Differentiation of benign and malignant bowel lesions by transabdominal ultrasound using grey-scale and Doppler parameters.

BACKGROUND AND STUDY AIMS: The aim of this study was to assess the ability of transabdominal ultrasonographic morphologic features and Doppler flow parameters in differentiating benign from malignant bowel lesions.

PATIENTS AND

METHODS

Sixty patients with sonographically detected gastrointestinal lesions and 30 control subjects were prospectively enrolled. Bowel wall thickness; length of the affected segment; the wall layering pattern; the resistive index (RI); pulsatility index (PI); flow volume (FV) of the intramural vessels, the superior mesenteric artery (SMA), and the portal vein (PV) were recorded. The final diagnosis was histopathological. Biopsies were obtained endoscopically, ultrasound-guided, or by surgery.

RESULTS

Of the patients, 48 proved to be histopathologically malignant and 12 were benign. Malignant bowel lesions were found to have a higher mean wall thickness (a cutoff value of 12.3mm), more frequent loss of wall layering pattern (88.2% vs. 38.9%), a shorter length of affected segment (11.2 vs. 49.2cm); P=0.001. The RI, PI of the intramural vessels and SMA showed no difference between the inflammatory and malignant groups. Ultrasound-guided biopsy was resorted to in 13 patients (21.7%) and it was diagnostic in all of them.

CONCLUSION

Ultrasonography is helpful in the characterisation of bowel lesions suggesting their benign or malignant nature. Ultrasound-guided biopsy has certain indications. The Doppler parameters of different pathologies are overlapping and thus are of little help in this regard.