P0290Systematic Review of Ultrasound Elastography Protocols, Techniques, and Diagnostic Value in Inflammatory Bowel Disease: Distinguishing Fibrosis from Inflammation

Abstract Background Differentiating fibrosis from inflammation in inflammatory bowel disease (IBD) remains difficult in clinical practice, creating interest in imaging tools. Elastography, paired with intestinal ultrasound (IUS), offers a non-invasive tool to assess bowel stiffness as a relative marker of fibrosis. Variability in technique and reporting still limits consistent clinical use of strain and shear wave elastography for the bowel. This systematic review explores the diagnostic performance and technical characteristics of IUS-based elastography for identifying fibrosis in Crohn’s Disease (CD) and ulcerative colitis (UC). Methods A literature search of MEDLINE, Embase, and Scopus was completed up to August 19th 2025. Study rigor was appraised using the QUADAS-2 framework. Extracted variables included study methodology, participant demographics, imaging platforms and transducers, as well as the specific elastography approaches employed and corresponding diagnostic outputs (sensitivity, specificity). Measures of bowel activity, such as wall thickness, vascularity, and stricture were noted when provided. To ensure accurate evaluation of fibrosis versus inflammation, only investigations that directly compared elastography findings with full-thickness histopathology were eligible for inclusion. Results A total of 24 studies met inclusion criteria, representing 672 CD and 70 UC patients. Among these, 17 studies (70.8%) compared elastography results with full-thickness histology, while two studies (8.3%) used endoscopic biopsies as a reference for their 139 patients. Shear-wave elastography generally demonstrated higher diagnostic accuracy for fibrosis detection, achieving sensitivities of up to 75.0% and specificities reaching 100%. In contrast, strain elastography showed broader variability, with reported sensitivities spanning from 5% to 100%. Inter-rater reliability was examined in seven studies, showing moderate to excellent agreement (ICC 0.54-0.84). Considerable heterogeneity persisted in imaging protocols, including differences in probe selection, region-of-interest placement, fasting conditions and histologic scoring systems. Conclusion Elastography shows considerable promise as a non-invasive marker of fibrosis in IBD. Advancing this field will require standardizing methodology, defining consistent diagnostic thresholds, and conducting multicenter comparisons when using validated histologic fibrosis scales. Overall, this review provides the data to inform future consensus development on the performance of elastography in CD and UC. Conflict of interest: Khalaf, Roy: No conflict of interest Hoque, Sami: No conflict of interest Mak, Eva: No conflict of interest O’Brien, Maureen: I have nothing to disclose. Allocca, Mariangela: Personal Fees: consulting fees from Nikkiso Europe, Mundipharma, Janssen, Abbvie, Pfizer, Ferring, Galapagos, Sandoz, Lilly and Alfasigma Calabrese, Emma: none Gecse, Krisztina B.: Grant: Abbvie, Pfizer Inc, Celltrion and Galapagos/Alfasigma Personal Fees: Consultancy fees from AbbVie, ​Galapagos, Gilead, Immunic Therapeutics, Janssen Pharmaceuticals, Pfizer Inc., and Takeda and speaker’s honoraria from Celltrion, Eli Lilly, Janssen Pharmaceuticals, Pfizer Inc. and Takeda. Maconi, Giovanni: Personal Fees: Abbvie, Arena Pharmaceuticals, Alfa-Wasserman, Fresenius-Kabi, Gilead, Janssen Cilag, Roche Non-financial Support: Takeda, Abbvie, Alfa-Wasserman Medellin, Alexandra: No conflict of interest Novak, Kerri L.: Research Grants: Helmsley Trust, Pfizer, Janssen Adboard, consulting fees: Abbvie, Janssen, Pfizer, Pendopharm, Takeda, Elli Lilly, Celltrion, Bristal Myers Non financial support (ultrasound machine) McKesson Pharmcy. Pfizer, Celltrion Petersen, Frauke: No conflict of interest Poulsen, Anja: Research grants and personal fees from Janssen, Takeda, and MSD, personal fees from Bristol Myers Squibb, national coordinator of studies from Agomab, Boehringer Ingelheim and Bristol Myers. Panaccione, Remo: Grant: Abbvie, Janssen, Pfizer, Takeda Other: Consultant for: Abbott, AbbVie, Abbivax, Alimentiv (formerly Robarts), Amgen, AnaptysBio, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, Eli Lilly, Ferring, Galapagos, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pendopharm, Pfizer, Progenity, Prometheus Biosciences, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Spyre Therapeutics, Takeda Pharmaceuticals, Theravance Biopharma, Trellus, Union Biopharma, Viatris, Ventyx, UCB Speaker’s Fees for: AbbVie, Amgen, Arena Pharmaceuticals, Bristol-Myers Squibb, Celgene, Eli Lilly, Ferring, Fresenius Kabi, Gilead Sciences, Janssen, Merck, Organon, Pfizer, Roche, Sandoz, Shire, Takeda Pharmaceuticals Advisory Boards for: AbbVie, Alimentiv (formerly Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Ferring, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pfizer, Progenity, Protagonist Therapeutics, Roche, SandozShire, Sublimity Therapeutics, Takeda Pharmaceuticals, Ventyx. Rieder, Florian: Personal Fees: Adiso, Adnovate, Agomab, Allergan, AbbVie, Arena, Astra Zeneca, Boehringer-Ingelheim, Celgene/BMS, Celltrion, CDISC, Celsius, Cowen, Ferring, Galapagos, Galmed, Genentech, Gilead, Gossamer, Granite, Guidepoint, Helmsley, Horizon Therapeutics, Image Analysis Limited, Index Pharma, Landos, Jannsen, Koutif, Mestag, Metacrine, Mopac, Morphic, Organovo, Origo, Palisade, Pfizer, Pliant, Prometheus Biosciences, Receptos, RedX, Roche, Samsung, Sanofi, Surmodics, Surrozen, Takeda, Techlab, Teva, Theravance, Thetis, UCB, Ysios, 89Bio St-Pierre, Joelle: Consultant for Pfizer, Abbvie, Eli Lilly and Pendopharm, and speaker for Takeda. Wilkens, Rune Levring: Personal Fees: Janssen, Takeda Denmark, AbbVie, Pfizer Denmark, Alimentiv Wilson, Stephanie: Advisory board, Definity. Lantheus Medical Imaging Speaker’s bureau, Philips Equipment support Siemens, Samsung and Philips. Sagami, Shintaro: Shintaro Sagami has served as an advisory board member, consultant, or speaker for AbbVie, Alimentiv, Bristol Myers Squibb, Celltrion, EA Pharma, Eli Lilly, Ferring Pharmaceuticals, Gilead Sciences, Janssen Pharmaceuticals, Kyorin Pharmaceutical, Mitsubishi Tanabe Pharma, Mochida Pharmaceutical, Nippon Kayaku, Pfizer, Takeda, and Zeria Pharmaceutical, and has received research funding from Bristol Myers Squibb, EA Pharma, Gilead Sciences, Helmsley Charitable Trust, JIMRO, Kyorin Pharmaceutical, Miyarisan, Mochida Pharmaceutical, Nippon Kayaku, Pfizer, Sekisui Medical, Samsung, Takeda, and Zeria Pharmaceutical. Dr. Lu, Cathy: Advisory board - Abbvie, Johnson and Johnson, Takeda, Ferring, Merck, Celltrion, Lilly, Pfizer, Pendopharm, Agomab. Research Funding - Abbvie, Helmsley Charitable Trust, Alberta Innovates