PURPOSE: The aim of this study was to determine whether progressive increase of bowel wall thickness during nonoperative treatment is a reliable indicator for surgery in patients with adhesive small bowel obstruction....PURPOSE: The aim of this study was to determine whether progressive increase of bowel wall thickness during nonoperative treatment is a reliable indicator for surgery in patients with adhesive small bowel obstruction. METHODS: The study consisted of a prospective case series of 121 patients with adhesive small bowel obstruction who underwent an abdominal ultrasonographic examination. The results of ultrasonographic examinations were classified into two groups according to the presence (Group I) or absence (Group II) of bowel wall thickening. Bowel wall thickening was recognized as a visible small bowel wall ≥ 3 mm in width as seen by ultrasonographic examination. The findings of subsequent ultrasonographic examinations taken 24 hours later were compared with those taken at admission. Surgery was determined based on the presence of any toxic signs or the failure of nonoperative treatment. The number of patients who had successful nonoperative treatment, the number of patients who underwent surgeries, and the number of complications in each group were calculated to correlate with the ultrasonographic findings. RESULTS: There are 49 and 72 patients in Groups I and II, respectively. The number of patients who had successful nonoperative treatment and number of patients who underwent surgeries in Group I are 40 (81.6 percent) and 9 (18.4 percent) and in Group II the numbers are 68 (94.4 percent) and four (5.6 percent), respectively (P = 0.036). All 12 (100 percent) patients with progressive increase of bowel wall thickness underwent surgery. Progressive increase of bowel wall thickness as an indicator for surgery has a sensitivity of 92.3 percent (95 percent confidence interval, 62.1- 99.6 percent) and a specificity of 100 percent (95 percent confidence interval, 95.7- 100 percent). CONCLUSIONS: Patients with initial bowel wall thickening have a higher incidence of surgery, and progressive increase of bowel wall thickness that appears 24 hours later is a reliable indicator for surgery in patients with adhesive small bowel obstruction.展开更多
Objective. To assess the possibility of quantitative determination of bowel wall vascularity using contrast-enhanced (SonoVue ) wideband harmonic imaging ultrasound and the HDI-Lab software in patients with Crohn’ ...Objective. To assess the possibility of quantitative determination of bowel wall vascularity using contrast-enhanced (SonoVue ) wideband harmonic imaging ultrasound and the HDI-Lab software in patients with Crohn’ s disease. Material andmethods. Twenty-one patients (13 F, 8 M, average age 33.8 ± 12.7 years, range 21-60 years) with histologically confirmed Crohn’ s disease and bowel wall thickness≥ 5mm were recruited for the study. All ultrasound examinations were performed using a Philips HDI 5000 scanner. Bowel wall vascularity was determined at the site of maximum bowel wall thickness at baseline and at 30, 60, 90 and 120 s following application of the contrast enhancer SonoVue (1.2 ml) using the HDI-Lab software. Results. The mean length of bowel segments exhibiting increased wall thickness was 122.3 mm (range: 23-350 ± 74.7 mm), with a mean wall thickness of 7.6 ± 1.2 mm. Onset of echo enhancement secondary to contrast medium application was observed after an average 13.4 s (range 7-19 ± 4.2 s).Echo intensity corresponding to maxi.mum vascularity was measured 30 s after application of contrast medium. Maximum average contrast medium uptake was 217.5% (range 118-466 ± 100.1% ). Conclusions. It is possible to quantify bowel wall vascularity accurately in patients with Crohn’ s disease using contrast-enhanced pulse inversion ultrasound (low-MI).展开更多
Introduction: The purpose of this study was to assess the diagnostic accuracy of magnetic resonance colonography (MRC) for its ability to detect and quantify inflammatory bowel disease (IBD) affecting the colon. Endos...Introduction: The purpose of this study was to assess the diagnostic accuracy of magnetic resonance colonography (MRC) for its ability to detect and quantify inflammatory bowel disease (IBD) affecting the colon. Endoscopically obtained histopathology specimens were used as the standard of reference. Materials and methods: Fifteen normal subjects and 23 patients with suspected IBD of the large bowel underwent MRC. Three dimensional T1 weighted data sets were collected following rectal administration of water prior to and 75 seconds after intravenous administration of paramagnetic contrast (gadolinium-BOPTA). The presence of inflammatory changes in patients was documented based on bowel wall contrast enhancement, bowel wall thickness, presence of perifocal lymph nodes, and loss of haustral folds. All four criteria were quantified relative to data obtained from normal subjects and summarised in a single score. This MRC based score was compared with histopathological data based on conventional endoscopic findings. Results: MRC correctly identified 68 of 73 segments found to reveal IBD changes by histopathology. All severely inflamed segments were correctly identified as such and there were no false positive findings. Based on the proposed composite score,MRC detected and characterised clinically relevant IBD of the large bowel with sensitivity and specificity values of 87%and 100%, respectively, for all investigated colonic segments. Conclusion: MRC may be considered a promising alternative to endoscopic biopsy in monitoring IBD activity or assessing therapeutic effectiveness.展开更多
文摘PURPOSE: The aim of this study was to determine whether progressive increase of bowel wall thickness during nonoperative treatment is a reliable indicator for surgery in patients with adhesive small bowel obstruction. METHODS: The study consisted of a prospective case series of 121 patients with adhesive small bowel obstruction who underwent an abdominal ultrasonographic examination. The results of ultrasonographic examinations were classified into two groups according to the presence (Group I) or absence (Group II) of bowel wall thickening. Bowel wall thickening was recognized as a visible small bowel wall ≥ 3 mm in width as seen by ultrasonographic examination. The findings of subsequent ultrasonographic examinations taken 24 hours later were compared with those taken at admission. Surgery was determined based on the presence of any toxic signs or the failure of nonoperative treatment. The number of patients who had successful nonoperative treatment, the number of patients who underwent surgeries, and the number of complications in each group were calculated to correlate with the ultrasonographic findings. RESULTS: There are 49 and 72 patients in Groups I and II, respectively. The number of patients who had successful nonoperative treatment and number of patients who underwent surgeries in Group I are 40 (81.6 percent) and 9 (18.4 percent) and in Group II the numbers are 68 (94.4 percent) and four (5.6 percent), respectively (P = 0.036). All 12 (100 percent) patients with progressive increase of bowel wall thickness underwent surgery. Progressive increase of bowel wall thickness as an indicator for surgery has a sensitivity of 92.3 percent (95 percent confidence interval, 62.1- 99.6 percent) and a specificity of 100 percent (95 percent confidence interval, 95.7- 100 percent). CONCLUSIONS: Patients with initial bowel wall thickening have a higher incidence of surgery, and progressive increase of bowel wall thickness that appears 24 hours later is a reliable indicator for surgery in patients with adhesive small bowel obstruction.
文摘Objective. To assess the possibility of quantitative determination of bowel wall vascularity using contrast-enhanced (SonoVue ) wideband harmonic imaging ultrasound and the HDI-Lab software in patients with Crohn’ s disease. Material andmethods. Twenty-one patients (13 F, 8 M, average age 33.8 ± 12.7 years, range 21-60 years) with histologically confirmed Crohn’ s disease and bowel wall thickness≥ 5mm were recruited for the study. All ultrasound examinations were performed using a Philips HDI 5000 scanner. Bowel wall vascularity was determined at the site of maximum bowel wall thickness at baseline and at 30, 60, 90 and 120 s following application of the contrast enhancer SonoVue (1.2 ml) using the HDI-Lab software. Results. The mean length of bowel segments exhibiting increased wall thickness was 122.3 mm (range: 23-350 ± 74.7 mm), with a mean wall thickness of 7.6 ± 1.2 mm. Onset of echo enhancement secondary to contrast medium application was observed after an average 13.4 s (range 7-19 ± 4.2 s).Echo intensity corresponding to maxi.mum vascularity was measured 30 s after application of contrast medium. Maximum average contrast medium uptake was 217.5% (range 118-466 ± 100.1% ). Conclusions. It is possible to quantify bowel wall vascularity accurately in patients with Crohn’ s disease using contrast-enhanced pulse inversion ultrasound (low-MI).
文摘Introduction: The purpose of this study was to assess the diagnostic accuracy of magnetic resonance colonography (MRC) for its ability to detect and quantify inflammatory bowel disease (IBD) affecting the colon. Endoscopically obtained histopathology specimens were used as the standard of reference. Materials and methods: Fifteen normal subjects and 23 patients with suspected IBD of the large bowel underwent MRC. Three dimensional T1 weighted data sets were collected following rectal administration of water prior to and 75 seconds after intravenous administration of paramagnetic contrast (gadolinium-BOPTA). The presence of inflammatory changes in patients was documented based on bowel wall contrast enhancement, bowel wall thickness, presence of perifocal lymph nodes, and loss of haustral folds. All four criteria were quantified relative to data obtained from normal subjects and summarised in a single score. This MRC based score was compared with histopathological data based on conventional endoscopic findings. Results: MRC correctly identified 68 of 73 segments found to reveal IBD changes by histopathology. All severely inflamed segments were correctly identified as such and there were no false positive findings. Based on the proposed composite score,MRC detected and characterised clinically relevant IBD of the large bowel with sensitivity and specificity values of 87%and 100%, respectively, for all investigated colonic segments. Conclusion: MRC may be considered a promising alternative to endoscopic biopsy in monitoring IBD activity or assessing therapeutic effectiveness.
