Radiological evaluation of wall thickness of terminal ileum detected on ct in the patients presenting to emergency service

Radiological evaluation of wall thickness of terminal ileum detected on CT in the patients presenting to emergency serviceObjective: The present study aimed at comparing clinical and/or pathological results with imaging studies of the patients presenting to emergency service with right lower quadrant pain and in whom thickening of wall of terminal ileum was detec-ted on computerized tomography (CT).Materials and Methods: In the present study, the patients who presented to emergency service with acute right lower quadrant pain between December 2008 and August 2011 and in whom wall thickening of terminal ileum was detected on CT scanning extracted from image archiving and communicating system (PACS) of Ra-diology Department of Dokuz Eylul University were reviewed retrospectively. After obtaining information from medical files of the patients, a total of 84 patients above 18 years old were found with pathological diagnosis made through operative or colo-noscopy findings or for whom definitive diagnosis was made following clinical obser-vation or long-term follow-up. All images were evaluated independently by 2 radio-logy residents who were in their last training-year and at the same level of expertise, and who didn?t know clinical and pathological results of the patients.For all patients length and symmetry of thickening of wall of terminal ileum, in-volvement of other intestinal segments, mural enhancement and presence of target sign, inflammatory findings on the surrounding mesenteric fatty tissue and presence of fluid in the abdominal cavity, mass lesion in any intestinal segment, presence of ileo-cecal diverticulitis and abscess, and presence of gynecological pathology in fe-male patients were evaluated. Additionally amount of wall thickness of terminal ileum, number of local lymph nodes involved and biggest diameter of the local lymph nodes were evaluated radiologically. Finally, radiological diagnosis was made considering the available findings. Data from two independent observers (wall thickness of the terminal ileum, number of local lymph nodes and size of the biggest lymph node) we-re averaged. Scalar data and radiological diagnosis were re-considered to make a consensus.Results: Clinical/pathological diagnoses of 84 patients included in the present study were acute appendicitis in 25 patients (29,8%), non-specific ileitis in 32 (38,1%) and Crohn?s disease (CD) in 27 (32,1%). Sensitivity and specificity rates and positive predictive value and negative predictive value of MDCT were 92%, 94%, 100%, and 96% respectively for acute appendicitis; 53%, 90%, 77%, and 75% respectively for non-specific ileitis; and 77%, 73%, 58% and 87% respectively for CD. Of the measu-rable data, wall thickness of terminal ileum, number of the local lymph nodes and the biggest diameter of the local lymph nodes were found to be significantly different among all three groups, between the acute appendicitis and CD groups and particu-larly between the non-specific ileitis and CD groups.Conclusion: In the present study, reactive thickening due to acute appendicitis could be diagnosed with a high level of accuracy in the patients presenting to emer-gency service with right lower quadrant pain and in whom thickening of wall of termi-nal ileum was detected on CT. Amount of thickening, number and diameter of the lymph nodes involved had potential to be accurate measurements in distinguishing non-specific ileitis from Crohn?s disease. Prospectively planned, wide case-series, however, are needed to support this conclusion.Key words: Wall thickening on the terminal ileum, acute appendicitis, non-specific ileitis, Crohn?s disease.