{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T14:06:46Z","timestamp":1787062006214,"version":"build-2736575974"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T00:00:00Z","timestamp":1774310400000},"content-version":"vor","delay-in-days":23,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Perianal complications such as fistulas and abscesses are common in Crohn\u2019s disease (CD) and contribute to significant morbidity. Transperineal ultrasonography (TPUS) has emerged as a non-invasive and accurate method for perianal fistulizing CD (pfCD). This review evaluates the diagnostic accuracy of TPUS compared with magnetic resonance imaging (MRI), transrectal ultrasonography (TRUS), and examination under anesthesia (EUA) for detecting and classifying perianal fistulas and abscesses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A comprehensive literature search was conducted across multiple databases through January 2025 to identify studies evaluating TPUS accuracy in detecting perianal fistulas and abscesses compared with MRI, TRUS, or EUA as the reference standard. Meta-analysis was performed to assess TPUS accuracy for fistula detection (FD), fistula classification (FC), internal opening (IO) detection, and abscess detection (AD). The Quality Assessment of Diagnostic Accuracy Studies-2 tool was used to evaluate risk of bias.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1059 studies identified, 29 were included in this review. Pooled sensitivities for FD (18 studies, 1474 patients), FC (11 studies, 585 patients), IO detection (six studies, 481 patients), and AD (16 studies, 1276 patients) were 97.5%, 80.3%, 89.6%, and 93.5% respectively while pooled specificities for FD, IO detection, and AD were 69.0%, 66.3%, and 94.5% respectively. The overall TPUS accuracy for FD, FC, IO detection, and AD was 88.0%, 88.6%, 77.8%, and 91.8% respectively. Subgroup analysis on CD patients showed an accuracy of 86.4%, 87.6%, and 83.3% for FD, FC, and AD respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TPUS demonstrates high accuracy in detecting perianal fistulas and abscesses, supporting its use as a non-invasive, first-line diagnostic tool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjag032","type":"journal-article","created":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T10:35:38Z","timestamp":1774348538000},"source":"Crossref","is-referenced-by-count":2,"title":["Transperineal ultrasonography in detecting penetrating perianal disease: a systematic review and meta-analysis"],"prefix":"10.1093","volume":"20","author":[{"given":"Chong-Teik","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre , Amsterdam, 1081 HV,","place":["The Netherlands"]},{"name":"Department of Gastroenterology and Hepatology, Singapore General Hospital , 169856,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7457-8353","authenticated-orcid":false,"given":"Maarten","family":"Pruijt","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre , Amsterdam, 1081 HV,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gek-Hsiang","family":"Lim","sequence":"additional","affiliation":[{"name":"Health Services Research Unit, Singapore General Hospital , 169608,","place":["Singapore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faridi","family":"Jamaludin","sequence":"additional","affiliation":[{"name":"Medical Library AMC, Amsterdam UMC location University of Amsterdam , Amsterdam, 1105 AZ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3080-9806","authenticated-orcid":false,"given":"Christoph","family":"Teichert","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre , Amsterdam, 1081 HV,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4058-252X","authenticated-orcid":false,"given":"Floris","family":"de Voogd","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre , Amsterdam, 1081 HV,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"D\u2019Haens","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre , Amsterdam, 1081 HV,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8746-4275","authenticated-orcid":false,"given":"Britt","family":"Christensen","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, The Royal Melbourne Hospital , Parkville,VIC 3050,","place":["Australia"]},{"name":"Department of Medicine, University of Melbourne , Parkville, VIC 3050,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0810-4026","authenticated-orcid":false,"given":"Giovanni","family":"Maconi","sequence":"additional","affiliation":[{"name":"Gastroenterology Unit, Department of Biomedical and Clinical Sciences, \u2018L. Sacco\u2019 Hospital, University of Milano , Milan 20157,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krisztina","family":"Gecse","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology, Amsterdam University Medical Centre , Amsterdam, 1081 HV,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,24]]},"reference":[{"key":"2026032406353395100_jjag032-B1","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.1016\/S0140-6736(23)02586-2","article-title":"Crohn\u2019s disease","volume":"403","author":"Dolinger","year":"2024","journal-title":"Lancet"},{"key":"2026032406353395100_jjag032-B2","doi-asserted-by":"publisher","first-page":"466","DOI":"10.3390\/jcm12020466","article-title":"Crohn\u2019s disease-associated and cryptoglandular fistulas: differences and similarities","volume":"12","author":"Zhou","year":"2023","journal-title":"J Clin Med"},{"key":"2026032406353395100_jjag032-B3","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/S2468-1253(22)00007-3","article-title":"Classifying perianal fistulising Crohn\u2019s disease: an expert consensus to guide decision-making in daily practice and clinical trials","volume":"7","author":"Geldof","year":"2022","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"2026032406353395100_jjag032-B4","doi-asserted-by":"publisher","first-page":"111046","DOI":"10.1016\/j.ejrad.2023.111046","article-title":"Typical MR features and interpretation of perianal fistulas in patients with Crohn\u2019s disease","volume":"167","author":"Kim","year":"2023","journal-title":"Eur J Radiol"},{"key":"2026032406353395100_jjag032-B5","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1080\/17474124.2017.1309285","article-title":"New horizons in the imaging of perianal Crohn\u2019s disease: transperineal ultrasonography","volume":"11","author":"Bezzio","year":"2017","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"2026032406353395100_jjag032-B6","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1055\/s-0043-103954","article-title":"Transperineal ultrasound for perianal fistulas and abscesses - a systematic review and meta-analysis","volume":"38","author":"Maconi","year":"2017","journal-title":"Ultraschall Med"},{"key":"2026032406353395100_jjag032-B7","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1097\/RLI.0000000000000675","article-title":"From anatomy to functional and molecular biomarker imaging and therapy: ultrasound is safe, ultrafast, portable, and inexpensive","volume":"55","author":"Wang","year":"2020","journal-title":"Invest Radiol"},{"key":"2026032406353395100_jjag032-B8","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1001\/jama.2017.19163","article-title":"Preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies: the PRISMA-DTA statement","volume":"319","author":"McInnes","year":"2018","journal-title":"JAMA"},{"key":"2026032406353395100_jjag032-B9","doi-asserted-by":"publisher","first-page":"529","DOI":"10.7326\/0003-4819-155-8-201110180-00009","article-title":"QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies","volume":"155","author":"Whiting","year":"2011","journal-title":"Ann Intern Med"},{"key":"2026032406353395100_jjag032-B10","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1002\/9781119756194.ch10","volume-title":"Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy","author":"Takwoingi","year":"2023"},{"key":"2026032406353395100_jjag032-B11","doi-asserted-by":"publisher","first-page":"627","DOI":"10.2214\/ajr.177.3.1770627","article-title":"Transperineal and transvaginal sonography of perianal inflammatory disease","volume":"177","author":"Stewart","year":"2001","journal-title":"AJR Am J Roentgenol"},{"key":"2026032406353395100_jjag032-B12","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1055\/s-2004-813100","article-title":"Transperineal sonography in anorectal disorders]","volume":"25","author":"Bonatti","year":"2004","journal-title":"Ultraschall Med"},{"key":"2026032406353395100_jjag032-B13","doi-asserted-by":"publisher","first-page":"19","DOI":"10.7863\/jum.2004.23.1.19","article-title":"Detection and characterization of perianal inflammatory disease: accuracy of transperineal combined gray scale and color Doppler sonography","volume":"23","author":"Mallouhi","year":"2004","journal-title":"J Ultrasound Med"},{"key":"2026032406353395100_jjag032-B14","doi-asserted-by":"publisher","first-page":"2859","DOI":"10.3748\/wjg.v10.i19.2859","article-title":"Transcutaneous perianal sonography: a sensitive method for the detection of perianal inflammatory lesions in Crohn\u2019s disease","volume":"10","author":"Wedemeyer","year":"2004","journal-title":"World J Gastroenterol"},{"key":"2026032406353395100_jjag032-B15","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1007\/s10151-006-0296-8","article-title":"Transperineal versus hydrogen peroxide-enhanced endoanal ultrasonography in never operated and recurrent cryptogenic fistula-in-ano: a pilot study","volume":"10","author":"Zbar","year":"2006","journal-title":"Tech Coloproctol"},{"key":"2026032406353395100_jjag032-B16","doi-asserted-by":"publisher","first-page":"29","DOI":"10.7863\/jum.2007.26.1.29","article-title":"Role of transcutaneous perianal ultrasonography in evaluation of fistulas in ano","volume":"26","author":"Domkundwar","year":"2007","journal-title":"J Ultrasound Med"},{"key":"2026032406353395100_jjag032-B17","doi-asserted-by":"publisher","first-page":"2214","DOI":"10.1111\/j.1572-0241.2007.01441.x","article-title":"Transperineal ultrasound in the detection of perianal and rectovaginal fistulae in Crohn\u2019s disease","volume":"102","author":"Maconi","year":"2007","journal-title":"Am J Gastroenterol"},{"key":"2026032406353395100_jjag032-B18","doi-asserted-by":"publisher","first-page":"2737","DOI":"10.1097\/01.MIB.0000436274.95722.e5","article-title":"Transperineal perineal ultrasound versus magnetic resonance imaging in the assessment of perianal Crohn\u2019s disease","volume":"19","author":"Maconi","year":"2013","journal-title":"Inflamm Bowel Dis"},{"key":"2026032406353395100_jjag032-B19","doi-asserted-by":"publisher","first-page":"1011","DOI":"10.1111\/codi.12204","article-title":"Transperineal ultrasonography in perianal Crohn\u2019s disease and recurrent cryptogenic fistula-in-ano","volume":"15","author":"Nevler","year":"2013","journal-title":"Colorectal Dis"},{"key":"2026032406353395100_jjag032-B20","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1007\/s10151-013-1031-x","article-title":"Transperineal ultrasonography as a complementary diagnostic tool in identifying acute perianal sepsis","volume":"18","author":"Plaikner","year":"2014","journal-title":"Tech Coloproctol"},{"key":"2026032406353395100_jjag032-B21","doi-asserted-by":"publisher","first-page":"e78","DOI":"10.1016\/j.dld.2014.07.036","article-title":"Transperineal ultrasound (TPUS) in pediatric perianal disease","volume":"46","author":"Terracciano","year":"2014","journal-title":"Dig Liver Dis"},{"key":"2026032406353395100_jjag032-B22","doi-asserted-by":"publisher","first-page":"874","DOI":"10.1016\/j.dld.2016.03.027","article-title":"Transperineal ultrasonography: First level exam in IBD patients with perianal disease","volume":"48","author":"Terracciano","year":"2016","journal-title":"Dig Liver Dis"},{"key":"2026032406353395100_jjag032-B23","doi-asserted-by":"publisher","first-page":"2367","DOI":"10.7863\/ultra.15.09043","article-title":"Prospective comparison of magnetic resonance imaging, transrectal and transperineal sonography, and surgical findings in complicated perianal Crohn disease","volume":"35","author":"Bor","year":"2016","journal-title":"J Ultrasound Med"},{"key":"2026032406353395100_jjag032-B24","doi-asserted-by":"publisher","first-page":"482","DOI":"10.4103\/ijri.IJRI_417_16","article-title":"Role of transperineal ultrasound in infective and inflammatory disorders","volume":"27","author":"Puranik","year":"2017","journal-title":"Indian J Radiol Imaging"},{"key":"2026032406353395100_jjag032-B25","doi-asserted-by":"publisher","first-page":"131","DOI":"10.17656\/jsmc.10114","article-title":"Accuracy of transperineal ultrasound relative to magnetic resonance imaging in evaluation of perianal fistulas","volume":"7","author":"Fateh","year":"2017","journal-title":"JSMC"},{"key":"2026032406353395100_jjag032-B26","doi-asserted-by":"publisher","first-page":"614","DOI":"10.1097\/MPG.0000000000001752","article-title":"Comparison of transperianal ultrasound with colonoscopy and magnetic resonance imaging in perianal Crohn disease","volume":"66","author":"Lee","year":"2018","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"2026032406353395100_jjag032-B27","doi-asserted-by":"publisher","first-page":"1033","DOI":"10.13929\/j.1003-3289.201711097","article-title":"End-fire endoprobe transperineal sonography in preoperative localizing of anal fistula internal opening in males","volume":"34","author":"Yan","year":"2018","journal-title":"Chin J Med Imag Technol"},{"key":"2026032406353395100_jjag032-B28","first-page":"533","volume":"9","author":"Anand","year":"2022","journal-title":"Eur J Mol Clin Med"},{"key":"2026032406353395100_jjag032-B29","doi-asserted-by":"publisher","first-page":"goac071","DOI":"10.1093\/gastro\/goac071","article-title":"Can transcutaneous perianal ultrasonography be the first-line diagnostic instrument for evaluating pediatric perianal fistulas?","volume":"10","author":"Ding","year":"2022","journal-title":"Gastroenterol Rep (Oxf)."},{"key":"2026032406353395100_jjag032-B30","doi-asserted-by":"publisher","first-page":"770","DOI":"10.14366\/usg.22057","article-title":"Transperineal ultrasonography for treatment response evaluation in children with perianal Crohn\u2019s disease","volume":"41","author":"Jung","year":"2022","journal-title":"Ultrasonography"},{"key":"2026032406353395100_jjag032-B31","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1186\/s43055-022-00812-1","article-title":"Role of transperineal ultrasound in evaluation of patients with perianal inflammatory disorders","volume":"53","author":"Roman Boles","year":"2022","journal-title":"Egypt J Radiol Nucl Med"},{"key":"2026032406353395100_jjag032-B32","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1055\/s-0042-1743111","article-title":"Role of transcutaneous perianal ultrasonography in evaluation of perianal fistulae with MRI correlation","volume":"32","author":"Singh","year":"2022","journal-title":"Indian J Radiol Imaging"},{"key":"2026032406353395100_jjag032-B33","doi-asserted-by":"publisher","first-page":"2","DOI":"10.5339\/jemtac.2023.24","article-title":"Feasibility of using transperineal ultrasound as a diagnostic test in perianal abscesses and fistulas under resource-limited setting: a retrospective study","volume":"2023","author":"Altam","year":"2023","journal-title":"J Emerg Med Trauma Acute Care."},{"key":"2026032406353395100_jjag032-B34","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1002\/jcu.23446","article-title":"Incidence and diagnostic performance of ultrasound for perianal abscess or fistula-in-ano in pediatric patients with perianal inflammation","volume":"51","author":"Hosokawa","year":"2023","journal-title":"J Clin Ultrasound"},{"key":"2026032406353395100_jjag032-B35","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1007\/s10151-007-0375-5","article-title":"The role of transperineal ultrasonography in the assessment of the internal opening of cryptogenic anal fistula","volume":"11","author":"Klein\u00fcbing","year":"2007","journal-title":"Tech Coloproctol"},{"key":"2026032406353395100_jjag032-B36","doi-asserted-by":"publisher","first-page":"516","DOI":"10.59218\/makrjms.2023.12.516.520","article-title":"Comparative analysis of transcutaneous perianal ultrasonography and magnetic resonance imaging in evaluating perianal fistulas: a cross-sectional study","volume":"17","author":"Garg","year":"2023","journal-title":"Res J Med Sci"},{"key":"2026032406353395100_jjag032-B37","doi-asserted-by":"publisher","first-page":"goae002","DOI":"10.1093\/gastro\/goae002","article-title":"Preoperative assessment of fistula-in-ano using SonoVue enhancement during three-dimensional transperineal ultrasound","volume":"12","author":"Yang","year":"2024","journal-title":"Gastroenterol Rep (Oxf)."},{"key":"2026032406353395100_jjag032-B38","doi-asserted-by":"publisher","first-page":"903","DOI":"10.18203\/2349-2902.isj20241388","article-title":"Correlation between transcutaneous perianal ultrasonography findings and preoperative findings of fistula in ano","volume":"11","author":"Islam","year":"2024","journal-title":"Int Surg J"},{"key":"2026032406353395100_jjag032-B39","doi-asserted-by":"publisher","first-page":"101221","DOI":"10.4329\/wjr.v17.i1.101221","article-title":"High-resolution direct magnetic resonance imaging fistulography with hydrogen peroxide for diagnosing anorectal fistula: a preliminary retrospective study","volume":"17","author":"Chang","year":"2025","journal-title":"World J Radiol"},{"key":"2026032406353395100_jjag032-B40","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1007\/BF02234179","article-title":"Endosonographic criteria for an internal opening of fistula-in-ano","volume":"42","author":"Cho","year":"1999","journal-title":"Dis Colon Rectum"},{"key":"2026032406353395100_jjag032-B41","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.1111\/apt.15767","article-title":"Transperineal ultrasound predicts endoscopic and histological healing in ulcerative colitis","volume":"51","author":"Sagami","year":"2020","journal-title":"Aliment Pharmacol Ther"},{"key":"2026032406353395100_jjag032-B42","doi-asserted-by":"publisher","first-page":"523","DOI":"10.1093\/ecco-jcc\/jjab180","article-title":"ECCO-ESGAR topical review on optimizing reporting for cross-sectional imaging in inflammatory bowel disease","volume":"16","author":"Kucharzik","year":"2022","journal-title":"J Crohns Colitis"},{"key":"2026032406353395100_jjag032-B43","doi-asserted-by":"publisher","first-page":"1450","DOI":"10.1097\/DCR.0000000000003445","article-title":"Comparative study of diluted hydrogen peroxide and sulfur hexafluoride in the contrast-enhanced ultrasound assessment of anal fistulas","volume":"67","author":"de la Portilla de Juan","year":"2024","journal-title":"Dis Colon Rectum"},{"key":"2026032406353395100_jjag032-B44","doi-asserted-by":"publisher","first-page":"9165","DOI":"10.21037\/apm-21-1624","article-title":"A comparison of trans-fistula contrast-enhanced endoanal ultrasound and MRI in the diagnosis of anal fistula","volume":"10","author":"Lin","year":"2021","journal-title":"Ann Palliat Med"},{"key":"2026032406353395100_jjag032-B45","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1097\/DCR.0000000000002473","article-title":"The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula","volume":"65","author":"Gaertner","year":"2022","journal-title":"Dis Colon Rectum"},{"key":"2026032406353395100_jjag032-B46","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1093\/ibd\/izab286","article-title":"Strategies to distinguish perianal fistulas related to Crohn\u2019s disease from cryptoglandular disease: systematic review with meta-analysis","volume":"28","author":"Chin Koon Siw","year":"2022","journal-title":"Inflamm Bowel Dis"},{"key":"2026032406353395100_jjag032-B47","doi-asserted-by":"publisher","first-page":"102940","DOI":"10.1016\/j.eclinm.2024.102940","article-title":"Development and validation of the MRI-based deep learning classifier for distinguishing perianal fistulizing Crohn\u2019s disease from cryptoglandular fistula: a multicenter cohort study","volume":"78","author":"Zhang","year":"2024","journal-title":"EClinicalMedicine"}],"container-title":["Journal of Crohn's and Colitis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ecco-jcc\/article-pdf\/20\/3\/jjag032\/67498034\/jjag032.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ecco-jcc\/article-pdf\/20\/3\/jjag032\/67498034\/jjag032.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,24]],"date-time":"2026-03-24T10:35:40Z","timestamp":1774348540000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ecco-jcc\/article\/doi\/10.1093\/ecco-jcc\/jjag032\/8539564"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3]]},"references-count":47,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3,10]]}},"URL":"https:\/\/doi.org\/10.1093\/ecco-jcc\/jjag032","relation":{},"ISSN":["1873-9946","1876-4479"],"issn-type":[{"value":"1873-9946","type":"print"},{"value":"1876-4479","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2026,3]]},"article-number":"jjag032"}}