Radiological evaluation of the abdomen and pelvis usually involves CT imaging. Indications include acute abdomen, clinical suspicion of malignancy or inflammatory disease. When bowel wall thickening(BWT) is identified on CT, normal variants (Figure 1) as well as pathological conditions(Figures 2,3) can give rise to this appearance1. Patients are often referred for colonoscopy, in order to further investigate abnormalities reported on CT imaging. We were interested in comparing reported luminal pathologies on CT and subsequent colonoscopic findings.

Our study was conducted in Epsom General Hospital, a District General Hospital in Surrey, UK. Data was collected using the electronic patient records(EPR) and patient archive and communication system(PACS), the DI-COM system in our hospital. All patients referred for colonoscopy based on abnormal CT imaging, over a twelve-month period, were identified retrospectively. Endoscopic findings were recorded. The corresponding CT scan report (that lead to endoscopic referral) was reviewed for each patient, noting the luminal pathologies. Furthermore, two assessors independently scored each CT report with a...

159 colonoscopies were performed, over a period of 12 months as a result of abnormalities reported following imaging. 32 were excluded due to unavailable imaging. Sex Number of colonoscopies Mean age Male 55 65(18-96) Female 72 68(23-92) Table 1. Demographics- Percentages in brackets Of the imaging techniques leading to colonoscopy, CT had been used 98 out of 127 (77%) of the times. The other modalities used are detailed in Table 2. Imaging Number(%) CT Pneumocolon 17(14) CT 98(77) Ultrasound 3(2) Barium studies 4(3) MRI 5(4)...

Overall, 35% of colonoscopies revealed a neoplastic pathology; 20% cancer and 15% polyps. Even in the least sensitive of the radiological descriptions, which was NSBWT the detection rate for these 2 pathologies was 20%. Similar results have been reported in other studies2,3. For example, bowel wall thickening reported on CT, revealed abnormalities on colonoscopy in 58% and had a malignant outcome in 22% of cases4. Therefore, our results show that colonoscopy should be performed following luminal abnormalities reported on CT scan. Further discussion of cases...

1. Macari M, Balthazar EJ; CT of bowel wall thickening: significance and pitfalls of interpretation; AJR Am J Roentgenol. 2001 May;176(5):1105-16. 2. Karim MS, Miranda MC, Shamma'a JM, Goebel SU, Sundaram U; Utility of upper endoscopy and colonoscopy in evaluating gastrointestinal luminal wall thickening found on computed tomography; W V Med J. 2010 Nov-Dec;106(7):16-9. 3. Prospective evaluation of patients with bowel wall thickening; Rockey DC, Halvorsen RA Jr, Higgins JL, Cello JP; Am J Gastroenterol. 1995 Jan;90(1):99-103. 4. Uzzaman MM, Alam A, Nair MS, Borgstein...

Dr D. Tzias is a Radiology Trainee in London UK. Dr C. Alexakis is a Trainee in GI in London UK. Dr P. Patel is a Consultant in GI in London UK. Dr S. Moodie is a Consultant in GI London UK.