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Lnu R, Khanduri S, Khan Z, Ansari D, Mulani M, Gupta A, Alam N, Aggarwal A, Lnu S, Agrawal A. A Study of Small and Large Bowel Wall Thickness Using Computed Tomography and Its Histopathological Correlation. Cureus 2024; 16:e72932. [PMID: 39628742 PMCID: PMC11614315 DOI: 10.7759/cureus.72932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2024] [Indexed: 12/06/2024] Open
Abstract
BACKGROUND Small bowel imaging presents significant challenges due to the bowel's length, narrow caliber, and complex looping. Accurate diagnosis of gastrointestinal disorders often requires detailed imaging to differentiate various pathologies, such as inflammatory bowel disease (IBD), infections, ischemic conditions, and neoplasms. INTRODUCTION The small bowel plays a crucial role in digestion and absorption and is susceptible to various pathologies. CT imaging is essential for diagnosing bowel wall thickening, which can indicate a range of conditions. Dual-energy CT (DECT) and CT enterography offer advanced imaging capabilities to address these diagnostic challenges. This study aims to evaluate the efficacy of CT in staging malignant lesions by correlating imaging findings with histopathology to enhance non-invasive diagnosis and treatment strategies. METHODOLOGY This cross-sectional study was conducted over two years at Era's Medical College and Hospital, Lucknow, India, with 60 subjects. Patients with abnormal bowel wall thickening (>5 mm) on ultrasound were included, while those with renal dysfunction or pregnancy were excluded. After informed consent, subjects consumed a mannitol solution before undergoing CT scans using a 384-slice Dual Energy CT scanner (Somatom Force, Siemens Healthcare, Erlangen, Germany). All images were post-processed on a workstation using Synovia software (Synovia Solution, Fort Worth, Texas), which allows for image analysis using three-material decomposition. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York). RESULTS The majority of patients were young adults aged 20-39 years (63.33%), with a slight male predominance (53.33%). Abdominal pain was the most common complaint (35.00%). Mild wall thickening (<10 mm) was associated with IBD (48.28%), while marked thickening (>10 mm) was linked to neoplastic lesions (48.39%). Symmetrical thickening was common in infective and inflammatory conditions, whereas asymmetrical thickening was typical of neoplastic lesions. CT scans demonstrated high diagnostic accuracy, with 83.33% sensitivity, 95.24% specificity, 88.24% positive predictive value, and 93.02% negative predictive value, resulting in an overall accuracy of 91.67%. CONCLUSION The study highlights that neoplastic lesions are associated with marked bowel wall thickening, while inflammatory conditions present with mild thickening. CT scans proved highly effective in diagnosing gastrointestinal disorders, with significant accuracy in distinguishing between benign and malignant lesions. This underscores the importance of advanced imaging techniques in clinical practice for improved patient outcomes.
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Affiliation(s)
- Rohit Lnu
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Sachin Khanduri
- Radiology, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Zaara Khan
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Danish Ansari
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Mohsin Mulani
- Radiology, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Ashok Gupta
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Nadeem Alam
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Akshay Aggarwal
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Sana Lnu
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
| | - Aastha Agrawal
- Radiodiagnosis, Era's Lucknow Medical College and Hospital, Lucknow, IND
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Boyer S, Lombard C, Urbaneja A, Vogrig C, Regent D, Blum A, Teixeira PAG. CT in non-traumatic acute abdominal emergencies: Comparison of unenhanced acquisitions and single-energy iodine mapping for the characterization of bowel wall enhancement. RESEARCH IN DIAGNOSTIC AND INTERVENTIONAL IMAGING 2022; 2:100010. [PMID: 39076837 PMCID: PMC11265197 DOI: 10.1016/j.redii.2022.100010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/21/2022] [Indexed: 07/31/2024]
Abstract
Objectives To evaluate the benefit of unenhanced CT and single energy iodine mapping (SIM) to conventional contrast-enhanced CT for bowel wall enhancement characterization in an acute abdomen setting. Methods CT images from 45 patients with a suspected acute abdomen who underwent abdominopelvic CT from April 2018 to June 2018 were analyzed retrospectively by two independent radiologists. These patients had been referred by emergency department physicians in a context of acute abdominal pain and had a confirmed etiological diagnosis. Three image sets were evaluated separately (portal phase images alone; portal phase images and unenhanced images, portal phase images, and single energy iodine maps). Diagnostic accuracy and confidence were assessed. Quantitative analysis of bowel wall enhancement was also performed. Results The number of correct diagnoses increased by 8% and 12% with unenhanced images and 6% and 13% with SIM for readers 1 and 2, respectively, compared to the portal phase only. There was an improvement in the confidence of the etiological diagnosis with the number of certain diagnoses increasing from 23% to 100%, which was statistically significant for reader 2 and of borderline significance for reader 1 (P = 0.002 and 0.052, respectively) when unenhanced phase and SIM were added. The inter-rater agreement improved when unenhanced and portal phase images were associated, compared to portal phase images alone (kappa = 0.652 [ICC=0.482-0.822] and 0.42 [ICC=0.241-0.607] respectively). Conclusion SIM and unenhanced images improve the reproducibility and the diagnostic confidence to diagnose ischemic and inflammatory/infectious bowel wall thickening compared to portal phase images alone. Summary sentence The analysis of unenhanced and SIM images in association with portal phase images improves the reproducibility and the radiologist's confidence in the etiological diagnosis of acute non-traumatic bowel wall thickening in adults.
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Affiliation(s)
- Sophie Boyer
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Charles Lombard
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Ayla Urbaneja
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Céline Vogrig
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Denis Regent
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Alain Blum
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
| | - Pedro Augusto Gondim Teixeira
- Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France
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Yu SJ, Heo JH, Choi EJ, Kim JH, Lee HS, Kim SY, Lim JH. Role of multidetector computed tomography in patients with acute infectious colitis. World J Clin Cases 2022; 10:3686-3697. [PMID: 35647171 PMCID: PMC9100710 DOI: 10.12998/wjcc.v10.i12.3686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/14/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The role of multidetector computed tomography (MDCT) in patients with acute infectious colitis is still unclear.
AIM To examine the usefulness of MDCT in distinguishing the etiology of acute infectious colitis.
METHODS Overall, 244 patients who met the criteria for acute infectious colitis and visited the Hospital from February 2015 to 2018 were retrospectively enrolled and divided into two groups (bacterial: 204, viral: 40) according to causes of acute colitis, based on stool PCR. Eleven MDCT parameters, including wall thickening, submucosal edema, mucosal enhancement, serosa involvement, empty colon sign, small bowel involvement, comb sign, continuous distribution, accordion sign, mucosal thickening, and lymph node enlargement, were constructed in a blinded fashion.
RESULTS MDCT parameters of wall thickening (OR: 13.60; 95%CI: 5.80–31.88; P < 0.001), submucosal edema (OR: 36.08; 95%CI: 13.54–96.13; P < 0.001), mucosal enhancement (OR: 22.55; 95%CI: 9.28–54.81; P < 0.001), serosal involvement (OR: 14.50; 95%CI: 3.33–63.23; P < 0.001), empty colon sign (OR: 6.68; 95%CI: 2.44–18.32; P < 0.001), continuous distribution (OR: 24.09; 95%CI: 9.38–61.90; P < 0.001), accordion sign (OR: 9.02; 95%CI: 1.12–72.35; P = 0.038), mucosal thickening (OR: 46.41; 95%CI: 10.38–207.51; P < 0.001), and lymph node enlargement (OR: 4.39; 95%CI: 1.22–15.72; P = 0.023) were significantly associated with bacterial colitis. At least one positive finding in four CT outcomes (submucosal edema, mucosal enhancement, continuous distribution, mucosal thickening) in summer showed a high probability of bacterial colitis (sensitivity, 41.67; specificity, 92.50; OR: 24.95).
CONCLUSION MDCT provides many clues that can be useful in suggesting a specific etiology of acute infectious colitis.
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Affiliation(s)
- Seung Jung Yu
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan 47392, South Korea
| | - Jae Hyuk Heo
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan 47392, South Korea
| | - Eun Jeong Choi
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan 47392, South Korea
| | - Jong Hyuk Kim
- Department of Radiology, Myongji Hospital, Hanyang University College of Medicine, Goyang 10475, South Korea
| | - Hong Sub Lee
- Department of Internal Medicine, Inje University Busan Paik Hospital, Busan 47392, South Korea
| | - Sun Young Kim
- Department of Cancer Control and Population Health, National Cancer Center, Goyang 10408, South Korea
| | - Jae Hoon Lim
- Department of Radiology, Myongji Hospital, Hanyang University College of Medicine, Goyang 10475, South Korea
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Donlon NE, Kelly ME, Zafar M, Boland PA, Davis C, Wei Teh J, Corless K, Khan W, Khan I, Waldron R, Barry K. The Use of Clinical Parameters as Adjuncts to Endoscopic Evaluation of Mural Thickening on Conventional Computed Tomography in Diagnosing Malignancy. Dig Surg 2021; 38:230-236. [PMID: 33784697 DOI: 10.1159/000514777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/19/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Mural thickening (MT) on computed tomography (CT) poses a diagnostic dilemma in the absence of clear reporting guidelines. The aim of this study was to analyse CT reports, identifying patients in whom gastrointestinal wall MT was observed, and to correlate these reports with subsequent endoscopic evaluation. METHODS Patients with MT who had follow-up endoscopy were included in the study (n = 308). The cohort was subdivided into upper gastrointestinal mural thickening (UGIMT) & lower gastrointestinal mural thickening (LGIMT). RESULTS In total, 55.71% (n = 122) of colonoscopies and 61.8% (n = 55) of gastroscopies were found to be normal. Haemoglobin (HB) level in combination with MT was a predictor of neoplasia in both arms (p = 0.04 UGIMT cohort, p < 0.001 LGIMT cohort). In addition to this, age was a significant correlative parameter in both UGIMT and LGIMT cohorts (p = 0.003, p < 0.001 respectively). Dysphagia and weight loss were associated with UGI malignancies (38 and 63% respectively) and rectal bleeding was correlative in 20% of patients with LGI malignancies. CONCLUSION HB, advancing age, and red flag symptoms are potentially useful adjuncts to MT in predicting upper and lower gastrointestinal malignancies. We propose the adoption of a streamlined pathway to delineate patients who should undergo endoscopic investigation following CT identification of MT.
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Affiliation(s)
- Noel E Donlon
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Michael E Kelly
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Muneeb Zafar
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Patrick A Boland
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Cian Davis
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Jia Wei Teh
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Kevin Corless
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Waqar Khan
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Iqbal Khan
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Ronan Waldron
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
| | - Kevin Barry
- Department of General Surgery, Mayo University Hospital, Mayo, Castlebar, Ireland
- Discipline of Surgery National University of Ireland, Galway, Ireland
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Karacin C, Türker S, Eren T, Imamoglu GI, Yılmaz K, Coskun Y, Gunes SO, Sökmen F, Yazilitas D, Şimşek Z, Altınbaş M. Predictors of Neoplasia in Colonic Wall Thickening Detected via Computerized Tomography. Cureus 2020; 12:e10553. [PMID: 32968607 PMCID: PMC7505674 DOI: 10.7759/cureus.10553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Colonic wall thickening (CWT) is frequently observed incidentally via abdominal computerized tomography (aCT). Although the general approach to evaluating incidental CWT is a colonoscopic examination, there is a lack of definitive recommendation guidelines. Thus, we aimed to determine neoplasia rates and identify the factors predictive of neoplasia via colonoscopic examinations of patients with CWT incidentally diagnosed via aCT. Methods We retrospectively reviewed 5,300 colonoscopy reports. A total of 122 patients who had CWT incidentally observed via aCT were included in the study. CWT was graded as mild (3-5 mm), moderate (6-12 mm), or severe (≥12 mm). A logistic regression model was used to determine the predictive factors for neoplasia. Results The mean age of the patients was 60 years, and abnormal findings were noted in 52% of the colonoscopies. Neoplastic lesions were detected in 24 patients (19.6%), while colon adenocarcinoma was detected in 8 patients (6.5%). Multivariate analysis showed that moderate-severe, focal, and asymmetric CWT were independent factors for predicting neoplasia (p=0.049, p=0.033, and p=0.018, respectively). Conclusion Pathological findings can be noted via colonoscopic examination in cases of incidental CWT; therefore, patients with moderate-severe, focal, or asymmetric CWT require colonoscopic examination for the purpose of detecting neoplasia.
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Affiliation(s)
- Cengiz Karacin
- Medical Oncology, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, TUR
| | - Sema Türker
- Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Tulay Eren
- Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Goksen Inanc Imamoglu
- Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Kemalettin Yılmaz
- Gastroenterology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Yusuf Coskun
- Gastroenterology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Serra Ozbal Gunes
- Radiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Fevzi Sökmen
- Internal Medicine, Dr. Abdurrahman Yurtaslan Oncology Training and Research Hospital, Ankara, TUR
| | - Dogan Yazilitas
- Medical Oncology, Diskapi Yildirim Beyazit Research and Education Hospital, Ankara, TUR
| | - Zahide Şimşek
- Gastroenterology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
| | - Mustafa Altınbaş
- Medical Oncology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, TUR
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To H, Stella DL, Chandra R. Infiltrating caecal carcinoma versus appendicitis with caecal phlegmon-can computer tomography differentiate them? J Surg Case Rep 2017; 2017:rjx006. [PMID: 28458817 PMCID: PMC5400485 DOI: 10.1093/jscr/rjx006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 12/18/2016] [Accepted: 01/18/2017] [Indexed: 11/12/2022] Open
Abstract
Right iliac fossa pain is a common acute general surgery presentation, and computer tomography (CT) is often used as an aid in determining the diagnosis. CT can play an important role in differentiating malignant and inflammatory causes of caecal wall thickening if certain key features are identified. Two patients with similar presentations of right iliac fossa pain had pre-operative CT, which showed inflammation and caecal thickening, the first was focal with homogenous enhancement, and the second eccentric with stratification. At operation, these were proven to be malignant and inflammatory caecal thickening. Although the clinical presentation of appendicitis and caecal carcinoma may be similar, and the correct recognition and interpretation of differentiating CT characteristics enables the patient for an appropriately tailored operation.
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Affiliation(s)
- Henry To
- Department of Surgery, Level 2, Royal Melbourne Hospital, Grattan St, Parkville, Victoria 3052, Australia
| | - Damien L Stella
- Department of Radiology, Level 1, Royal Melbourne Hospital, Grattan St, Parkville, Victoria 3052, Australia
| | - Raaj Chandra
- Department of Surgery, Level 2, Royal Melbourne Hospital, Grattan St, Parkville, Victoria 3052, Australia
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