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Bowel Wall Thickening on Computed Tomography in Children: A Novel Method of Measurement and Its Clinical Significance
Do Kyung Lee1, Ky Young Cho2, Hyun-Hae Cho3
1Department of Pediatrics, Ewha Womans University College of Medicine, Seoul, Korea.
Insights
Bowel wall thickening on CT scans in children often indicates nonspecific findings. This study establishes reference values, suggesting many cases can be monitored without immediate intervention.
Area of Science:
- Pediatric Radiology
- Gastrointestinal Imaging
- Computed Tomography
Background:
- Clinical significance of bowel wall thickening (BWT) in children via abdominal computed tomography (CT) is not well-defined.
- A novel method for measuring BWT and assessing its clinical importance in pediatric patients is needed.
Purpose of the Study:
- To establish reference values for BWT in the small intestine and colon in children using a new measurement technique.
- To determine the clinical significance of BWT detected on abdominal CT in pediatric patients.
Main Methods:
- Retrospective analysis of 423 pediatric patients with acute abdomen undergoing abdominal CT.
- Measurement of maximal bowel wall thickness (MT), normal bowel wall thickness (NT), and their ratios for each bowel segment in 262 patients with BWT.
Main Results:
- Significant differences in thickness and MT/NT ratios were observed between the small bowel and colon.
- BWT correlated with infectious etiologies (viral vs. bacterial) and specific bowel segments.
- 158 initially undiagnosed patients with BWT showed spontaneous symptom resolution without progression.
Conclusions:
- This study provides crucial pediatric reference values for BWT using a novel CT measurement method.
- BWT in children may represent nonspecific findings, often manageable with observation and follow-up, unlike in adults.
Purpose:
The clinical implications of bowel wall thickening (BWT) on abdominal computed tomography (CT) among children are unknown. We aimed to suggest a new method for measuring BWT and determining its clinical significance in children.
Methods:
We retrospectively analyzed 423 patients with acute abdomen who underwent abdominal CT; 262 were classified into the BWT group. For this group, the pediatric radiologist described the maximal bowel wall thickness (MT), normal bowel wall thickness (mm) (NT), and their ratios for each segment of the bowel wall.
Results:
In the thickened bowel walls, the thickness differed significantly between the small bowel (6.83±2.14 mm; mean±standard deviation) and the colon (8.56±3.46 mm; p<0.001). The ratios of MT to NT in the small bowel (6.09±3.17) and the colon (7.58±3.70) were also significantly different (p<0.001). In the BWT group, 35 of 53 patients had positive fecal polymerase chain reaction results; 6 patients infected with viruses predominantly had BWT in the small intestine, while the terminal ileum and the colon were predominantly affected in 29 patients with bacterial infections. In the initially undiagnosed 158 patients with BWT, the symptoms improved spontaneously without progression to chronic gastrointestinal disease.
Conclusion:
This study provides a clinical reference value for BWT in the small intestine and colon using a new method in children. The BWT on abdominal CT in children might indicate nonspecific findings that can be observed and followed up without additional evaluation, unlike in adults.
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