Abstract Background Intestinal ultrasound (IUS) cine loops enable small bowel motility assessment, yet current clinical practice still relies on subjective visual assessment. qMotion (Motilent Ltd) is a quantitative algorithm that computes the temporal standard deviation of the Jacobian determinant (StdJD) from optical-flow motion fields, providing an objective motility metric. This study evaluated the relationship between qMotion metrics and expert visual motility scoring, and explored the association between quantitative motility and endoscopic disease activity. Methods Crohn’s disease patients underwent fasted 10-second breath-hold IUS cine acquisition of the terminal ileum in both cross-sectional and longitudinal orientations. A single expert ultrasonographer (10 years of experience) graded motility on a three-point scale (1 = none, 2 = some, 3 = high motility). Using the qMotion-generated motility reference image, the reader delineated a 2D polygon around the bowel wall to extract qMotion metrics (StdJD-Mean and StdJD-Std). Clinical biomarkers and SES-CD scores were collected. Group differences in qMotion metrics across visual categories were assessed using Kruskal–Wallis tests. ROC analyses were performed to evaluate the ability of qMotion to discriminate active disease defined by SES-CD thresholds. Results Twenty CD patients were included, providing 20 cross-sectional and 20 longitudinal cine loops. Median (range) clinical values were: ileal SES-CD score 3.0 (0–12), total SES-CD score 4.0 (0–18), CRP 2.65 mg/L (0.1–88), and fecal calprotectin 231.5 µg/g (4–2846). Visual grading classified cross-sectional scans as 1 (n = 6), 2 (n = 4), and 3 (n = 10), and longitudinal scans as 1 (n = 4), 2 (n = 7), and 3 (n = 9). qMotion motility metrics differed significantly across visual motility categories in both scan orientations. For cross-sectional cine loops, StdJD-Mean (H = 12.64, p = 0.0018) and StdJD-Std (H = 10.91, p = 0.0043) demonstrated clear separation across grades. Longitudinal loops showed similar significant differences for StdJD-Mean (H = 13.41, p = 0.0012) and StdJD-Std (H = 12.33, p = 0.0021). In ROC analysis, qMotion demonstrated a fair discriminatory ability for endoscopic activity. Cross-sectional StdJD-Std achieved AUCs of 0.69 for detecting ileal SES-CD ≥3 and 0.77 for total SES-CD ≥3, while StdJD-Mean achieved AUCs of 0.64 and 0.80 for ileal and total activity, respectively (Figure 1). Conclusion Quantitative motility assessment using qMotion aligns well with expert visual grading and demonstrates fair ability to discriminate active CD based on SES-CD, particularly for cross-sectional acquisitions. These findings support the potential utility of qMotion as an objective marker of small bowel motility in IUS-based evaluation of Crohn’s disease. Conflict of interest: Zilli, Alessandra: Personal Fees: Speaking and consulting fees from Tillotts, Galapagos, Abbvie, Takeda, Janssen, Alfasigma, Sandoz, Lilly, Pfizer Danny, Ramasawmy: Employed by Motilent Ltd, London, UK Dr. Naim, Iyad: Employed by Motilent Ltd, London, UK Menys, Alex: CEO Motilent Associate Prof UCL Robbins, Tom: Employed by Motilent Ltd, London, UK Furfaro, Federica: Grant: IG-IBD Personal Fees: Pfizer, Biogen, J&J, Abbvie, Amgen, Janssen D’Amico, Ferdinando: Grant/Personal Fees: Abbvie, Alfasigma, Ferring, Lilly, Sandoz, Janssen, Fresenius Kabi, Galapagos, Giuliani, MSD, Pfizer, Takeda, Tillotts, and Omega Pharma he also served as an advisory board member for Abbvie, AnaptysBio, Ferring, Fresenius Kabi, Galapagos, Janssen, Lilly, MSD, Takeda, and Nestlè. Lorenzo Parigi, Tommaso: No conflict of interest Danese, Silvio: Personal Fees: AbbVie, Alimentiv, Allergan, Amgen, Applied Molecular Transport, AstraZeneca, Athos Therapeutics, Biogen, Boehringer Ingelheim, Bristol Myers Squibb, Celgene, Celltrion, Dr Falk Pharma, Eli Lilly, Enthera, Ferring Pharmaceuticals Inc., Gilead, Hospira, Inotrem, Janssen, Johnson & Johnson, Morphic, MSD, Mundipharma, Mylan, Pfizer, Roche, Sandoz, Sublimity Therapeutics, Takeda, Teladoc Health, TiGenix, UCB Inc., Vial, Vifor Lecture fees from Abbvie, Amgen, Ferring Pharmaceuticals Inc., Gilead, Janssen, Mylan, Pfizer, Takeda Allocca, Mariangela: Personal Fees: consulting fees from Nikkiso Europe, Mundipharma, Janssen, Abbvie, Pfizer, Ferring, Galapagos, Sandoz, Lilly and Alfasigma
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