Imaging diagnosis of cryptogenic multifocal ulcerous stenosing enteritis.

Abstract

Objective: This study aimed to summarize the intestinal ultrasound (IUS) and computed tomography enterography (CTE) features of cryptogenic multifocal ulcerous stenosing enteritis (CMUSE) and compare the performance of IUS and CTE in the evaluation of CMUSE in a single tertiary center.

Methods: Clinically or pathologically confirmed CMUSE patients between December 2009 and April 2023 were recruited. Imaging features of CMUSE patients who underwent both IUS and CTE were summarized retrospectively.

Results: Twenty-nine patients were included. All patients were found to have ileum involvement, with the majority (96.6%, 28/29) showing superficial ulcers and stenosis at endoscopy. Nineteen patients who underwent both IUS and CTE during the same period were identified for image review. Intestinal lesions were present in 19 patients (100%) both on IUS and CTE. IUS features of CMUSE included minimal to moderate thickened small bowel wall with over half of the patients presenting with hypoechogenicity and vague stratification, over one-third of patients exhibiting proximal bowel dilation and increased bowel wall vascularity in most patients; on CTE, it presented as slight to moderate thickened bowel wall with mural enhancement, multiple short circumferential strictures and mild proximal bowel dilation in most patients. There was no statistically significant difference between IUS and CTE in detecting lesions (19/19 vs. 19/19), bowel wall thickening, bowel strictures (p = 0.727), and bowel wall vascularity (p = 0.375).

Conclusion: IUS features of CMUSE were comparable with CTE in detecting lesions, bowel wall thickening, strictures and bowel wall vascularity, suggesting that IUS could serve as a radiation-free imaging modality for the diagnosis and surveillance of CMUSE.

Critical relevance statement: This pathology is relevant for gastroenterologists, radiologists, and the medical community, as well as for patients with small bowel disorders. Intestinal ultrasound could be of value and serve as a radiation-free imaging modality in assessing cryptogenic multifocal ulcerous stenosing enteritis (CMUSE).

Key points: More data are needed to characterize the intestinal ultrasound (IUS) findings of cryptogenic multifocal ulcerating stenosing enteritis (CMUSE). IUS features of CMUSE manifested as thickened bowel wall, with more than half of the patients presenting with hypoechogenicity with vague stratification. Computed tomography enterography (CTE) features of CMUSE included bowel wall thickening with mural enhancement, multiple short circumferential strictures, and mild small intestine dilation. IUS and CTE were comparable in detecting lesions, bowel wall thickening, bowel strictures, and bowel wall vascularity.