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