with surgical findings (κ\u0026thinsp;=\u0026thinsp;0.88).(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDiagnostic performance of SICUS for SBID-related complications compared with surgical findings (N\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntraoperative Diagnosis\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTrue\u003c/p\u003e\u003cp\u003ePositive\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eFalse\u003c/p\u003e\u003cp\u003ePositive\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFalse\u003c/p\u003e\u003cp\u003eNegative\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eTrue\u003c/p\u003e\u003cp\u003eNegative\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSensitivity\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSpecificity\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eAccuracy\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eKappa Coefficient\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003estenosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e87.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e87.7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003efistulas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e82.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e91.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.83\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eabscesses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e81.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c9\"\u003e\u003cp\u003e96.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e0.88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.4 Diagnostic Performance of SICUS in SBID and SBID-Related Complications\u003c/h2\u003e\u003cp\u003eSICUS demonstrated a positive detection rate of 96.5% (55/57) for SBID, identical to that of MRE (96.5%). In the identification of complications such as strictures, enteric fistulas, and abscesses, the sensitivity of SICUS was 87.0%, 82.8%, and 81.8%, respectively, with a specificity of 100% for all. Compared with MRE, SICUS showed higher sensitivity and accuracy in detecting small bowel inflammatory complications. However, there was no significant difference between the two modalities in the overall diagnosis of small bowel inflammatory lesions (P\u0026thinsp;=\u0026thinsp;1.00).(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)༈Figure \u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e2\u003c/span\u003e༉\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSensitivity, specificity, and accuracy of SICUS versus MRE in detecting SBID-related complications (N\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eComplication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntraoperative Diagnosis\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImaging\u003c/p\u003e\u003cp\u003eModality\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTrue\u003c/p\u003e\u003cp\u003ePositive\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFalse\u003c/p\u003e\u003cp\u003ePositive\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eFalse\u003c/p\u003e\u003cp\u003eNegative\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eTrue\u003c/p\u003e\u003cp\u003eNegative\u003c/p\u003e\u003cp\u003e(n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSensitivity\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eSpecificity\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\"\u003e\u003cp\u003eAccuracy\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003estenosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSICUS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e87.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e87.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMRE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e83.3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e84.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003efistulas\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSICUS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e82.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e91.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMRE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e65.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e82.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eabscesses\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSICUS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e81.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e96.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMRE\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e81.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e97.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e\u003cp\u003e94.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eSIBD presents with a wide range of nonspecific clinical symptoms, including abdominal pain, diarrhea, gastrointestinal bleeding, bloating, and weight loss\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. In our study, abdominal pain was the most frequently reported symptom (89.5%), followed by altered bowel habits (24.6%). Due to the limited visualization of the entire small intestine by conventional endoscopy, these nonspecific symptoms often lead to misdiagnoses or missed diagnoses. Therefore, SIBD should be considered in patients with recurrent, unexplained gastrointestinal complaints despite negative findings on routine endoscopy. In this context, oral 2.5% mannitol SICUS has demonstrated substantial diagnostic value, with a positivity rate of 96.5% in identifying SIBD. By effectively distending the small intestine and minimizing gas interference, SICUS enables clear visualization of intestinal structures and lesions\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. It allows dynamic assessment of bowel wall morphology and peristalsis, enhancing the detection of stenotic and rigid segments\u0026mdash;particularly during the \"peak effect\" phase\u0026mdash;thus reducing false positives. In our study, SICUS showed a sensitivity of 87% for detecting stenosis, slightly outperforming MRE (83.3%). For fistulas, its real-time scanning capability enabled tracking of contrast flow\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e, resulting in a higher detection sensitivity (82.8%) compared to MRE (65.5%), with strong concordance to surgical findings (κ\u0026thinsp;=\u0026thinsp;0.83). In detecting abscesses, SICUS provided a superior acoustic window due to improved bowel preparation and distension\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, yielding diagnostic performance comparable to MRE, with no statistically significant differences (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\u003cp\u003eIn this study, both SICUS and MRE demonstrated high diagnostic performance for SIBD, each yielding a positive detection rate of 96.5%. The few missed cases may be attributed to examinations performed during remission phases. Compared to previous studies, such as Zhu et al. (88.3%) \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e, our higher diagnostic rate may be due to the surgical confirmation of cases and the advanced expertise of our gastrointestinal ultrasonography specialists \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. In the detection of complications, SICUS showed notable advantages. For strictures, SICUS achieved a sensitivity of 87% and specificity of 100%, slightly outperforming MRE, likely due to its real-time dynamic scanning and effective intestinal distension, which enhance visualization of stiff, narrowed segments. In diagnosing fistulas, SICUS demonstrated higher sensitivity (82.8%) than MRE (65.5%) and excellent agreement with surgical findings (κ\u0026thinsp;=\u0026thinsp;0.83), consistent with previous research \u003csup\u003e48,49\u003c/sup\u003e. For abscesses, SICUS provided comparable sensitivity to MRE (81.8%), benefiting from improved acoustic windows following bowel preparation. Overall, SICUS offers high diagnostic accuracy for SIBD and its complications and is especially advantageous for patients requiring repeated assessments or with limited access to advanced imaging modalities.\u003c/p\u003e\u003cp\u003eSICUS demonstrated higher sensitivity than MRE in detecting complications such as strictures and fistulas, and its non-invasive, cost-effective, and easy-to-perform nature makes it especially suitable for primary healthcare settings and patients ineligible for MRE. There are several strengths and novel aspects in this study:(1)Surgical pathology was used as the gold standard, providing objective validation of imaging results.(2)The study focused on patients with confirmed and complicated SIBD, offering insights into the performance of SICUS in severe cases.(3)All SICUS examinations were performed by an experienced specialist, ensuring high image quality and diagnostic accuracy.(4)The study specifically assessed SICUS\u0026rsquo;s ability to detect complications such as strictures and fistulas.\u003c/p\u003e\u003cp\u003eThere are several limitations in this study: (1) The data were sourced from a single-center study with a small sample size, which may limit the generalizability of the findings; (2) Surgical results were used as the gold standard in this study, which may introduce selection bias and lead to overestimation of results; (3) Although the SICUS examinations were performed by two experienced physicians, inter-operator consistency was not formally evaluated.Future research should evaluate inter-operator consistency, and large-scale, multicenter studies are needed to further validate the diagnostic efficacy of SICUS.\u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eSICUS is a non-invasive, radiation-free, cost-effective, and easily repeatable small bowel examination technique that is well tolerated by patients. It can clearly demonstrate the characteristics of small bowel inflammatory lesions and their associated complications. In diagnosing SIBD and its complications, SICUS shows high sensitivity and accuracy, particularly outperforming MRE in detecting strictures and fistulas. Given its low cost and ease of implementation, SICUS can serve as an effective alternative to MRE, especially in primary healthcare settings and for patients who are unsuitable for MRE. It provides strong support for the early diagnosis and management of SIBD.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that financial support was received for the research and/or publication of this article. This study was supported by Fujian Medical University QiHang Fund [grant no. 2022QH1093].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in this study are included in this article/Supplementary material, further inquiries can be directed to the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRefeEthics statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was in accordance with the Ethical Standards of the Institutional Ethics Committee of First Affiliated Hospital of Fujian Medical University and with the 1964 Helsinki declaration and its later amendments or comparable Ethical Standards. Ethics batch number: IEC-FOM-013-2.0. As a purely retrospective review of medical records that did not involve any personally identifiable information, the requirement for informed consent was waived.rences\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors\u0026nbsp;have no conflicts of interest that are directly relevant to the content of this article.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAhuang Cai: Conceptualization, Formal Analysis, Investigation, Methodology, Software, Writing \u0026ndash; original draft. Yu Xu: Formal Analysis,Data curation, Investigation, Funding acquisition, Writing \u0026ndash; original draft. Liqin Yu:Formal Analysis, Data curation, Investigation, Writing \u0026ndash; original draft. Hailan Chen: Acquisition, analysis, or interpretation of data. Yan Chen: Acquisition, analysis, or interpretation of data. Shengnan Wu: Acquisition, analysis, or interpretation of data. Xuan Wang: Acquisition, analysis, or interpretation of data. Linglin Wei: Methodology, Project administration, Writing \u0026ndash; review and editing. Xinxiu Liu: Conceptualization, Project administration, Resources, Supervision, Validation, Writing \u0026ndash; review and editing.All authors have reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDanese S, Fiocchi C. Ulcerative colitis. N Engl J Med. 2011;365(18):1713\u0026ndash;1725.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol. 2019;16(7):453\u0026ndash;463.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eG\u0026ouml;lder SK, Schreyer AG, Endlicher E, et al. Comparison of capsule endoscopy and magnetic resonance (MR) enteroclysis in suspected small bowel disease. Int J Colorectal Dis. 2006;21(2):97\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBarreiro-de Acosta M, Molero A, Artime E, et al. Epidemiological, Clinical, Patient-Reported and Economic Burden of Inflammatory Bowel Disease(Ulcerative colitis and Crohn's disease) in Spain: A Systematic Review. Adv Ther. 2023;40(5):1975\u0026ndash;2014.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMa JJ, Wang Y, Xu XM, et al. Capsule endoscopy and single-balloon enteroscopy in small bowel diseases: Competing or complementary?. World J Gastroenterol. 2016;22(48):10625\u0026ndash;10630.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZakeri N, Pollok RC. Diagnostic imaging and radiation exposure in inflammatory bowel disease. World J Gastroenterol. 2016;22(7):2165\u0026ndash;2178.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasselli G, Gualdi G. MR imaging of the small bowel. Radiology. 2012;264(2):333\u0026ndash;348.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePallotta N, Baccini F, Corazziari E. Small intestine contrast ultrasonography. J Ultrasound Med. 2000;19(1):21\u0026ndash;26.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNagarajan KV, Bhat N. Intestinal ultrasound in inflammatory bowel disease: New kid on the block. Indian J Gastroenterol. 2024;43(1):160\u0026ndash;171.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFraquelli M, Colli A, Casazza G, et al. Role of US in detection of Crohn disease: meta-analysis. Radiology. 2005;236(1):95\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBiko DM, Rosenbaum DG, Anupindi SA. Ultrasound features of pediatric Crohn disease: a guide for case interpretation. Pediatr Radiol. 2015;45(10):1557\u0026ndash;1556.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBollegala N, Griller N, Bannerman H, Habal M, Nguyen GC. Ultrasound vs Endoscopy, Surgery, or Pathology for the Diagnosis of Small Bowel Crohn's Disease and its Complications. Inflamm Bowel Dis. 2019;25(8):1313\u0026ndash;1338.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoelho R, Ribeiro H, Maconi G. Bowel Thickening in Crohn's Disease: Fibrosis or Inflammation? Diagnostic Ultrasound Imaging Tools. Inflamm Bowel Dis. 2017;23(1):23\u0026ndash;34.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePallotta N, Tomei E, Viscido A, et al. Small intestine contrast ultrasonography: an alternative to radiology in the assessment of small bowel disease. Inflamm Bowel Dis. 2005;11(2):146\u0026ndash;153.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOberhuber G, Stangl PC, Vogelsang H, Schober E, Herbst F, Gasche C. Significant association of strictures and internal fistula formation in Crohn's disease. Virchows Arch. 2000;437(3):293\u0026ndash;297.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eM'Koma AE. Inflammatory Bowel Disease: Clinical Diagnosis and Pharmaceutical Management. Med Res Arch. 2023;11(1):\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18103/mra.v11i1.3135\u003c/span\u003e\u003cspan address=\"10.18103/mra.v11i1.3135\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu C, Ma X, Xue L, et al. Small intestine contrast ultrasonography for the detection and assessment of Crohn disease: A meta-analysis. Medicine (Baltimore). 2016;95(31):e4235.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLin T, Ye Z, Hu J, Yin H. A comparison of trans-fistula contrast-enhanced endoanal ultrasound and MRI in the diagnosis of anal fistula. Ann Palliat Med. 2021;10(8):9165\u0026ndash;9173.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMocci G, Migaleddu V, Cabras F, et al. SICUS and CEUS imaging in Crohn's disease: an update. J Ultrasound. 2017;20(1):1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu C, Ma X, Xue L, Xu J, Li Q, Wang Y, Zhang J. Small intestine contrast ultrasonography for the detection and assessment of Crohn disease: A meta-analysis. Medicine (Baltimore). 2016;95(31):e4235.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePallotta N, Vincoli G, Montesani C, Chirletti P, Pronio A, Caronna R, Ciccantelli B, Romeo E, Marcheggiano A, Corazziari E. Small intestine contrast ultrasonography (SICUS) for the detection of small bowel complications in crohn's disease: a prospective comparative study versus intraoperative findings. Inflamm Bowel Dis. 2012;18(1):74\u0026ndash;84.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAllocca M, Fiorino G, Bonifacio C, et al. Comparative Accuracy of Bowel Ultrasound Versus Magnetic Resonance Enterography in Combination With Colonoscopy in Assessing Crohn's Disease and Guiding Clinical Decision-making. J Crohns Colitis. 2018;12(11):1280\u0026ndash;1287.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"small bowel inflammatory disorders, SICUS, MRE, mannitol, diagnosis","lastPublishedDoi":"10.21203/rs.3.rs-7275932/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7275932/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThis study aimed to evaluate the diagnostic value of Small Intestine Contrast Ultrasonography (SICUS) using oral 2.5% mannitol for detecting Small Bowel Inflammatory Disease (SBID), and to compare its efficacy with Magnetic Resonance Enterography (MRE).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eFifty-seven patients with pathologically confirmed SBID who underwent both SICUS and MRE before surgery were retrospectively analyzed. The sensitivity, specificity, and agreement with surgical findings were calculated for each modality in detecting SBID and its complications, including strictures, fistulas, and abscesses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eBoth SICUS and MRE achieved a detection rate of 96.5% for SBID. SICUS showed higher sensitivity than MRE in detecting strictures (87.0% vs. 83.3%) and fistulas (82.8% vs. 65.5%), with strong consistency with surgical findings (κ = 0.83 for fistulas). The sensitivity for detecting abscesses was 81.8% for both modalities. SICUS had 100% specificity in all complications. Its advantages include real-time dynamic imaging, high resolution, reduced interference from intestinal gas, and better accessibility in primary care settings.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eSICUS is a reliable, non-invasive, and cost-effective imaging method for evaluating SBID and its complications. It provides diagnostic performance comparable or superior to MRE, particularly in detecting strictures and fistulas. SICUS is especially valuable for patients requiring repeated assessments or those who cannot undergo MRE, offering a practical alternative in clinical practice.\u003c/p\u003e","manuscriptTitle":"Oral 2.5% Mannitol-Enhanced SICUS for Small Bowel Inflammatory Disease: A Surgical-Validated Comparative Study with MRE","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 17:56:04","doi":"10.21203/rs.3.rs-7275932/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0d2f374d-78b5-4242-966f-b28b4d840b12","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-20T12:39:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-08 17:56:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7275932","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7275932","identity":"rs-7275932","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}