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Prospective evaluation of contrast-enhanced ultrasonography with advanced dynamic flow for the diagnosis of intestinal ischaemia

Department of Gastroenterology, Miyoshi Central Hospital, 531 Higashisakeya, Miyoshi, Hiroshima 728-8502, Japan

Correspondence: Toshihide Hamada, Gastroenterology, Miyoshi Central Hospital, Higashisakeya-cho 531, Miyoshi, Hiroshima 728-8502, Japan. E-mail: jesuisth{at}orange.ocn.ne.jp

This study aims to prospectively evaluate the importance of contrast-enhanced ultrasonography with advanced dynamic flow in the diagnosis of intestinal ischaemia in bowel obstruction. 50 patients admitted for bowel obstruction were included in this study. Of these, 17 patients had intestinal ischaemia (bowel strangulation, nine; superior mesenteric artery thromboembolism, four; non-occlusive mesenteric ischaemia, four), whereas 33 patients had simple obstructions. The definitive diagnosis of intestinal ischaemia was established by surgery. After administration of SHU 508A, the least peristaltic and/or the most dilated segments were imaged by this method. Colour signals depicted in the bowel wall were classified as normal, diminished or absent. The ultrasonographic findings were later correlated with the clinical outcomes and surgical findings. The colour signals were absent in 12 patients (bowel strangulation, six; superior mesenteric artery thromboembolism, four; non-occlusive mesenteric ischaemia, two), were diminished in four patients (bowel strangulation, two; non-occlusive mesenteric ischaemia, two) and were normal in 34 patients (simple obstruction, 33; bowel strangulation, one). Assuming that the diminished and absent colour signals indicate the presence of intestinal ischaemia, the sensitivity, specificity, positive predictive value and negative predictive value of the method were 94.1%, 100%, 100% and 97.1%, respectively. Our preliminary experience suggests that contrast-enhanced ultrasonography with advanced dynamic flow is a highly sensitive method for the diagnosis of intestinal ischaemia in patients with bowel obstruction.