Bowel wall thickening: Differentiation of inflammation from ischemia with color Doppler and duplex US

PURPOSE: To determine whether ultrasonography (US) can be used to differentiate inflammatory from ischemic bowel wall thickening. MATERIALS AND METHODS: Thirty-five patients (aged 23-96 years) with inflammatory or ischemic bowel wall thickening underwent US. Thickness was recorded, echotexture categorized, color Doppler flow graded, presence of intramural arterial signal recorded, and resistive index calculated. RESULTS: The difference between inflammatory and ischemic bowel wall thicknesses was not significant (P = .49). Differences in color Doppler flow (P < .0001), arterial signal (P = .0005), and bowel wall echotexture (P ≤ .0200) between patients with inflammatory and ischemic bowel wall thickening were significant. Absence of or barely visible color Doppler flow and absence of arterial signal suggested ischemia; readily visible color Doppler flow and a stratified echotexture suggested inflammation. A resistive index less than 0.60 indicated inflammation. The difference in resistive index between the two groups was not significant (P = .12). CONCLUSION: Duplex and color Doppler flow US are helpful in differentiation between ischemic and inflammatory bowel wall thickening.