Pitfalls in ultrasound imaging of the stomach and the intestines

Abstract

The gastrointestinal tract is an extraordinary human organ in terms of its morphology and function. Its complex structure and enormous length as well as frequent presence of gas discourage many doctors performing ultrasound examination from its exploration. Moreover, there are anatomical structures in multiple locations which can mimic certain abnormalities. It is difficult to present an exhaustive account of the problem of gastrointestinal tract ultrasound imaging errors in a single work; therefore, this study focuses mainly on false positive errors which usually result from a lack of knowledge of anatomical variants of the gastrointestinal tract structure. In the case of the stomach, rugae and muscle layer thickening towards the pylorus have been mentioned, which constitute variants of the structure of this organ examined when empty. Diagnostic pitfalls in the small intestine may include the dudenojejunal flexure (ligament of Treitz), the horizontal part of the duodenum and the ileocaecal valve. The status of the apparent lesions in all of the cases mentioned will be resolved following fluid intake by the patient. In the colon, the varied structure of semilunar folds should be taken note of. Their large thickness can warrant suspicion of wall invasion or a polyp. In addition, the study emphasises the importance of appropriate preparation of a patient for gastrointestinal tract examination since it determines the accuracy of the diagnosis. The authors also take note of common ‘sins’ of physicians such as hasty examination and failure to comply with the stomach and appendix examination protocol.

An integrated ultrasound imaging and abdominal compression device for respiratory motion management in radiation therapy

“…However, accurate delineation of pancreas and stomach in US imaging sometimes is difficult. 19,36 Our study further confirmed the difficulty of direct pancreas/stomach tracking and found that the pancreas and stomach in 12 out of 21 volunteers could not be directly tracked. To investigate the possibility of indirect pancreas/stomach tracking, we examined the motion correlation between liver and pancreas/stomach.…”

“…If the patient's pancreas/stomach tumor is clearly visible, there is no need for using other markers as tracking surrogates. However, accurate delineation of pancreas and stomach in US imaging sometimes is difficult 19,36 . Our study further confirmed the difficulty of direct pancreas/stomach tracking and found that the pancreas and stomach in 12 out of 21 volunteers could not be directly tracked.…”

“…As stated in previous studies, the accurate delineation of pancreas in US imaging often is difficult, 19 and it is also challenging to evaluate stomach motion in US imaging due to stomach peristalsis and presence of gas 36 . Previous 4D CT studies demonstrated the feasibility of using liver as a surrogate for pancreas tumor tracking 37 .…”

“…As stated in previous studies, the accurate delineation of pancreas in US imaging often is difficult, 19 and it is also challenging to evaluate stomach motion in US imaging due to stomach peristalsis and presence of gas. 36 Previous 4D CT studies demonstrated the feasibility of using liver as a surrogate for pancreas tumor tracking. 37 Here, we also examined the possibility of using liver as a surrogate to predict the pancreas/stomach motion on nine selected volunteers by the locations obtained using template matching algorithm.…”

Clinical Study on the Evaluation of the Condition of Patients with Gastric Tumors and the Choice of Surgical Treatment by Gastric Ultrasonic Filling Method

“…However, as an invasive examination, gastroscopy has many problems, such as discomfort, mucosal injury, aspiration, and so on. Relatively speaking, ultrasonography is a convenient, noninvasive, and economical examination method, but due to the interference of gas in the gastrointestinal tract, its application in the diagnosis of gastrointestinal diseases is often limited [ 19 ]. Warren et al [ 20 ] first used hydrophilic methylfibronectin oral suspension to fill the stomach in ultrasonography in 1978.…”