35 Higher BMI Does Not Impair Visualization of Bowel Segments or Anastomoses in Point-of-Care Intestinal Ultrasound
Notice bibliographique
Résumé
Background: Intestinal ultrasound (IUS) is a non-invasive, point-of-care modality to assess disease activity in inflammatory bowel disease (IBD). Among IUS parameters, bowel wall thickness (BWT) is one of the most reliable indicators of active inflammation. A longstanding concern in ultrasound imaging is that higher body mass index (BMI) may impair visualization due to increased abdominal wall thickness and ultrasound beam attenuation. Real-world IUS studies have identified abdominal fat as a contributor to inconclusive examinations; however, systematic evidence quantifying the effect of BMI on IUS performance in IBD is limited. We sought to evaluate whether BMI influences the ability to visualize bowel segments and anastomoses in clinical IUS practice. We hypothesized that BMI does not significantly impair segmental visualization. Methods: We retrospectively analyzed consecutive IUS scans of patients at a tertiary IBD center (August 2021 to May 2025). Successful visualization was defined by the ability to obtain a BWT measurement. All scans were acquired by 3 experienced bowel sonographers using standardized protocols. Rectal visualization was assessed in a predefined subgroup (n = 135). Visualization rates were reported by bowel segment and BMI category (<18, 18–25, 25–30, ≥30 kg/m2) and compared with Freeman-Halton test. Results: A total of 643 scans from 430 patients (median age 43 years [IQR 32–58], 50% female, median BMI 24.8 [22.0–28.4]) were included. Among patients with native anatomy (n = 496), visualization was consistently high: the terminal ileum (TI) was visualized in 100% (14/14) of underweight, 96.0% (234/244) of normal BMI, 90.9% (130/143) of patients with overweight, and 93.6% (89/95) of patients with obesity. Colonic segments were visualized in >95% across all BMI groups; the only significant difference was in the ascending colon (P = 0.049). Rectal assessment (subset, n = 135) was visualized in 100% (3/3) of underweight, 84.5% (49/58) of normal BMI, 72.5% (29/40), and 70.5% (24/34) of patients with overweight and obesity, respectively. Among patients with prior ileocecal resection (n = 151), anastomoses were visualized in 100% (9/9) of underweight, 82.1% (55/67) of normal BMI, 88.5% (46/52) of overweight, and 66.7% (14/21) of patients with obesity, with no significant difference (P = 0.12). In patients with TI Crohn’s disease (n = 235), TI visualization exceeded 94.8% across all BMI categories with no significant difference (P = 0.20). In patients without TI disease (n = 259), visualization differed significantly across BMI groups (P = 0.003), ranging from 81.4% (patients with overweight) to 100% (low BMI). A notable difference between TI and non-TI IBD was observed in the overweight group (99.2% vs 81.7%, P < 0.0001). In sub-analysis restricted to latest scan (n = 430), results were unchanged, except visualization of the ascending colon with native anatomy (n = 330) was no longer significant (P = 0.089). Conclusions: Bowel segment visualization by IUS was consistently >90% across BMI categories. Rectal and anastomotic assessment were slightly less reliable in overweight/obese patients but remained feasible. Importantly, BMI did not affect TI visualization in patients with TI Crohn’s disease, while differences emerged in non-TI IBD. These findings support the robustness of IUS across BMI categories and highlight disease location as a greater determinant of visualization than BMI.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».