Aktueller Stand der Sonografie in der Gastroenterologie - Darm und oberer Gastrointestinaltrakt Teil 2

Zusammenfassung

Die Sonografie hat sich in der Diagnostik von Erkrankungen des Gastrointestinaltraktes (GIT) neben Endoskopie und radiologischer Bildgebung durchgesetzt. Besprochen wurde bereits der Einsatz in der Notfalldiagnostik (akute Appendizitis, Divertikulitis/Peridivertikulitis, Ileus, Invagination und Perforation) (vgl. Teil 1 [1]). Dem Umfang der Thematik geschuldet, bleibt es dieser Übersicht vorbehalten, den aktuellen Stand der Sonografie bei den chronisch entzündlichen Darmerkrankungen (CED), seltenen Darmentzündungen (u. a. bakterielle, pseudomembranöse, neutropene Kolitis, Darmtuberkulose), ischämischen Darmkrankheiten sowie bei Erkrankungen des oberen Gastrointestinaltraktes (Magen) darzustellen. Bei der CED sind wichtige Zusatzinformationen für Ausdehnung, Aktivität, Komplikationen (Fistel, Abszess, Stenose) und Differenzialdiagnose zu erhalten. Der Wert liegt insbesondere in der Verlaufskontrolle und ggf. „Einsparung” endoskopischer Untersuchungen. Die Bedeutung der Farb-Doppler-Sonografie zur Aktivitätsbeurteilung und Differenzierung von Stenosen wird diskutiert. Die Sonografie dient darüber hinaus als Steuermethode bei therapeutischen Interventionen zur Behandlung von Abszessen (Punktion und Drainage). Ischämische Darmerkrankungen sind mittels der Farb-Doppler- und Duplexsonografie zu diagnostizieren und ebenfalls differenzialsonografisch abzugrenzen. Der Sonografie kommt eine größere Bedeutung in der Bewertung und Verlaufsbeurteilung der chronischen Darmischämien zu. Am Magen sind Wandveränderungen und Passagestörungen auch der Sonografie zugängig. Tumoren und Ulzera und deren Komplikationen (Perforation, Penetration) sind unter günstigen Bedingungen darstellbar, ein Ausschluss ist jedoch nicht möglich.

Abstract

Ultrasound has gained acceptance in the diagnosis of diseases of the gastrointestinal tract beside the classical methods such as endoscopy and X-ray. In a previous publication we discussed the use of ultrasound in emergency diagnostics (e. g., acute appendicitis, diverticulitis/peridiverticulitis, ileus, invagination and perforation) (part 1). Because of the vast extent of this topic, in this overview we will focus on the current role of ultrasound in the detection and assessment of chronic inflammatory bowel diseases, rare forms of colitis (e. g., bacterial, pseudomembranous and neutropenic colitis as well as intestinal tuberculosis), ischaemic bowel diseases as well as diseases of the upper gastrointestinal tract. In chronic inflammatory bowel diseases, ultrasound can give important additional information such as extension, activity, complication (fistula, abscess, stenosis) and in differential diagnosis. It plays an important role in follow-up investigations and can possibly reduce the number of endoscopic examinations. There is still some debate going on about the significance of colour Doppler ultrasound in assessing the activity and differentiation of stenosis. Furthermore, ultrasound is used as a method to guide interventional therapies for abscesses (puncture and drainage). Colour Doppler ultrasound can diagnose ischaemic bowel diseases and also differentiate these from other aetiologies. Ultrasound plays a greater role in the follow-up and assessment of chronic intestinal ischaemia. In the diagnosis of stomach diseases under favourable conditions ultrasound can show changes of the stomach wall, tumours, ulcers and their complication (perforation, penetration) and disturbances of the motility. But an exlusion is not possible.

Schlüsselwörter

Darmsonografie - CED - ischämische Kolitis - Magensonografie - Ulkuskomplikationen

Key words

Ultrasound of bowel - CID - ischaemic colitis - sonography of stomach - ulcus complications

Literatur

• 1 Borner N, Clement T, Behringer U. et al . Die Farbduplexsonographie zur Aktivitätsbeurteilung chronisch entzündlicher Darmerkrankungen.  Z Gastroenterol. 1998;  36 725
• 2 Khaw K T, Yeoman L J, Saverymuttu S H. et al . Ultrasonic patterns in inflammatory bowel disease.  Clin Radiol. 1991;  43 (3) 171-175
• 3 Schwerk W B, Beckh K H, Raith M. A prospective evaluation of high resolution sonography in the diagnosis of inflammatory bowel disease.  Europ J Gastroenterol Hepatol. 1992;  4 173-182
• 4 Balthazar E J, Gordon R, Hulnick D. Ileocecal tuberculosis: CT and radiologic evaluation.  AJR Am J Roentgenol. 1990;  154 (3) 499-503
• 5 Bozkurt T, Butsch B, Schmiegelow P. et al . Ultrasound imaging of mesenchymal small intestine tumors in diagnosis of unexplained gastrointestinal hemorrhage.  Ultraschall in Med. 1993;  14 (6) 264-268
• 6 Dietrich C F, Jacobi V, Schulte-Bockholt A. et al . Atypische Mykobacteriose des Darmes - Ultraschall als wegweisender Befund.  Ultraschall in Med. 1996;  17 58
• 7 Downey D B, Wilson S R. Pseudomembranous colitis: sonographic features.  Radiology. 1991;  180 (1) 61-64
• 8 Mathis G, Metzler J. Sonography in salmonella enterocolitis.  Ultraschall in Med. 1992;  13 (3) 106-109
• 9 Oei T K, Engelshoven J M. Pseudomembranous colitis: an ultrasound diagnosis.  Eur J Radiol. 1992;  15 (2) 154-156
• 10 Ros P R, Buetow P C, Pantograg-Brown van L. et al . Pseudomembranous colitis.  Radiology. 1996;  198 (1) 1-9
• 11 Seelen J L, Puylaert J B. Bacterial ileocecitis: a „new” disease.  Ultraschall in Med. 1991;  12 (6) 269-271
• 12 Wehrman T, Lembcke B. Antibiotika-assoziierte Durchfälle.  Z Gastroenterol. 1996;  33 35-40
• 13 Schlottmann K. Sonography as a tool for follow-up and complication management after endoscopic or percutaneous drainage implantation.  Z Gastroenterol. 2005;  43 (2) 147-148
• 14 Erdozain J C, Herrera A, Molina E. et al . Usefulness of abdominal echography in the diagnosis of active Crohn’s disease.  Gastroenterol Hepatol. 1998;  21 (6) 272-276
• 15 Esteban J M, Maldonado L, Sanchiz V. et al . Activity of Crohn’s disease assessed by colour Doppler ultrasound analysis of the affected loops.  Eur Radiol. 2001;  11 (8) 1423-1428
• 16 Futagami Y, Haruma K, Hata J. et al . Development and validation of an ultrasonographic activity index of Crohn’s disease.  Eur J Gastroenterol Hepatol. 1999;  11 (9) 1007-1012
• 17 Haber H P, Busch A, Ziebach R. et al . Ultrasonographic findings correspond to clinical, endoscopic, and histologic findings in inflammatory bowel disease and other enterocolitides.  J Ultrasound Med. 2002;  21 (4) 375-382
• 18 Hata J, Haruma K, Yamanaka H. et al . Ultrasonographic evaluation of the bowel wall in inflammatory bowel disease: comparison of in vivo and in vitro studies.  Abdom Imaging. 1994;  19 (5) 395-399
• 19 Heyne R, Rickes S, Bock P. et al . Non-invasive evaluation of activity in inflammatory bowel disease by power Doppler sonography.  Z Gastroenterol. 2002;  40 (3) 171-175
• 20 Limberg B. Diagnosis of chronic inflammatory bowel disease by ultrasonography.  Z Gastroenterol. 1999;  37 (6) 495-508
• 21 Maconi G, Parente F, Bollani S. et al . Abdominal ultrasound in the assessment of extent and activity of Crohn’s disease: clinical significance and implication of bowel wall thickening.  Am J Gastroenterol. 1996;  91 (8) 1604-1609
• 22 Mayer D, Reinshagen M, Mason R A. et al . Sonographic measurement of thickened bowel wall segments as a quantitative parameter for activity in inflammatory bowel disease.  Z Gastroenterol. 2000;  38 (4) 295-300
• 23 Neye H, Voderholzer W, Rickes S. et al . Evaluation of criteria for the activity of Crohn’s disease by power Doppler sonography.  Dig Dis. 2004;  22 (1) 67-72
• 24 Scholbach T, Herrero I, Scholbach J. Dynamic color Doppler sonography of intestinal wall in patients with Crohn disease compared with healthy subjects.  J Pediatr Gastroenterol Nutr. 2004;  39 (5) 524-528
• 25 Maconi G, Di S A, Ardizzone S. et al . Prevalence and clinical significance of sonographic detection of enlarged regional lymph nodes in Crohn’s disease.  Scand J Gastroenterol. 2005;  40 (11) 1328-1333
• 26 Maconi G, Sampietro G M, Parente F. et al . Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn’s disease: a prospective comparative study.  Am J Gastroenterol. 2003;  98 (7) 1545-1555
• 27 Fraquelli M, Colli A, Casazza G. et al . Role of US in detection of Crohn disease: meta-analysis.  Radiology. 2005;  236 (1) 95-101
• 28 Parente F, Maconi G, Bollani S. et al . Bowel ultrasound in assessment of Crohn’s disease and detection of related small bowel strictures: a prospective comparative study versus × ray and intraoperative findings.  Gut. 2002;  50 (4) 490-495
• 29 Pascu M, Roznowski A B, Muller H P. et al . Clinical relevance of transabdominal ultrasonography and magnetic resonance imaging in patients with inflammatory bowel disease of the terminal ileum and large bowel.  Inflamm Bowel Dis. 2004;  10 (4) 373-382
• 30 Borthne A S, Abdelnoor M, Rugtveit J. et al . Bowel magnetic resonance imaging of pediatric patients with oral mannitol MRI compared to endoscopy and intestinal ultrasound.  Eur Radiol. 2006;  16 (1) 207-214
• 31 Bremner A R, Griffiths M, Argent J D. et al . Sonographic evaluation of inflammatory bowel disease: a prospective, blinded, comparative study.  Pediatr Radiol. 2006;  36 (9) 947-953
• 32 Potthast S, Rieber A, Von Tirpitz C. et al . Ultrasound and magnetic resonance imaging in Crohn’s disease: a comparison.  Eur Radiol. 2002;  12 (6) 1416-1422
• 33 Albert J, Scheidt T, Basler B. et al . Magnetic Resonance Imaging in diagnosis and follow-up of Crohn’s Disease - Is conventional enteroclysis still necessary?.  Z Gastroenterol. 2002;  40 (9) 789-794
• 34 Hata J, Haruma K, Suenaga K. et al . Ultrasonographic assessment of inflammatory bowel disease.  Am J Gastroenterol. 1992;  87 (4) 443-447
• 35 Hollerbach S, Geissler A, Schiegl H. et al . The accuracy of abdominal ultrasound in the assessment of bowel disorders.  Scand J Gastroenterol. 1998;  33 (11) 1201-1208
• 36 Limberg B, Osswald B. Diagnosis and differential diagnosis of ulcerative colitis and Crohn’s disease by hydrocolonic sonography.  Am J Gastroenterol. 1994;  89 (7) 1051-1057
• 37 Maconi G, Carsana L, Fociani P. et al . Small bowel stenosis in Crohn’s disease: clinical, biochemical and ultrasonographic evaluation of histological features.  Aliment Pharmacol Ther. 2003;  18 (7) 749-756
• 38 Hirche T O, Russler J, Schroder O. et al . The value of routinely performed ultrasonography in patients with Crohn disease.  Scand J Gastroenterol. 2002;  37 (10) 1178-1183
• 39 Spalinger J, Patriquin H, Miron M C. et al . Doppler US in patients with crohn disease: vessel density in the diseased bowel reflects disease activity.  Radiology. 2000;  217 (3) 787-791
• 40 Yekeler E, Danalioglu A, Movasseghi B. et al . Crohn disease activity evaluated by Doppler ultrasonography of the superior mesenteric artery and the affected small-bowel segments.  J Ultrasound Med. 2005;  24 (1) 59-65
• 41 Parente F, Greco S, Molteni M. et al . Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn’s disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy.  Gut. 2004;  53 (11) 1652-1657
• 42 Kratzer W, Schmidt S A, Mittrach C. et al . Contrast-enhanced wideband harmonic imaging ultrasound (SonoVue): a new technique for quantifying bowel wall vascularity in Crohn’s disease.  Scand J Gastroenterol. 2005;  40 (8) 985-991
• 43 Rapaccini G L, Pompili M, Orefice R. et al . Contrast-enhanced power doppler of the intestinal wall in the evaluation of patients with Crohn disease.  Scand J Gastroenterol. 2004;  39 (2) 188-194
• 44 Robotti D, Cammarota T, Debani P. et al . Activity of Crohn disease: value of Color-Power-Doppler and contrast-enhanced ultrasonography.  Abdom Imaging. 2004;  29 (6) 648-652
• 45 Schlottmann K, Kratzer W, Scholmerich J. Doppler ultrasound and intravenous contrast agents in gastrointestinal tract disorders: current role and future implications.  Eur J Gastroenterol Hepatol. 2005;  17 (3) 263-275
• 46 Byrne M F, Murray F E, Lee M J. Use of Doppler ultrasound of the SMA for Crohn’s disease activity evaluation in clinical practice.  Clin Radiol. 2002;  57 (6) 537
• 47 Maconi G, Radice E, Greco S. et al . Bowel ultrasound in Crohn’s disease.  Best Pract Res Clin Gastroenterol. 2006;  20 (1) 93-112
• 48 Bolondi L, Gaiani S, Brignola C. et al . Changes in splanchnic hemodynamics in inflammatory bowel disease. Non-invasive assessment by Doppler ultrasound flowmetry.  Scand J Gastroenterol. 1992;  27 (6) 501-507
• 49 Maconi G, Parente F, Bollani S. et al . Factors affecting splanchnic haemodynamics in Crohn’s disease: a prospective controlled study using Doppler ultrasound.  Gut. 1998;  43 (5) 645-650
• 50 Sigirci A, Baysal T, Kutlu R. et al . Doppler sonography of the inferior and superior mesenteric arteries in ulcerative colitis.  J Clin Ultrasound. 2001;  29 (3) 130-139
• 51 Giovagnorio F, Picarelli A, GF. et al . Evaluation with Doppler sonography of mesenteric blood flow in celiac disease.  AJR Am J Roentgenol. 1998;  171 (3) 629-632
• 52 Lee C C, Su C P, Chen S Y. et al . Mesenteric adenitis caused by Salmonella enterica serovar Enteritidis.  J Formos Med Assoc. 2004;  103 (6) 463-466
• 53 Puylaert J B, Van der Zant F M, Mutsaers J A. Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings.  Eur Radiol. 1997;  7 (1) 3-9
• 54 Dietrich C F, Zeuzem S, Caspary W F. et al . Ultrasound lymph node imaging in the abdomen and retroperitoneum of healthy probands.  Ultraschall in Med. 1998;  19 (6) 265-269
• 55 Puylaert J B, Van der Zant F M. Mesenteric lymphadenitis or appendicitis?.  AJR Am J Roentgenol. 1995;  165 (2) 490
• 56 Dietrich C F, Brunner V, Lembcke B. Intestinal ultrasound in rare small and large intestinal diseases.  Z Gastroenterol. 1998;  36 (11) 955-970
• 57 Dietrich C F, Lembcke B, Seifert H. et al . Ultrasound diagnosis of penicillin-induced segmental hemorrhagic colitis.  Dtsch Med Wochenschr. 2000;  125 (24) 755-760
• 58 Dietrich C F, Hermann S, Klein S. et al . Sonographic signs of neutropenic enterocolitis.  World J Gastroenterol. 2006;  12 (9) 1397-1402
• 59 Dietrich C F, Brunner V, Seifert H. et al . Intestinal B-mode sonography in patients with endemic sprue. Intestinal sonography in endemic sprue.  Ultraschall in Med. 1999;  20 (6) 242-247
• 60 Nuernberg D, Ignee A, Dietrich C F. Aktueller Stand der Sonographie in der Gastroenterologie - Darm und oberer Gastrointestinaltrakt Teil 1.  Z Gastroenterol. 2007;  45 (9) 1-12
• 61 Bargon J, Stein J, Dietrich C F. et al . Gastrointestinal complications of adult patients with cystic fibrosis.  Z Gastroenterol. 1999;  37 (8) 739-749
• 62 Dietrich C F, Chichakli M, Hirche T O. et al . Sonographic findings of the hepatobiliary-pancreatic system in adult patients with cystic fibrosis.  J Ultrasound Med. 2002;  21 (4) 409-416
• 63 Pohl M, Krackhardt B, Posselt H G. et al . Ultrasound studies of the intestinal wall in patients with cystic fibrosis.  J Pediatr Gastroenterol Nutr. 1997;  25 (3) 317-320
• 64 Whitby E H, Peck R J. Case report: ultrasound of primary generalised AL amyloid of the small bowel.  Clin Radiol. 1996;  51 (6) 447-448
• 65 Hollerweger A, Macheiner P, Dirks K. et al . Differential diagnosis of severe hypoechoic oedema of the small bowe.  Ultraschall in Med. 2006;  27 (3) 234-239
• 66 Hollerweger A, Dietrich C F. „White bowel”. A sonographic sign of intestinal lymph edema?.  Ultraschall in Med. 2005;  26 (2) 127-133
• 67 English W P, Pearce J D, Craven T E. et al . Chronic visceral ischemia: symptom-free survival after open surgical repair.  Vasc Endovascular Surg. 2004;  38 (6) 493-503
• 68 Klein S A, Martin H, Schreiber-Dietrich D. et al . A new approach to evaluating intestinal acute graft-versus-host disease by transabdominal sonography and colour Doppler imaging.  Br J Haematol. 2001;  115 (4) 929-934
• 69 Izbicki J R, Schneider C G, Kastl S. Partial ischemia. Occlusive and nonocclusive mesenteric ischemia, ischemic colitis, systemic lupus erythematosus.  Chirurg. 2003;  74 (5) 413-418
• 70 Lock G, Scholmerich J. Non-occlusive mesenteric ischemia.  Hepatogastroenterology. 1995;  42 (3) 234-239
• 71 Trompeter M, Brazda T, Remy C T. et al . Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy.  Eur Radiol. 2002;  12 (5) 1179-1187
• 72 Roobottom C A, Dubbins P A. Significant disease of the celiac and superior mesenteric arteries in asymptomatic patients: predictive value of Doppler sonography.  AJR Am J Roentgenol. 1993;  161 (5) 985-988
• 73 Perko M J, Just S, Schroeder T V. Importance of diastolic velocities in the detection of celiac and mesenteric artery disease by duplex ultrasound.  J Vasc Surg. 1997;  26 (2) 288-293
• 74 Moneta G L, Yeager R A, Dalman R. et al . Duplex ultrasound criteria for diagnosis of splanchnic artery stenosis or occlusion.  J Vasc Surg. 1991;  14 (4) 511-518
• 75 Teefey S A, Roarke M C, Brink J A. et al . Bowel wall thickening: differentiation of inflammation from ischemia with color Doppler and duplex US.  Radiology. 1996;  198 (2) 547-551
• 76 Drelich-Zbroja A, Jargiello T, Szymanska A. et al . The diagnostic value of levovist in Doppler imaging of visceral arteries in patients with abdominal angina before and after angioplasty.  Eur J Ultrasound. 2003;  16 (3) 225-235
• 77 Sabba C, Ferraioli G, Sarin S K. et al . Feasibility spectrum for Doppler flowmetry of splanchnic vessels in normal and cirrhotic populations.  J Ultrasound Med. 1990;  9 (12) 705-710
• 78 Dietrich C F, Ignee A, Seitz K H. et al . Duplex sonography of visceral arteries.  Ultraschall in Med. 2001;  22 (6) 247-257
• 79 Desmond C P, Roberts S K. Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome.  Scand J Gastroenterol. 2004;  39 (12) 1310-1313
• 80 Holland A J, Ibach E G. Long-term review of coeliac axis compression syndrome.  Ann R Coll Surg Engl. 1996;  78 (5) 470-472
• 81 Moldovan C, Dumitrascu D L, Demian L. et al . Gastroparesis in diabetes mellitus: an ultrasonographic study.  Rom J Gastroenterol. 2005;  14 (1) 19-22
• 82 Sogabe M, Okahisa T, Tsujigami K. et al . Ultrasonographic assessment of gastric motility in diabetic gastroparesis before and after attaining glycemic control.  J Gastroenterol. 2005;  40 (6) 583-590
• 83 Ripolles T, Garcia-Aguayo J, Martinez M J. et al . Gastrointestinal bezoars: sonographic and CT characteristics.  AJR Am J Roentgenol. 2001;  177 (1) 65-69
• 84 Ishigami S, Yoshinaka H, Sakamoto F. et al . Preoperative assessment of the depth of early gastric cancer invasion by transabdominal ultrasound sonography (TUS): a comparison with endoscopic ultrasound sonography (EUS).  Hepatogastroenterology. 2004;  51 (58) 1202-1205
• 85 Kuntz C, Dux M, Pollock A. et al . Hydrosonography as an alternative or supplement to endosonography in stomach carcinoma.  Chirurg. 1998;  69 (4) 438-442
• 86 Darnell A, Dalmau E, Pericay C. et al . Gastrointestinal stromal tumors.  Abdom Imaging. 2006;  31 (4) 387-399
• 87 Giacobbe A, Facciorusso D. Transabdominal US-guided FNAB in the diagnosis of gastric GIST.  Recenti Prog Med. 2004;  95 (5) 254-256
• 88 Arroyo A, Traipe E, Manquez P. Ultrasonographic images of gastroduodenal ulcer.  Rev Med Chil. 1994;  122 (8) 913-920
• 89 Chang Y S, Wang H P, Huang G T. et al . Sonographic „gastric corona sign”: diagnosis of gastric pneumatosis caused by a penetrating gastric ulcer.  J Clin Ultrasound. 1999;  27 (7) 409-412
• 90 Coulier B, Maldague P, Broze B. Gastric ulcer penetrating the anterior abdominal wall: ultrasound diagnosis.  Abdom Imaging. 2003;  28 (2) 248-251
• 91 Minardos I, Ziogana D, Hristopoulos H. et al . Peptic ulcer perforation: sonographic imaging of active fluid leakage.  J Clin Ultrasound. 2006;  34 (1) 38-41
• 92 Wallstabe L, Veitt R, Korner T. Diagnosis of perforated gastric ulcers by ultrasound.  Z Gastroenterol. 2002;  40 (10) 877-880
• 93 Haider N, Spicer R, Grier D. Ultrasound diagnosis of infantile hypertrophic pyloric stenosis: determinants of pyloric length and the effect of prematurity.  Clin Radiol. 2002;  57 (2) 136-139
• 94 Dixit R, Chowdhury V, Kumar N. Hydrocolonic sonography in the evaluation of colonic lesions.  Abdom Imaging. 1999;  24 (5) 497-505
• 95 Dux M, Richter G M, Roeren T. et al . Gastrointestinal imaging with hydrosonography and hydro-CT.  Fortschr Röntgenstr. 1996;  164 (5) 359-367
• 96 Limberg B. Diagnosis and staging of colonic tumors by conventional abdominal sonography as compared with hydrocolonic sonography.  N Engl J Med. 1992;  327 (2) 65-69
• 97 Limberg B. Hydrocolonic sonography - potentials and limitations of ultrasonographic diagnosis of colon diseases.  Z Gastroenterol. 2001;  39 (12) 1007-1015
• 98 Magnano G, Granata C, Barabino A. et al . Polyethylene glycol and contrast-enhanced MRI of Crohn’s disease in children: preliminary experience.  Pediatr Radiol. 2003;  33 (6) 385-391
• 99 Parente F, Greco S, Molteni M. et al . Oral contrast enhanced bowel ultrasonography in the assessment of small intestine Crohn’s disease. A prospective comparison with conventional ultrasound, x ray studies, and ileocolonoscopy.  Gut. 2004;  53 (11) 1652-1657
• 100 Caprioli F, Losco A, Vigano C. et al . Computer-assisted evaluation of perianal fistula activity by means of anal ultrasound in patients with Crohn’s disease.  Am J Gastroenterol. 2006;  101 (7) 1551-1558
• 101 Giovannini M, Ardizzone S. Anorectal ultrasound for neoplastic and inflammatory lesions.  Best Pract Res Clin Gastroenterol. 2006;  20 (1) 113-135
• 102 Roche B, Deleaval J, Fransioli A. et al . Comparison of transanal and external perineal ultrasonography.  Eur Radiol. 2001;  11 (7) 1165-1170
• 103 Stiatti A, Martinuzzi A, Bartolini M. et al . Ultrasonography in the diagnosis of chronic inflammatory intestinal disease.  Radiol Med (Torino). 1990;  80 (3) 301-303
• 104 Sheridan M B, Nicholson D A, Martin D F. Transabdominal ultrasonography as the primary investigation in patients with suspected Crohn’s disease or recurrence: a prospective study.  Clin Radiol. 1993;  48 (6) 402-404
• 105 Brignola C, Belloli C, Iannone P. et al . Comparison of scintigraphy with indium-111 leukocyte scan and ultrasonography in assessment of X-ray-demonstrated lesions of Crohn’s disease.  Dig Dis Sci. 1993;  38 (3) 433-437
• 106 Solvig J, Ekberg O, Lindgren S. et al . Ultrasound examination of the small bowel: comparison with enteroclysis in patients with Crohn disease.  Abdom Imaging. 1995;  20 (4) 323-326
• 107 Andreoli A, Cerro P, Falasco G. et al . Role of ultrasonography in the diagnosis of postsurgical recurrence of Crohn’s disease.  Am J Gastroenterol. 1998;  93 (7) 1117-1121
• 108 Miao Y M, Koh D M, Amin Z. et al . Ultrasound and magnetic resonance imaging assessmentof active bowel segments in Crohn’s disease.  Clin Radiol. 2002;  57 (10) 913-918
• 109 Schmidt T, Reinshagen M, Brambs H J. et al . Comparison of conventional enteroclysis, intestinal ultrasound and MRI-enteroclysis for determining changes in the small intestine and complications in patients with Crohn’s disease.  Z Gastroenterol. 2003;  41 (7) 641-648
• 110 Maconi G, Sampietro G M, Parente F. et al . Contrast radiology, computed tomography and ultrasonography in detecting internal fistulas and intra-abdominal abscesses in Crohn’s disease: a prospective comparative study.  Am J Gastroenterol. 2003;  98 (7) 1545-1555
• 111 Rispo A, Imbriaco M, Celentano L. et al . Noninvasive diagnosis of small bowel Crohn’s disease: combined use of bowel sonography and Tc-99m-HMPAO leukocyte scintigraphy.  Inflamm Bowel Dis. 2005;  11 (4) 376-382
• 112 Gentile A T, Moneta G L, Lee R W. et al . Usefulness of fasting and postprandial duplex ultrasound examinations for predicting high-grade superior mesenteric artery stenosis.  Am J Surg. 1995;  169 (5) 476-479
• 113 Harward T R, Smith S, Seeger J M. Detection of celiac axis and superior mesenteric artery occlusive disease with use of abdominal duplex scanning.  J Vasc Surg. 1993;  17 (4) 738-745