Keywords:
Abdomen, Gastrointestinal tract, Management, Ultrasound, Contrast agent-intravenous, Inflammation
Authors:
E. Garcia Martinez1, D. H. Jiménez1, T. Ripollés2, L. Navarro Vilar3, C. P. Fernandez Ruiz1, F. Rocuts Martinez4; 1VALENCIA/ES, 246007/ES, 3Valencia, Va/ES, 4Las Palmas Gran Canaria/ES
DOI:
10.1594/ecr2013/C-2269
Results
We performed 871 contrast-enhanced ultrasound (CEUS) for gastrointestinal application between June 2006 and May 2012.
Of these,
a group of 80 patients were included because terms as “inflammatory mass”,
“phlegmon” or “abscess” were on the report.
Nine examinations were excluded because of lack of confirmation or inadequate follow-up.
Our final cohort consisted of 71 inflammatory masses in 50 patients,
22 women and 28 men with an average age of years 41 ± SD15 (range years: 18-77).
Thirty-three patients had a confirmed diagnosis of Crohn´s disease,
10 had acute appendicitis,
six patients had acute diverticulitis and one patient a perforated cancer of colon sigmoid.
Fifty-seven inflammatory masses,
21 phlegmons and 36 abscesses,were confirmed by other imaging techniques: CT (n=19),
MRI (n=16),
surgery (n=23),
percutaneous drainage (n=18),
20 of them by more than one technique.Fourteen phlegmons were confirmed by CEUS follow-up.Kappa coefficient between CEUS and other techniques in the diagnosis of phlegmon or abscess was excellent (kappa= 0.972).
After contrast agent injection 35 out of the 36 abscesses showed partial or total absence of enhancement of the hypoechoic mass (Fig. 1,Fig. 3 Fig. 4) and were confirmed by imaging techniques,
surgery or percutaneous drainage.
Surgery detected in one patient a small abscess (<2 cm) into a 5 cm phlegmon with homogeneous enhancement on CEUS examination.
Twenty-one phlegmons showed homogeneous enhancement of the hypoechoic mass on contrast-enhanced ultrasound examination (Fig. 6,
Fig. 7,
Fig. 11),
being all of them confirmed by other techniques.
In 3 patients,
a combination of the previously described patterns of enhancement was seen; a small zone without enhancement was shown inside the phlegmon,
corresponding to small abscess (5-6mm).Fig. 10.
The average size of the hypoechoic inflammatory masses before contrast agent injection was 43.4mm (range: 16-160mm).Statistically significant differences were found between the size of the abscesses before (55.8± SD29.3mm) and after contrast agent injection (48.7 ± SD30.5mm) (p=0,001)The size of the abscesses were <2 cm in 4 cases,
between 2-4 cm in 12 cases and >4 cm in 19.
It was identified small volumes of internal gas within eleven abscesses; in any case prevented the air the measure of the abscess size.
Size correlation with CT or MRI was excellent; mean size: 49.6± SD27.08mm on CEUS versus 50.07± SD 27.57mm on CT and MRI,p= 0.707.
The size of the phlegmons ranged between 16 and 70mm.
The interobserver agreement in the diagnosis of phlegmon or abscess was excellent (kappa= 0.953).