Bowel wall thickening: differentiation of inflammation from ischemia with color Doppler and duplex US.

Abstract

To determine whether ultrasonography (US) can be used to differentiate inflammatory from ischemic bowel wall thickening. Thirty-five patients (aged 23-96 years) with inflammatory or ischemic bowel wall thickening underwent US. Thickness was recorded, echotexture categorized, color Doppler flow graded, presence of intramural arterial signal recorded, and resistive index calculated. The difference between inflammatory and ischemic bowel wall thicknesses was not significant (P = .49). Differences in color Doppler flow (P < .0001), arterial signal (P = .0005), and bowel wall echotexture (P < or = .0200) between patients with inflammatory and ischemic bowel wall thickening were significant. Absence of or barely visible color Doppler flow and absence of arterial signal suggested ischemia; readily visible color Doppler flow and a stratified echotexture suggested inflammation. A resistive index less than 0.60 indicated inflammation. The difference in resistive index between the two groups was not significant (P = .12). Duplex and color Doppler flow US are helpful in differentiation between ischemic and inflammatory bowel wall thickening.