35 Higher BMI Does Not Impair Visualization of Bowel Segments or Anastomoses in Point-of-Care Intestinal Ultrasound
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".