Bowel wall thickening at CT: simplifying the diagnosis

Area of Science:

• Radiology
• Gastroenterology
• Abdominal Imaging

Background:

• Bowel wall thickening on computed tomography (CT) can indicate neoplastic, inflammatory, infectious, or ischemic conditions.
• Distinguishing between focal and segmental/diffuse thickening is crucial for diagnosis.
• Analysis of wall symmetry and perienteric anomalies aids in differentiating causes of focal thickening.

Purpose of the Study:

• To present a simplified algorithm-based approach for evaluating small and large bowel wall thickening on routine abdominal CT.
• To assist radiologists in differentiating between benign and malignant causes of bowel wall thickening.
• To improve diagnostic accuracy for various bowel pathologies.

Main Methods:

• Development of a simplified algorithm for CT-based bowel wall thickening assessment.
• Categorization of thickening into focal (<5 cm) and segmental/diffuse (≥5 cm).
• Correlation of imaging features (symmetry, attenuation, fat stranding) with clinical findings.

Main Results:

• Focal, irregular, and asymmetrical thickening often suggests malignancy.
• Disproportionately severe perienteric fat stranding indicates inflammatory conditions.
• Regular, symmetric, and homogeneous thickening can be benign or neoplastic (e.g., lymphoma, adenocarcinoma).
• Segmental or diffuse thickening is typically benign (ischemic, infectious, inflammatory), with attenuation patterns aiding diagnosis.

Conclusions:

• The algorithm aids in differentiating causes of focal bowel wall thickening, distinguishing tumors from inflammatory conditions.
• Segmental or diffuse bowel wall thickening is usually associated with benign conditions, excluding lymphoma.
• CT findings like fat stranding and attenuation patterns are key to narrowing the differential diagnosis for bowel wall thickening.