Multiparametric ultrasound in the diagnosis and follow-up of diverticulitis

Congress:

ECR 2020

Poster Number:

C-12481

Type:

Educational Exhibit

Keywords:

GI Tract, Abdomen, Colon, Gastrointestinal tract, Ultrasound, Ultrasound-Colour Doppler, Contrast agent-intravenous, Diagnostic procedure, Radiation safety, Abscess, Diverticula, Inflammation, Not applicable

Authors:

A. M. Bozzato¹, P. Martingano¹, C. Marrocchio¹, J. De Groodt¹, G. Poillucci², M. F. Cavallaro³, M. A. Cova¹; ¹Trieste/IT, ²Trieste, Italia/IT, ³Trieste (TS)/IT

DOI:

10.26044/ecr2020/C-12481

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-12481

Fig. 2: 61-year-old woman with diverticulitis. (A): Gray scale US image using a linear...

Fig. 4: (A): Axial contrast-enhanced CT scan of a 60-year-old patient with acute...

Fig. 6: (A): Axial contrast-enhanced CT scan of a 31-year-old man with acute...

Learning objectives

To illustrate the imaging findings of multiparametric ultrasound (MPUS), which includes gray-scale US, color Doppler and contrast agent–enhanced US (CEUS), in uncomplicated and complicated diverticulitis.

Background

Acute diverticulitis is a clinically evident macroscopic inflammation of a diverticulum. Admission rates for acute diverticulitis are increasing, particularly in those under 40 years of age, and 15% of patients will develop complications, including phlegmon, abscess, bowel obstruction or fistula formation. If imaging is required, computed tomography is the modality of choice; nevertheless, MPUS has high sensitivity and specificity (77-98% and 80-99% respectively) for the diagnosis of diverticulitis, with the additional advantages of wide availability, no ionizing radiation exposure and low costs [1,2,3].

Findings and procedure details

Gray-scale US On US images, the normal bowel has a mural thickness measuring up to 3-5 mm and a stratified morphology of five concentric rings, called gut signature. Each of the rings corresponds to a different layer: the innermost one appears as an echogenic line, representing the interface between the lumen and the mucosa, followed by an adjacent hypoechoic ring (muscularis mucosa), an echogenic ring (submucosa), a hypoechoic ring (muscularis propria), and an outermost echogenic ring (serosa) (Fig.1) [4,5]. During the exam, the wall thickness...

Conclusion

MPUShas emerged as a safe, non-invasive, low-cost modality for the management of diverticulitis and its complications (obstruction, fistula, abscess and phlegmon). The knowledge of the ultrasonographic patterns of acute uncomplicated and complicated diverticulitis allows an effective management of the disease using an accessible and radiation-free technique.

Personal information and conflict of interest

A. M. Bozzato; Trieste/IT - nothing to disclose P. Martingano; Trieste/IT - nothing to disclose C. Marrocchio; Trieste/IT - nothing to disclose J. de Groodt; Trieste/IT - nothing to disclose G. Poillucci; Trieste, ITALIA/IT - nothing to disclose M. F. Cavallaro; Trieste (TS)/IT - nothing to disclose M. A. A. Cova; Trieste/IT - nothing to disclose

References

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