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Roushan N, Ebrahimi Daryani N, Azizi Z, Pournaghshband H, Niksirat A. Differentiation of Crohn's disease and ulcerative colitis using intestinal wall thickness of the colon: A Diagnostic accuracy study of endoscopic ultrasonography. Med J Islam Repub Iran 2019; 33:57. [PMID: 31456981 PMCID: PMC6708083 DOI: 10.34171/mjiri.33.57] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Indexed: 12/22/2022] Open
Abstract
Background: The differentiation between Ulcerative Colitis (UC) and Crohn's Disease (CD) is an important issue for choosing the appropriate treatment. Endoscopic Ultrasonography (EUS) has been used to distinguish different layers of the gastrointestinal wall. We performed this study to evaluate the accuracy of EUS in differentiating colonic UC from CD compared to standard tests (colonoscopy, pathology, imaging, and clinical presentation). Methods: This is a prospective, single-blinded diagnostic accuracy study, on 70 patients (30 UC, 30 CD, and 10 healthy controls). After obtaining informed consent, patients underwent a complete workup and were referred to an endosonographist who was blind to the diagnosis. The thickness of mucosa, submucosa and the total wall (TWT) of mid-sigmoid colon were measured by Pentax radial echoendoscope EPKI-7000 with Avius Hitachi ultrasound system (Japan). Statistical analyses were performed using the SPSS statistical software (v23). Statistical significance was considered if P-values were less than 0.05. Results: Our study revealed a sensitivity of 100% (90.7-100%) and specificity of 90.9% (70.8-98.8%) for EUS to differentiate UC and CD compared to standard diagnostic tests. Mean mucosal thickness in patients with UC was significantly greater than patients with CD, while, the mean sub-mucosal thickness was significantly greater in patients with CD (p<0.001). The sensitivity and specificity of mean mucosal thickness for differentiating UC from CD and controls were 92.3% and 88.6% with a cut-off point of 1.1 mm (p<0.001). Moreover, sensitivity and specificity of mean submucosal thickness for differentiating CD from UC and controls were 100% and 86.1% with a cut-off point of 1.08 mm (p<0.001). Conclusion: EUS can be used as an efficient modality with acceptable accuracy to differentiate Crohn's disease and Ulcerative Colitis and to determine disease activity.
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Affiliation(s)
- Nader Roushan
- Department of internal medicine, Division of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasser Ebrahimi Daryani
- Department of internal medicine, Division of Gastroenterology, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Azizi
- Faculty of Health, York University, Toronto, Canada
| | - Helia Pournaghshband
- Medical Student, Department of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Niksirat
- Internist, Tehran University of Medical Sciences, Tehran, Iran
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Graded compression and power Doppler ultrasonography versus endoscopy to assess paediatric Crohn disease activity pre- and posttreatment. J Pediatr Gastroenterol Nutr 2012; 54:404-8. [PMID: 22343835 DOI: 10.1097/mpg.0b013e3181f8b55d] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE The aim of this study was to assess whether power Doppler ultrasound (PDU) can serve as a reliable replacement for endoscopy in follow-up assessment of disease activity in children with Crohn disease. METHODS Nineteen children (13 boys), median age 14.8 (5.4-15.8) years, with macroscopically diagnosed Crohn disease were included in the study. Clinical parameters, histological evaluation, and graded PDU assessments were undertaken in all patients at diagnosis and following their initial treatment. Discriminant analysis was used to build predictive models from the PDU data for the histological evaluation. RESULTS The median Pediatric Crohn's Disease Activity Index (PCDAI) was 31.5 (15.5-42.0) at diagnosis. All clinical and ultrasonographic parameters and the histological evaluation showed an improvement between pre- versus posttreatment results; 1-way analysis of variance showed a significant difference because of treatment (P < 0.005) for all variables apart from the superior mesenteric artery flow (SMA); paired sample t tests indicated that these differences were statistically significant (P < 0.001), with the exception of SMA (P = 0.178). There was a statistically significant correlation (P < 0.001) between the platelet count and the bowel wall stratification (STRAT). Significant correlation was also observed between the histology findings and the mean mucosal, transmural, and segmental flow (MFL) and STRAT and between platelets and both MFL and small bowel thickening (SBT) (P < 0.01 in all cases). There was a statistically significant correlation (P < 0.05) between C-reactive protein and MFL and between histology and SBT, MFL, and STRAT. Discriminant analysis using discriminating factors SBT, STRAT, and MFL could assign 84.6% of cases to the correct classification of "no/mild inflammation" or "medium/severe inflammation." CONCLUSIONS Results obtained using power Doppler ultrasonography and endoscopy showed statistically significant correlations. Power Doppler sonography, in the hands of an experienced examiner, can be used for follow-up assessment of disease activity in children with Crohn disease.
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Gluvic Z, Slovic M, Dugalic P, Tomasevic R, Pavlovic A, Jaksic D, Isenovic ER, Rasic-Milutinovic Z, Milicevic D. Is the routine abdominal ultrasound a sufficiently sensitive method for the detection of colonic malignancy? Intern Med 2008; 47:827-31. [PMID: 18451574 DOI: 10.2169/internalmedicine.47.0695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE This study examined the sensitivity of routine abdominal ultrasound scanning in the detection of colonic malignancy. PATIENTS AND METHODS A case control prospective study included 101 patients hospitalized at the Department of Gastroenterology and Liver Diseases of Zemun Clinical Hospital over a four-year period. Since the complaints pointed to colonic malignancy, the patients underwent routine golden standard diagnostic procedures. These patients were referred to an experienced abdominal ultrasound operator who searched for some characteristic signs of colonic malignancy. All of the participants were surgically treated after the completion of relevant procedures for diagnosing colonic malignancy. SPSS for Windows 10.0 was used for data analysis. RESULTS The sensitivity of an abdominal ultrasound scan in the detection and location of pathological changes pointed to colonic malignancy was different- 76% and 84% respectively. This method was very reliable in detecting right-sided colonic carcinoma (100%). Some specific ultrasonographic signs of colonic carcinoma were observed at the advanced stages of disease. CONCLUSIONS The routine abdominal ultrasonography can be used for the screening of colonic malignancy owing to its high sensitivity, particularly in advanced disease, but solely in conjunction with other methods. Finally, abdominal ultrasonography cannot be a definitive diagnostic tool for colonic carcinoma.
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Affiliation(s)
- Zoran Gluvic
- Department of Internal Medicine, Zemun Clinical Hospital, School of Medicine, Belgrade, Serbia.
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Chen MJ, Chen JH, Chiu HM, Lee JY, Hsu YC, Lin JT, Wang HP. Ultrasonographic Patterns of Non-neoplastic Small Bowel Diseases. J Med Ultrasound 2006. [DOI: 10.1016/s0929-6441(09)60064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Fraquelli M, Colli A, Casazza G, Paggi S, Colucci A, Massironi S, Duca P, Conte D. Role of US in detection of Crohn disease: meta-analysis. Radiology 2005; 236:95-101. [PMID: 15987966 DOI: 10.1148/radiol.2361040799] [Citation(s) in RCA: 196] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the accuracy of ultrasonography (US) in the detection of Crohn disease in adults by systematically reviewing both cohort studies (those including patients whose clinical characteristics were consistent with those caused by an inflammatory bowel disease) and case-control studies (those in which patients with Crohn disease were compared with patients with other bowel diseases or healthy control subjects). MATERIALS AND METHODS The MEDLINE, EMBASE, and Cochrane Library databases were used to retrieve all the cross-sectional studies that assessed the diagnostic accuracy of US against that of one of several predefined reference standards (ie, radiologic, endoscopic, or histologic findings). The studies that fulfilled the inclusion criteria were identified, and their methodological quality was evaluated. Of the 2860 primary studies identified, two case-control and five cohort series fulfilled the inclusion criteria. Statistical analysis was performed by using the summary receiver operating characteristic (SROC) model. RESULTS The ranges of US sensitivity and specificity for the diagnosis of Crohn disease reported for the included series were 75%-94% and 67%-100%, respectively; the heterogeneity of these values prevented the calculation of a cumulative value. The SROC curve revealed a clear cutoff effect that depended on the chosen bowel wall thickness threshold. Sensitivity and specificity of 88% and 93%, respectively, were achieved when a bowel wall thickness threshold greater than 3 mm was used, and sensitivity and specificity of 75% and 97%, respectively, were achieved when a threshold greater than 4 mm was used. CONCLUSION US examination seems appropriate for confirming or excluding Crohn disease as a diagnosis in a clinical context characterized by a pretest probability of Crohn disease that ranges from 12% to about 60%. In particular, for Crohn disease limited to the ileum, US may represent a valid alternative to the small-bowel series, while for colonic involvement US may be useful in ruling out the diagnosis.
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Affiliation(s)
- Mirella Fraquelli
- Postgraduate School of Gastroenterology, IRCCS Ospedale Maggiore, Via F. Sforza 35, 20122 Milan, Italy.
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Pascu M, Roznowski AB, Müller HP, Adler A, Wiedenmann B, Dignass AU. Clinical relevance of transabdominal ultrasonography and magnetic resonance imaging in patients with inflammatory bowel disease of the terminal ileum and large bowel. Inflamm Bowel Dis 2004; 10:373-82. [PMID: 15475745 DOI: 10.1097/00054725-200407000-00008] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Ileocolonoscopy represents the diagnostic standard in the work-up of patients with inflammatory bowel diseases (IBD). Patients are often reluctant to be colonoscoped because of the invasiveness and pain sensation during colonoscopy. AIMS To compare the usefulness oftransabdominal ultrasound (US) and magnetic resonance imaging (MRI) in assessing disease extension and activity in patients with IBD restricted to the terminal ileum and large bowel. PATIENTS AND METHODS 61 patients with IBD [37 Crohn's disease (CD) and 24 ulcerative colitis (UC)] were prospectively studied. All patients underwent clinical and laboratory assessment, ileocolonoscopy, transabdominal sonography, and MRI within 5 days. Involved bowel segments were defined as those with bowel wall thickness >3 mm and increased Doppler signal on US or contrast enhancement of the bowel wall on MRI. To compare disease activity endoscopic, MRI and US findings were graded with newly developed scores. RESULTS The segment-by-segment analysis revealed an overall accuracy of 89% for US and 73% for MRI in identifying active IBD. The accuracy was better in patients with UC than in patients with CD for both US and MRI. The endoscopic activity index (EAI) correlated stronger with the US activity index (r = 0.884) than with the MRI activity index (r = 0.344). The correlation of US and MRI activity indices with EAI was better in patients with UC compared with patients with CD. All three imaging methods showed a significant correlation with clinical disease activity in patients with UC but not in patients with CD. CONCLUSION This study provides strong evidence that US should be considered as a first-choice method for follow-up of patients with IBD of the terminal ileum and large bowel.
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Affiliation(s)
- M Pascu
- Department of Medicine, Charité Medical School, Campus Virchow, Berlin, Germany
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Di Mizio R, Maconi G, Romano S, D'Amario F, Bianchi Porro G, Grassi R. Small bowel Crohn disease: sonographic features. ABDOMINAL IMAGING 2004; 29:23-35. [PMID: 15160749 DOI: 10.1007/s00261-003-0087-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- R Di Mizio
- Department of Radiology, San Massimo Hospital, Via Santo Spirito, 16, 65017 Penne, Italy.
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Lee MC, Lin LH. Ultrasonographic Difference between Salmonella Enterocolitis and Rotavirus Gastroenteritis in Children. J Med Ultrasound 2002. [DOI: 10.1016/s0929-6441(09)60025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Affiliation(s)
- S D John
- Radiology and Pediatrics, University of Texas-Houston Medical School, Houston, TX, USA
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Bru C, Sans M, Defelitto MM, Gilabert R, Fuster D, Llach J, Lomeña F, Bordas JM, Piqué JM, Panés J. Hydrocolonic sonography for evaluating inflammatory bowel disease. AJR Am J Roentgenol 2001; 177:99-105. [PMID: 11418406 DOI: 10.2214/ajr.177.1.1770099] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The purpose of our study was to compare the usefulness of hydrocolonic sonography and (99m)Tc-hexamethylpropyleneamine oxime (HMPAO)--labeled leukocyte scintigraphy in the examination of patients with inflammatory bowel disease, using precise sonographic criteria of bowel involvement. SUBJECTS AND METHODS Sixty-eight consecutive patients with active inflammatory bowel disease (34 ulcerative colitis and 34 Crohn's disease), 12 with inactive inflammatory bowel disease, and 10 control subjects were prospectively studied. Patients with active disease underwent clinical assessment, hydrocolonic sonography, scintigraphy, and colonoscopy within 72 hr, whereas patients with inactive disease and control subjects underwent clinical examination and hydrocolonic sonography. RESULTS Involvement of a colonic segment by active inflammatory bowel disease was best defined by mucosal thickness greater than 1.5 mm, bowel wall thickness greater than 4 mm, mucosal irregularity, or the absence of haustra; and involvement of the terminal ileum by bowel wall thickness greater than 4 mm. Using these criteria, hydrocolonic sonography had 100% sensitivity for identifying patients with active inflammatory bowel disease and a greater overall accuracy (87%) than scintigraphy (77%) in the assessment of disease extension. In addition, strong correlation was shown between a hydrocolonic sonography activity index and clinical and endoscopic activity indexes. CONCLUSION This prospective study provides precise sonographic criteria for the definition of bowel involvement by active inflammatory bowel disease. Hydrocolonic sonography has a greater accuracy than scintigraphy for assessing disease extension and activity. Therefore, hydrocolonic sonography should be considered a first-choice technique to complete the study of inflammatory bowel disease after confirmation of the diagnosis by histology.
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Affiliation(s)
- C Bru
- Ultrasonography Unit, Centre de Diagnòstic per la Imatge, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
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Affiliation(s)
- S D John
- University of Texas-Houston Medical School, USA
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Ruess L, Blask AR, Bulas DI, Mohan P, Bader A, Latimer JS, Kerzner B. Inflammatory bowel disease in children and young adults: correlation of sonographic and clinical parameters during treatment. AJR Am J Roentgenol 2000; 175:79-84. [PMID: 10882251 DOI: 10.2214/ajr.175.1.1750079] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the sonographic findings of inflammatory bowel disease activity in children undergoing treatment. SUBJECTS AND METHODS Eighty-eight sonograms were obtained of 23 bowel segments in 17 children and young adults (age range, 10-21 years; mean, 16 years) with new or recurrent inflammatory bowel disease. Sixteen segments were involved with Crohn's disease and seven with ulcerative colitis. Serial sonography (range, two to eight examinations; mean, four per segment) was performed while patients underwent treatment. Bowel wall thickness measurements and color and power Doppler sonography grading were recorded and compared with clinical data. RESULTS All 17 patients had at least one abnormal bowel segment on initial sonography. The correlation was significant (p < 0.01). Agreement was 91% on direction of change over time between bowel wall thickness and Doppler grades, with 100% correlation between color and power Doppler sonography grades. In patients with Crohn's disease, the correlation was significant (p < 0.05) between bowel wall thickness and Doppler grades with two of seven and four of seven clinical parameters, respectively. In patients with ulcerative colitis, the correlation was significant (p < 0.05) between bowel wall thickness and Doppler sonography grades with four of seven and three of seven clinical parameters, respectively. The erythrocyte sedimentation rate correlated with all sonographic measurements in both patient groups. Combining bowel wall thickness and Doppler sonography, the percentage of agreement was significant in the direction of change, with five of seven clinical parameters in both patient groups. CONCLUSION Gray-scale and color or power Doppler sonography can show changes in disease activity in children and young adults undergoing treatment for inflammatory bowel disease.
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Affiliation(s)
- L Ruess
- Department of Diagnostic Imaging and Radiology, Children's National Medical Center, N.W. Washington, DC 20010, USA
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Abstract
BACKGROUND Use of an echocolonoscope to examine patients with inflammatory bowel disease is technically difficult. Catheter probe assisted endoluminal ultrasonography (US) may be a feasible alternative. METHODS Determination of demographic information and clinical disease activity was followed by colonoscopy with biopsy. Catheter probe assisted endoluminal US was performed with measurements of thickness of the intestinal wall and evaluation of the structure of the sonographic layers. RESULTS Twenty-eight patients, 7 with ulcerative colitis, 11 with Crohn's disease, and 10 healthy control subjects participated in a prospective study. Mean colonic wall thickness was 2.2 +/- 0.1 mm (controls) compared with 4. 1 +/- 0.4 mm (ulcerative colitis) (p < 0.001) and 4.4 +/- 0.4 mm (Crohn's disease) (p < 0.001). Among patients with ulcerative colitis, colonic wall thickness correlated with severity of colonoscopic changes (r = 0.84, p = 0.02). Among patients with Crohn's disease, loss of endosonographic layer structure correlated with disease activity score (r = 0.8, p = 0.003), and colonic wall thickness correlated with the severity of histologic changes (r = 0. 62, p = 0.04). CONCLUSIONS Catheter probe assisted endoluminal US is technically feasible in the care of patients with inflammatory bowel disease. Endosonographic measurements of colonic wall thickness and layer structure provide clinically significant information.
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Affiliation(s)
- A M Soweid
- Divisions of Gastroenterology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio 44106-1736, USA
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Tremaine WJ, Sandborn WJ. Practice guidelines for inflammatory bowel disease: an instrument for assessment. Mayo Clin Proc 1999; 74:495-501. [PMID: 10319083 DOI: 10.4065/74.5.495] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The development of practice guidelines is problematic because guidelines that are too broad have no value and guidelines that are highly specific cannot address the nuances of every patient's illness. In this article, we present the hypothesis that practice guidelines that provide specific objectives for assessment and intervention in inflammatory bowel disease can be used to measure practice variation. These guidelines are proposed as 15 specific objectives with options for intervention. These objectives could be used as an instrument to quantify variations in clinical practice and to assess the benefits of practice guidelines.
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Affiliation(s)
- W J Tremaine
- Inflammatory Bowel Disease Clinic, Mayo Clinic Rochester, MN 55905, USA
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Heriot AG, Kumar D, Thomas V, Young M, Pilcher J, Joseph AE. Ultrasonographically-guided fine-needle aspiration cytology in the diagnosis of colonic lesions. Br J Surg 1998; 85:1713-5. [PMID: 9876081 DOI: 10.1046/j.1365-2168.1998.00939.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of fine-needle aspiration cytology (FNAC) in the diagnosis of colonic lesions was investigated. METHODS Some 22 patients (median age 71 years) with a colonic lesion identified on abdominal ultrasonography underwent ultrasonographically-guided FNAC using a 21-G needle. The sample was checked immediately by a cytopathologist for adequacy. RESULTS Eighteen patients had colonic carcinoma; aspiration cytology detected malignant epithelial cells consistent with colonic carcinoma in 17 patients and severely dysplastic cells in one patient. The sensitivity and specificity of ultrasonographically-guided FNAC in the diagnosis of colonic carcinoma was 94 and 100 per cent respectively. The remaining four patients had a diagnosis of ileocaecal tuberculosis, ileocaecal Crohn's disease, and metastatic adenocarcinoma in the liver with no identifiable primary (two patients). One demonstrated granulomata, grew acid-fast bacilli and the patient was treated for tuberculosis. One had inflammatory cells and the patient was found to have Crohn's disease on histology. The remaining two patients had confirmed metastatic adenocarcinoma in the liver on aspiration cytology but suspected colonic lesions were found to be benign on cytological examination and no primary lesion was subsequently demonstrated. There were no complications of FNAC and patients complained of minimal discomfort. There has been no evidence of tumour recurrence with a median follow-up of 12 (range 1-25) months. CONCLUSION Ultrasonographically-guided FNAC is a valid method for the diagnosis of colonic tumours.
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Affiliation(s)
- A G Heriot
- Department of Colorectal Surgery, St George's Hospital, London, UK
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Abstract
BACKGROUND Colonic cancer is normally diagnosed by barium enema or colonoscopy. Neither investigation is ideal, especially in the elderly patient. This study investigates the potential role of abdominal ultrasonography in the diagnosis of colorectal carcinoma. METHODS Fifty-four patients with known or suspected colonic carcinoma were referred for abdominal ultrasonography. A single radiologist performed scans on these patients and the site of any colonic mass or wall thickening considered to be consistent with a colonic carcinoma was reported. All carcinomas were confirmed by histology on tissue obtained at colonoscopy or surgery against which the ultrasonographic diagnosis was compared. Colonic masses detected in patients undergoing routine abdominal ultrasonography for abdominal symptoms were also reported. RESULTS Forty-five of the 54 patients referred had colonic carcinoma and abdominal ultrasonography detected 43 of the tumours and correctly identified the site of 41. The sensitivity, specificity and accuracy of abdominal ultrasonography in the detection of colonic tumours considered to be consistent with a colonic carcinoma was 96, 67 and 91 per cent respectively. Seven tumours were identified in patients referred before any other investigation had been carried out. CONCLUSION Abdominal ultrasonography may detect a colonic mass or wall thickening consistent with a colonic carcinoma with a high degree of accuracy and may be useful when barium enema or colonoscopy is not possible.
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Affiliation(s)
- N G Richardson
- Department of Colorectal Surgery, St George's Hospital, London, UK
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Peck RJ, Jackson A, Gleeson D. Case report: ultrasound of coeliac disease with demonstration of response to treatment. Clin Radiol 1997; 52:244-5. [PMID: 9091265 DOI: 10.1016/s0009-9260(97)80284-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R J Peck
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK
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Hayden CK. ULTRASONOGRAPHY OF THE ACUTE PEDIATRIC ABDOMEN. Radiol Clin North Am 1996. [DOI: 10.1016/s0033-8389(22)00509-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Whitby EH, Peck RJ. Case report: ultrasound of primary generalised AL amyloid of the small bowel. Clin Radiol 1996; 51:447-8. [PMID: 8654016 DOI: 10.1016/s0009-9260(96)80170-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- E H Whitby
- Department of Radiology, Royal Hallamshire Hospital, Sheffield, UK
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Thomas SM, Howlett DC, Hearn FJ. Ultrasound appearance of pseudomembranous colitis. AUSTRALASIAN RADIOLOGY 1996; 40:162-4. [PMID: 8687352 DOI: 10.1111/j.1440-1673.1996.tb00374.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A case illustrating that ultrasound can be useful in the diagnosis of pseudomembranous colitis is reported. Diagnosis of pseudomembranous colitis is usually made from microbiological or histopathological investigations. The ultrasound appearance of grossly thickened bowel wall with luminal narrowing is non-specific, but in the correct clinical context should suggest the diagnosis of pseudomembranous colitis.
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Affiliation(s)
- S M Thomas
- Department of Diagnostic Radiology, Frimley Park Hospital, Surrey, UK
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Czechowski J. Conventional radiography and ultrasonography in the diagnosis of small bowel obstruction and strangulation. Acta Radiol 1996; 37:186-9. [PMID: 8600959 DOI: 10.1177/02841851960371p138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Ninety-six patients, 45 men and 51 women (mean age 39 years, range 13- 90 years), with clinically acute abdomen were examined by conventional abdominal radiography and ultrasonography during a period of one year. Ultrasonography was performed with a linear transducer, which permitted study of morphology and motility of small bowel loops: distention, paralysis, intramural thickening, and extraluminal fluid. Nineteen cases of mechanical obstruction (9 simple and 10 of strangulation type) were observed. In the strangulation group ultrasonographic findings were positive in 91% whereas conventional radiography solely was positive in 30%. In the simple obstruction, 89% and 78%, respectively, were correctly diagnosed by the 2 techniques. Ultrasonography is recommended as a routine examination beside conventional abdominal films in acute abdomen.
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Affiliation(s)
- J Czechowski
- Department of Diagnostic Radiology, Karolinska Institute, Danderyd Hospital, Sweden
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John SD, Swischuk E, Keith Hayden C. Gastrointestinal sonographic findings in Henoch-Schönlein purpura. Emerg Radiol 1996. [DOI: 10.1007/bf01508158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Solvig J, Ekberg O, Lindgren S, Florén CH, Nilsson P. Ultrasound examination of the small bowel: comparison with enteroclysis in patients with Crohn disease. ABDOMINAL IMAGING 1995; 20:323-6. [PMID: 7549736 DOI: 10.1007/bf00203364] [Citation(s) in RCA: 49] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Screening for inflammatory small bowel disease has hereto relied on barium examination, usually performed after duodenal intubation. A noninvasive technique for imaging of the small bowel in such patients would be preferable. METHODS A total of 59 patients were included in the study. A small bowel barium examination (SBE) was performed after duodenal intubation using a barium and air double-contrast technique. Ultrasound (US) of the right lower quadrant was performed with a 3.5- or 5-MHz transducer. The patients fasted overnight. RESULTS In 37 of 39 patients with a normal SBE, US was also normal. In 20 patients, SBE showed lesions compatible with Crohn disease and in 18 of these the US study showed thickening of the bowel wall. One of these patients later tested positive for Yersinia enterocolitica. There were two false-positive and two false-negative US examinations. For detection of inflammatory disease of the small bowel, US was calculated to have a sensitivity of 0.95, specificity of 0.93, accuracy of 0.93, predictive value of a positive test was 0.90, and a predictive value of a negative test was 0.95. CONCLUSIONS US, therefore, seems to be a reliable method in the workup of patients suspected of having inflammatory small bowel disease. Thereby, US probably can select patients for SBF.
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Affiliation(s)
- J Solvig
- Department of Radiology, University of Lund, Malmö General Hospital, Sweden
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Schiller VL, Schreiber L, Seaton C, Sarti DA. Transvaginal sonographic diagnosis of sigmoid diverticulitis. ABDOMINAL IMAGING 1995; 20:253-5. [PMID: 7620419 DOI: 10.1007/bf00200408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The development of the transvaginal technique has allowed for high-resolution, detailed evaluation of the female pelvis. Although not previously emphasized, gut pathology can also be recognized with this technique. We report two cases of sigmoid diverticulitis which were prospectively diagnosed using endovaginal sonography. In both patients, pelvic sonogram was the first imaging study performed for evaluation of nonspecific abdominal pain.
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Affiliation(s)
- V L Schiller
- St. John's-Tower Imaging, St John's Hospital and Health Center, Santa Monica, CA 90404, USA
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27
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Abstract
This article presents various imaging modalities, including plain films, ultrasonography, magnetic resonance imaging, and radionuclide imaging, used for the diagnosis of inflammatory bowel disease (IBD), ulcerative colitis (UC), and Crohn's disease (CD). Also discussed are how to distinguish UC from CD and some of the intestinal complications of IBD.
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Affiliation(s)
- D F Caroline
- Department of Diagnostic Imaging, Temple University School of Medicine, Philadelphia, Pennsylvania
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28
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Adams LS, Peltekian KM, Mitchell MJ. Detection of Crohn's ileitis by endovaginal ultrasonography. ABDOMINAL IMAGING 1994; 19:400-2. [PMID: 7950811 DOI: 10.1007/bf00206923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Transabdominal ultrasonography in a female patient hospitalized for acute right lower quadrant pain revealed a nonspecific tubular structure in the region of the right adnexa. Endovaginal ultrasonography clearly showed this structure to be an abnormal loop of small bowel with its "target lesion" appearance and thickened wall. A tentative diagnosis of Crohn's disease was made. This was later confirmed by barium studies and histology.
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Affiliation(s)
- L S Adams
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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29
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Shirahama M, Koga T, Ishibashi H, Uchida S, Ohta Y. Sonographic features of colon carcinoma seen with high-frequency transabdominal ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 1994; 22:359-365. [PMID: 8071453 DOI: 10.1002/jcu.1870220602] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
To assess the value of high-frequency ultrasonography as a diagnostic imaging procedure in patients with colon carcinoma, we first evaluated the sonograms of 37 patients who had been already diagnosed with contrast enema and/or colonoscopy as having colon carcinoma. As a result, the sonographic criteria for diagnosis of a possible colon carcinoma were (1) a localized and irregular thickening of the colonic wall with heterogenous low echogenicity, (2) an irregular contour, (3) a lack of demonstrable movement or change of configuration of the bowel on real-time scanning, and (4) absence of wall stratification. During the last 4 years, 41 consecutive patients had findings meeting our sonographic criteria. In 37 patients (90%), the presence of colon carcinoma was confirmed by contrast enema and/or colonoscopy. Our study suggests that high-frequency real-time ultrasonography may be a useful imaging technique in diagnosis of colon carcinoma.
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Affiliation(s)
- M Shirahama
- Department of Internal Medicine, Saga Prefectural Hospital, Japan
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30
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Schiller VL, Casal LJ, Hashimoto A. Ultrasound Diagnosis of Carcinoma of the Colon. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1994. [DOI: 10.1177/875647939401000407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ultrasound of the gastrointestinal tract is an extremely important, although underused, aspect of abdominal sonography. A case in which ultrasound examination led to a prospective diagnosis of unsuspected colon cancer is reported.
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Affiliation(s)
- Vicki L. Schiller
- Department of Radiological Sciences, Universitv of California at Los Angeles School of Medicine, Los Angeles, California; St. John's-Tower Imaging, St. John's Hospital and Health Center, 1328 22nd Street, Santa Monica, CA 90404
| | | | - Ann Hashimoto
- St. John's-Tower Imaging, St. John's Hospital and Health Center, Santa MIonica, California
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31
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Abstract
This study evaluates the role of ultrasound in the monitoring of abdominal symptoms of Henoch-Schonlein purpura. Clinical and radiological records of patients with gastrointestinal symptoms necessitating ultrasound scans were reviewed. Forty-four patients attended The Children's Hospital, Dublin, between August 1989 and December 1992, 15 (34%) of whom had abdominal ultrasound scans. There were 13 boys and two girls, ranging in age from 3.75 to 13.5 years. Abdominal radiographs in 13 patients did not add any significant information. Ultrasound detected thickened bowel wall in all 15 patients (0.4-1.1 cm), free peritoneal fluid in 10, ileus of affected loops in five, and bowel dilatation in eight. Serial ultrasound examinations in 12 patients followed the progress of bowel involvement, with resolution of mural thickening, return of peristalsis, reduction in ascites and bowel dilatation. There were seven intussusceptions in five patients, measuring 2.18-7.4 cm, which were documented as loose in four (i.e. where air or fluid lay between the intussusceptum and the intussuscipiens). Surgery was performed in three patients in the earlier years of the study; serial ultrasound monitoring has enabled a more conservative approach to be adopted in the latter years of the study. We conclude that ultrasound is the imaging modality of choice in evaluating the bowel manifestations of Henoch-Schonlein purpura. It provides an easy, noninvasive, objective method of monitoring patient progress. It allows direct visualization of bowel involvement and detection of complications such as intussusception. Routine abdominal radiographs are not recommended, unless perforation is clinically suspected.
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Affiliation(s)
- B Connolly
- Department of Radiology, Children's Hospital, Dublin
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32
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Abstract
Inflammatory or neoplastic bowel pathology is associated with thickening of the bowel wall. Ultrasound appearances reflect the pathological changes in the bowel. Crohn's disease is a transluminal disease leading to fibrosis. This fibrosis is responsible for the formation of an echo-poor halo surrounding a central echogenic zone. In the earlier stages with transmural oedema and inflammation, the halo assumes a ground glass appearance. Ulcerative colitis is a mucosal disease and hence the halo is a less prominent feature. Severe oedema in the bowel wall in fulminant ulcerative colitis can be recognized by the marked reduction of the haustral and central lumen of the colon.
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Affiliation(s)
- A E Joseph
- Dept. of Radiology, St. George's Hospital and Medical School, London, UK
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33
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Dewbury KC, Joseph AE. The role of ultrasound scanning. SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY. SUPPLEMENT 1994; 203:5-10. [PMID: 7973450 DOI: 10.3109/00365529409091388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Abdominal abscess, if left untreated, has a high mortality rate. Inadequate means of diagnosis and localization was responsible for this high mortality. Ultrasound now provides a simple non-invasive procedure permitting diagnosis with a high degree of sensitivity, although specificity is less commonly achieved. Abscesses do not have absolutely specific features, but given the appropriate clinical context and fine needle aspiration a diagnosis can be made in virtually 100% of cases, i.e. if the lesions can be identified and not obscured by bowel gas and examinations are not rendered difficult by surgical wounds and dressings. Diagnostic aspiration and therapeutic drainage are readily carried out using ultrasound guidance. Ultrasound is also of value in following the progress of lesions.
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Affiliation(s)
- K C Dewbury
- Dept. of Radiology, Southampton General Hospital, UK
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34
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Sheridan MB, Nicholson DA, Martin DF. Transabdominal ultrasonography as the primary investigation in patients with suspected Crohn's disease or recurrence: a prospective study. Clin Radiol 1993; 48:402-4. [PMID: 8293646 DOI: 10.1016/s0009-9260(05)81109-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Traditionally, patients with suspected or known and possible recurrent Crohn's disease have been investigated by small bowel barium radiology, which incurs a relatively high radiation dose. Despite patient selection a significant number have a normal barium examination. A prospective study was performed to evaluate the use of transabdominal ultrasound as the initial investigation in these two groups. One hundred and twenty-seven patients were examined, including 31 with a previous history of Crohn's disease. In the known Crohn's disease group there were 14 true positive ultrasound examinations and eight true negative, with six false positive and three false negative examinations. In the 96 patients not previously known to have Crohn's disease, there were 18 true positive and 70 true negative examinations, with two false positive and six false negative examinations. The overall sensitivity for ultrasound was 78% with a specificity of 91%. A significant learning curve was apparent in the early stages of study; in the last 64 patients the sensitivity was increased to 87%. These data support the use of ultrasound as the initial investigation in patients with suspected Crohn's disease or recurrence, prior to consideration for small bowel barium radiology, to reduce the large number of unnecessary small bowel barium examinations currently being performed.
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Affiliation(s)
- M B Sheridan
- Department of Radiology, Withington Hospital, University Hospital of South Manchester
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