{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T19:01:08Z","timestamp":1790794868208,"version":"4.1.0"},"reference-count":11,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>Perianal abscesses are serious complications of Crohn\u2019s disease (CD) requiring timely and accurate diagnosis. Contrast-enhanced ultrasound (CEUS), which in abdominal intestinal ultrasound (IUS) has shown diagnostic performance comparable to CT\/MRI in distinguishing intra-abdominal abscesses from inflammatory masses, has not been systematically evaluated in the transperineal assessment of perianal Crohn\u2019s disease. This study aimed to evaluate the diagnostic performance, inter- and intra-observer agreement, and diagnostic confidence of transperineal CEUS versus conventional B-mode TPUS in CD patients with perianal symptoms and suspected septic complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 52 examinations of 37 adult CD patients presenting with painful perianal symptoms and suspected septic complications. Patients were included if TPUS detected lesions\u2009&amp;gt;\u200910\u2009mm requiring CEUS characterization. Exclusion criteria were CEUS contraindications, simple fistulas, or large (&amp;gt;3\u2009cm) obvious abscesses. All examinations were recorded, and three blinded experts independently assessed anonymized videos in random order. Lesions were classified as abscesses, inflammatory masses, or phlegmons. Agreement for lesion size, fluid content, and final diagnosis was evaluated using intraclass correlation coefficients (ICC) and Fleiss\u2013Cohen\u2019s kappa (\u03ba). Diagnostic confidence was assessed using a 5-point Likert scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>On B-mode, 17 abscesses, 32 inflammatory masses, and 3 phlegmons were identified. CEUS reclassified several, yielding 16 abscesses, 31 inflammatory masses, and 5 phlegmons. Of the 17 abscesses diagnosed on B-mode, only 4 were also classified as abscesses on CEUS, while 13 were reclassified; conversely, 11 inflammatory masses were reclassified as abscesses. Intra-observer reliability improved from \u03ba\u2009=\u20090.55 with B-mode to \u03ba\u2009=\u20090.95 with CEUS. Inter-observer agreement for diagnosis was poor with B-mode (\u03ba\u2009=\u20090.31) but excellent with CEUS (\u03ba\u2009=\u20090.83).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Transperineal CEUS significantly improves inter- and intra-observer agreement and diagnostic confidence compared with conventional B-mode TPUS when differentiating perianal abscesses from inflammatory masses\/phlegmons in CD and frequently leads to lesion reclassification in clinically ambiguous cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ibd\/izag089","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T11:38:16Z","timestamp":1778153896000},"page":"1928-1936","source":"Crossref","is-referenced-by-count":1,"title":["Transperineal contrast-enhanced ultrasound: a rapid and reliable tool for differentiating abscesses from inflammatory masses in perianal Crohn\u2019s disease"],"prefix":"10.1093","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0810-4026","authenticated-orcid":false,"given":"Giovanni","family":"Maconi","sequence":"first","affiliation":[{"name":"Gastroenterology Unit, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC) L. Sacco, Universit\u00e0 degli Studi di Milano , Milan, 20157,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0076-8549","authenticated-orcid":false,"given":"Cristina","family":"Bezzio","sequence":"additional","affiliation":[{"name":"IBD Unit, Humanitas Hospital , Rozzano, MI 20089,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Saleh","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Texas Southwestern , Houston, TX 75390,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Silva Mendes","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Braga HospitalSchool of Medicine, University of Minho Life and Health Sciences Research Institute , Braga, 4710-243,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federica","family":"Lepore","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, Fondazione IRCCS Policlinico San Matteo , Pavia, 27100,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bincy P","family":"Abraham","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Houston Methodist Hospital , Houston, TX, 77030,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7979-6803","authenticated-orcid":false,"given":"Dan","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Chaim Sheba Medical CenterGray Faculty of Medicine, Tel Aviv University , Ramat Gan, Tel Aviv, 6997801,","place":["Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"2026093014400144500_izag089-B1","doi-asserted-by":"publisher","first-page":"1323","DOI":"10.14309\/ajg.0000000000002326","article-title":"Management of perianal Crohn\u2019s disease","volume":"118","author":"Parian","year":"2023","journal-title":"Am J Gastroenterol"},{"key":"2026093014400144500_izag089-B2","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1586\/17474124.2015.1031110","article-title":"Imaging of perianal fistulizing Crohn\u2019s disease","volume":"9","author":"Chidi","year":"2015","journal-title":"Expert Rev Gastroenterol Hepatol"},{"key":"2026093014400144500_izag089-B3","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":"2026093014400144500_izag089-B4","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":"2026093014400144500_izag089-B5","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":"2026093014400144500_izag089-B6","doi-asserted-by":"publisher","first-page":"jjaf106","DOI":"10.1093\/ecco-jcc\/jjaf106","article-title":"ECCO-ESGAR-ESP-IBUS guideline on diagnostics and monitoring of patients with inflammatory bowel disease: part 1","volume":"19","author":"Kucharzik","year":"2025","journal-title":"J Crohns Colitis"},{"key":"2026093014400144500_izag089-B7","doi-asserted-by":"publisher","first-page":"241","DOI":"10.1007\/s40477-019-00381-6","article-title":"Transperineal ultrasound for assessment of fistulas and abscesses: a pictorial essay","volume":"22","author":"Lavazza","year":"2019","journal-title":"J Ultrasound"},{"key":"2026093014400144500_izag089-B8","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":"2026093014400144500_izag089-B9","doi-asserted-by":"publisher","first-page":"e525","DOI":"10.1016\/j.ejrad.2013.05.043","article-title":"Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn\u2019s disease and other abdominal conditions","volume":"82","author":"Ripoll\u00e9s","year":"2013","journal-title":"Eur J Radiol"},{"key":"2026093014400144500_izag089-B10","doi-asserted-by":"publisher","first-page":"562","DOI":"10.1055\/a-1177-0530","article-title":"Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS) in the liver\u2014update 2020\u2014WFUMB in cooperation with EFSUMB, AFSUMB, AIUM, and FLAUS","volume":"41","author":"Dietrich","year":"2020","journal-title":"Ultraschall Med"},{"key":"2026093014400144500_izag089-B11","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1055\/s-0044-101254","article-title":"The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: update 2017 (short version)","volume":"39","author":"Sidhu","year":"2018","journal-title":"Ultraschall Med"}],"container-title":["Inflammatory Bowel Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ibdjournal\/article-pdf\/32\/10\/1928\/68397898\/izag089.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ibdjournal\/article-pdf\/32\/10\/1928\/68397898\/izag089.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T18:40:08Z","timestamp":1790793608000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ibdjournal\/article\/32\/10\/1928\/8694717"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":11,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5,26]]},"published-print":{"date-parts":[[2026,10,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ibd\/izag089","relation":{},"ISSN":["1078-0998","1536-4844"],"issn-type":[{"value":"1078-0998","type":"print"},{"value":"1536-4844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,5,26]]}}}