Computed tomography findings of bowel wall thickening: its significance and relationship to endoscopic abnormalities

Abstract

INTRODUCTION The aim of this study was to conduct retrospective analysis of abdominopelvic computed tomography (CT) reports, identifying those patients in whom bowel wall thickening (BWT) was observed, and to correlate these reports with subsequent endoscopic evaluation. METHODS Formal reports for all patients undergoing abdominopelvic CT between February 2007 and September 2009 were reviewed. Where patients were identified as having colorectal 'wall thickening', results of subsequent endoscopic evaluations were documented. Only those patients with a report of BWT who had follow-up endoscopy (colonoscopy, sigmoidoscopy) were included in the analysis. RESULTS A total of 165 patients were included. Abnormalities on endoscopy at the exact site of the BWT on CT were found in 95 patients (57.58%); in 36 cases (21.82%) this was a malignant lesion. BWT of the transverse colon was significantly more likely to correspond to an endoscopic finding of cancer than other sites (p=0.034). Rectal bleeding was reported significantly more often in patients with BWT and neoplastic disease on endoscopy compared with those with normal endoscopy (p=0.04). Excluding patients with inflammatory/diverticular lesions, 59.02% of Caucasians had a neoplastic lesion at the site of reported BWT, significantly higher than the other ethnic groups (p=0.008). There were 38 patients (23.03%) who did not present with bowel symptoms and, of these, 6 were diagnosed subsequently with colorectal cancer. CONCLUSIONS This study supports endoscopic evaluation to investigate patients with CT evidence of BWT, especially in cases involving the transverse colon, in Caucasian patients or in association with symptoms of rectal bleeding.

Systematic review and meta-analysis: does colonic mural thickening on CT correlate with endoscopic findings at colonoscopy?

“…There is a significant correlation between a CT finding of MT and a subsequent colonoscopic finding of neoplastic pathology. The association is particularly strong in cases of MT of the transverse colon 5. The association is also strong in white (Caucasian) patients and in those with a history of rectal bleeding 20.…”

“…Only two studies,5 6 with a sample size of 182, reported separate results for cases where colonic MT was on the left side. The results for the two studies were very similar (figure 3), with no evidence of heterogeneity (p=0.694).…”

“…This study, however, reported MT on both abdominopelvic CT (n=58) and CTC (n=36) and concluded that CTC may have higher sensitivity and specificity compared with standard CT. Reported studies in scientific literature also recommend a colonoscopic examination following the diagnosis of MT on CT examinations 15–17. Uzzaman et al 5 in a large study (n=165) found that the correlation between MT and neoplastic lesion was 35.7%, out of which 13.9% were benign (polyps).…”

Significance of ileal and/or cecal wall thickening on abdominal computed tomography in a tropical country

“…The bowel wall thickening could be a manifestation of underlying inflammatory, infectious, ischemic, or neoplastic pathology or may represent normal findings because of technical reasons, such as inadequate distension of the bowel. Previously, the significance of colonic wall thickness was evaluated by various studies, and most of the studies have concluded that patients with colonic wall thickness on CT should undergo colonoscopy and biopsy as a majority of these patients will have an underlying disease . This recommendation of endoscopy has been made because of the increased risk of neoplastic diseases in the colon.…”

Metastatic Infiltrating Ductal Carcinoma of the Breast to the Colon: A Case Report and Literature Review

“…With the new multiphase, multidetector CT scans, the accuracy of assessing mural penetration of metastases into the bowel wall is very high [25, 26]. Ultrasonographic examination has been shown to be a useful imaging modality in several reports.…”