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Gastrointestinal inflammation in children: color Doppler ultrasonography
1Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110.
Insights
Color Doppler ultrasonography shows increased bowel vascularity in pediatric inflammatory conditions. While not specific, it helps differentiate primary bowel issues from conditions like peritonitis.
Area of Science:
- Medical Imaging
- Gastroenterology
- Pediatric Radiology
Background:
- Gastrointestinal inflammatory conditions in children present diagnostic challenges.
- Color Doppler ultrasonography assesses blood flow, potentially identifying inflammation-associated vascularity.
Purpose of the Study:
- To evaluate color Doppler ultrasonography's ability to detect increased vascularity in pediatric gastrointestinal inflammation.
- To determine if specific flow patterns can aid in diagnosing inflammatory bowel processes.
Main Methods:
- Twenty-five children with suspected inflammatory bowel processes underwent color Doppler sonography alongside grayscale ultrasound.
- A control group of 19 patients was also examined.
- Inflammation was defined as increased vascularity in bowel layers or adjacent tissues.
Main Results:
- Crohn's disease and Yersinia enterocolitis showed diffuse wall thickening with central mucosal blood flow.
- Neutropenic colitis and Crohn's disease exhibited wall thickening with increased transmural vascularity.
- Peritonitis presented with thickened bowel walls and peripheral/adjacent hypervascularity; gastroenteritis showed no bowel vascularity.
Conclusions:
- Mucosal or transmural hypervascularity on color Doppler sonography is observed in various pediatric inflammatory bowel conditions but lacks specificity.
- Color Doppler ultrasonography can assist in distinguishing primary bowel diseases from extrinsic inflammatory processes like peritonitis.
Abstract:
We conducted this study to determine if color Doppler ultrasonography can identify increased vascularity associated with gastrointestinal inflammatory conditions and to determine if specific diagnoses can be established based on flow patterns. Twenty-five children with acute right lower quadrant pain and discharge diagnoses of inflammatory bowel processes were examined by color Doppler sonography, as an adjunct to routine gray-scale examinations. Final diagnoses included gastroenteritis (10 cases), Crohn's disease (five cases), neutropenic colitis (four cases), peritonitis (four cases), and Yersinia enterocolitis (two cases). The results of color Doppler sonography were considered positive for inflammation if increased vascularity was demonstrated in the bowel mucosa, muscularis layer, or adjacent tissues. A control group of 19 patients was examined. No sonographic abnormalities were identified in any patients in the control group. Diffuse, concentric wall thickening with increased blood flow centrally within the mucosa was seen in Crohn's disease (60%) and Yersinia enterocolitis (100%), whereas wall thickening with increased transmural vascularity was identified in neutropenic colitis (50%) and Crohn's disease (40%). In contrast, in peritonitis color Doppler sonography showed thickened bowel wall and hypervascularity within peripheral bowel wall or in adjacent soft tissues. No demonstrable bowel vascularity was seen in gastroenteritis. Our experience suggests that mucosal or transmural hypervascularity on color Doppler sonography can be seen with several inflammatory bowel processes, but it is nonspecific. However, color Doppler sonography may aid in differentiating primary bowel disease from extrinsic inflammatory conditions, such as peritonitis.