Elsevier

Clinical Radiology

Volume 63, Issue 9, September 2008, Pages 968-978
Clinical Radiology

Grey-scale and colour Doppler sonography in the evaluation of children with suspected bowel inflammation: correlation with colonoscopy and histological findings

https://doi.org/10.1016/j.crad.2008.02.009Get rights and content

Aim

To evaluate the correlation of grey-scale and colour Doppler sonography with colonoscopy and histology to detect bowel inflammation in children.

Material and methods

The records of 72 patients with suspected bowel inflammation were reviewed retrospectively. Patients were included in the study if sonography had been performed up to 30 days before colonoscopy. Grey-scale and colour Doppler sonography were used to evaluate bowel wall thickness and vascularity for the detection of distal bowel inflammation. Findings were correlated with colonoscopy and histological findings. The sensitivity and specificity of sonographic wall thickness to detect inflammation was determined. Spearman's coefficient (rs) was used to determine the correlation of Doppler findings with colonoscopy/histology.

Results

Sonograms of 372 bowel segments were evaluated and results were correlated with colonoscopy and histological findings of 352 segments. The sensitivity and specificity of sonographic bowel thickness to detect inflammation in the terminal ileum and the right colon were high; in the other segments, specificity was high but sensitivity was low. The correlation of Doppler sonography with colonoscopy and histology to detect inflammation in the terminal ileum was strong (rs: 0.84; p < 0.001) and in the other segments, weak to moderate; when the interval between examinations was shorter than 10 days, the correlation was stronger in all segments. Of nine patients with abnormal small bowel sonograms but normal colonoscopies, three had Crohn's disease.

Conclusion

Sensitivity and specificity of grey-scale sonography to detect inflammation in the terminal ileum and the right colon were high, and the correlation of Doppler with colonoscopy and histology was very strong in the same segments.

Introduction

Bowel inflammation is a term that describes a heterogeneous group of diseases. Patients with bowel inflammation may present with unspecific symptoms, such as abdominal pain, diarrhoea, intestinal bleeding, and weight loss, which are found in several diseases, such as inflammatory bowel disease (IBD), allergic reactions, vascular responses, infections, and polyps.

Among children, the diagnosis of IBD, particularly of Crohn's disease (CD), is often missed or delayed because of the non-specific nature of the intestinal and extra-intestinal symptoms at presentation, which overlap functional bowel disorders. Other less typical symptoms are: isolated short stature, chronic anaemia, unexplained fever, anorexia, erythema nodosum, mouth ulcers, arthritis, acute appendicitis, and pancreatitis.1 Therefore, other procedures, such as contrast radiology, which expose patients to ionizing radiation, or endoscopy, which is invasive, have to be used to eliminate other diagnoses.

Grey-scale sonography can evaluate the severity of wall thickening, the extent and distribution of colitis and transmural colitis, and the involvement of small bowel.2, 3, 4, 5 Colour Doppler sonography can detect increases in bowel wall perfusion and show changes in disease activity in paediatric patients with bowel inflammation.6 Therefore, the abnormal segments can be identified, and clinical progression can be monitored.7, 8 The use of colour Doppler sonography as the first imaging method to investigate bowel inflammation has been described in studies with adults and children.9, 10

To our knowledge, no study has correlated both grey-scale and colour Doppler sonographic findings of wall thickness and vascularity with colonoscopic and histological findings in a large number of children with suspected bowel inflammation. The purpose of the present study was to evaluate such correlations in a group of children seen in our institution.

Section snippets

Patients

This retrospective study evaluated clinical data, grey-scale and colour Doppler sonographic, colonoscopic and histological findings of children with suspected bowel inflammation seen consecutively in our institution from January 2000 to December 2006. Clinical and laboratory data were retrieved from patients' records in the hospital files; sonography, colonoscopy, and pathology data were retrieved from the files of the Radiology, Endoscopy, and Pathology Departments of our institution.

The

Results

A total of 72 children and adolescents underwent grey-scale and colour Doppler sonography examinations followed by colonoscopy and histology studies. Ages ranged from 2 months to 16 years, with a mean age of 7.6 years; 41.8% of the patients were girls. The mean number of days between sonography and colonoscopy was 9.6 days (range 1–30 days), but 64.9% of the studies were performed at an interval of ≤10 days. Clinical findings that led to consultation were: enterorrhagia (36.5%), abdominal pain

Discussion

In our hospital, the management of children and adolescents with suspected bowel inflammation was standardized approximately 15 years ago, and sonography is used before invasive procedures, such as colonoscopy. This standard procedure provides information about the abnormal segments and the severity of the condition before colonoscopy is performed. Grey-scale and colour Doppler sonography is also indicated for the follow-up of patients with IBD. Our experience indicates that colour Doppler

Acknowledgements

The authors thank all the staff of the Department of Radiology; Anelise Burmeister for assistance in writing and proofreading the text; Mario Wagner for helping with statistical calculations; Juliana Elói, Mario Furquim, Carolina Belotto, Andrea Lopes and Regina Camargo for their support.

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