Aktueller Stand der Sonografie in der Gastroenterologie - Darm und oberer Gastrointestinaltrakt - Teil 1

Zusammenfassung

Die Sonografie hat sich in der Diagnostik von Erkrankungen des Gastrointestinaltraktes (GIT) einen zunehmend wichtigeren Platz erobert. Sie beurteilt nicht nur Lumen, sondern auch Wand (inklusive deren Schichtung) und die Umgebung von Magen und Darm. Darüber hinaus sind funktionelle Abläufe (Peristaltik, Durchblutung) darzustellen und geben insbesondere wertvolle Hinweise zur Passage und Vaskularisation. Mit der hochauflösenden (Kompressions-)Sonografie verfügt der Gastroenterologe über ein ideales komplementäres Verfahren zur Endoskopie. Der Einsatz erfolgt unter anderem in der Notfalldiagnostik bei Fragestellungen wie akuter Appendizitis und Peridivertikulitis. Hier ist die Sonografie die Methode der ersten Wahl und erreicht eine hohe Treffsicherheit. Dies gilt in gleicher Weise für den Ileus, der deutlich früher als mit der herkömmlichen Abdomenübersichtsaufnahme (Röntgen) zu diagnostizieren ist. Wesentliches kann die Sonografie zur Klärung der Genese beitragen (z. B. Invagination und Intussuszeption). Das Erkennen einer Perforation ist stärker von der Untersucherkompetenz abhängig. Die Vorteile liegen insbesondere in der Erkennung der häufigeren gedeckten Perforation und in der Klärung der Genese (z. B. Ulkus). Weniger geläufig, aber umso wichtiger, ist der Einsatz bei der einheimischen Sprue, bei der nicht nur das floride Krankheitsbild, sondern auch deren Komplikationen erkannt werden können. Fortgeschrittene Tumoren des Gastrointestinaltraktes sind gut darstellbar, jedoch in den frühen Stadien der Sonografie nicht sicher zugängig und ein exaktes T-Staging ist mit der „perkutanen” Sonografie nicht möglich. Dies liegt nicht zuletzt daran, dass einzelne Darmabschnitte (z. B. Rektum) nicht komplett darstellbar sind. Ein Tumorausschluss bzw. eine Früherkennung ist sonografisch somit nicht möglich. Bei den Darmerkrankungen werden durch die Sonografie, ergänzend zum klinischen und endoskopischen Aspekt, wichtige zusätzliche Informationen geliefert. Die Sonografie ist in der Differenzialdiagnose und Verlaufskontrolle von Bedeutung und „erspart” oft belastendere endoskopische Eingriffe. In der Erkennung der Komplikationen (Fistel, Abszess, Stenose) ist der Ultraschall anderen Bildgebungen zumindest gleichwertig. Dem Umfang der Thematik geschuldet, bleibt es einer nachfolgenden Übersicht vorbehalten, den aktuellen Stand der Sonografie bei chronisch entzündlichen Darmerkrankungen (CED), seltenen Darmentzündungen (u. a. bakterielle, pseudomembranöse, neutropene Kolitis, Darmtuberkulose), ischämischen Darmkrankheiten sowie bei Erkrankungen des oberen Gastrointestinaltraktes (Magen) darzustellen.

Abstract

Ultrasonography has become widely accepted as a diagnostic tool for gastrointestinal diseases. It not only assesses the lumen but more importantly also the wall and the surrounding structures of the stomach and bowel. Furthermore, functional processes (peristalsis, blood flow) can be visualised and provide important information for passage and perfusion. Modern high resolution (compressive) sonography represents an ideal complementary method besides endoscopy for the gastroenterologist. It is used in emergency diagnosis in cases of acute appendicitis and peridiverticulitis. Here sonography is the method of first choice achieving a high sensitivity. The same applies to ileus, which can be diagnosed significantly earlier by sonography than with conventional X-ray methods. Meanwhile sonography can contribute considerable information to clarify pathogenesis (e. g., invagination, intususception). The detection of a perforation depends strongly on the competence of the examiner. The main advantage is the detection of a covered perforation and the genesis (e. g., ulcer). Ultrasound is less commonly considered in celiac sprue but important complementary information can be obtained. Advanced tumours of the gastrointestinal tract can easily be visualised, although early stages can hardly be detected by means of sonography. An accurate T-staging of tumours is not possible with transabdominal sonography, not least because some parts of the bowel (colon and rectum) cannot always and completely be seen. Exclusion of tumour or early detection is not possible by ultrasound. In intestinal diseases additional information besides clinical and endoscopic aspects can be achieved by ultrasound. Sonography is important for differential diagnosis and follow-up and spares the patient from more incriminatory endoscopic operations. Ultrasound is equal to other imaging methods in detecting complications (fistulas, abscess, stenosis). Due to the complexity of the topic the following review will concentrate on giving an idea of the present status of sonography in chronic inflammatory bowel disease, some less frequent intestinal infections (bacterial, pseudomembranous, neutropenic colitis, intestinal tuberculosis), the ischaemic bowel diseases as well as diseases of the upper gastrointestinal tract.

Darmsonografie - Ileus - Perforation - Appendizitis - Peridivertikulitis

transabdominal sonography - ileus - perforation - appendicitis - peridivertikulitis

Literatur

• 1 Ko Y T, Lim J H, Lee D H. et al . Small bowel obstruction: sonographic evaluation.  Radiology. 1993;  188 (3) 649-653
• 2 Borushok K F, Jeffrey R B, Laing F C. et al . Sonographic diagnosis of perforation in patients with acute appendicitis.  Am J Roentgenol. 1990;  154 (2) 275-278
• 3 Puylaert J B, Van der Zant F M. Mesenteric lymphadenitis or appendicitis?.  Am J Roentgenol. 1995;  165 (2) 490
• 4 Uebel Jr P, Weiss H, Trimborn C P. et al . Ultrasound diagnosis of acute appendicitis -possibilities and limits of the method - results of prospective and retrospective clinical studies.  Ultraschall in Med. 1996;  17 (3) 100-105
• 5 Schwerk W B, Schwarz S, Rothmund M. Sonography in acute colonic diverticulitis. A prospective study.  Dis Colon Rectum. 1992;  35 (11) 1077-1084
• 6 Wilson S R, Toi A. The value of sonography in the diagnosis of acute diverticulitis of the colon.  Am J Roentgenol. 1990;  154 (6) 1199-1202
• 7 Lembcke B. Die gastroenterologische Ultraschalldiagnostik. Reinbeck; Einhorn-Press-Verlag 1992
• 8 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
• 9 Portilla de la F, Leon-Jimenez E, Cisneros N. et al . Use of anorectal ultrasounds in perianal Crohn s disease: consistency with clinical data.  Rev Esp Enferm Dig. 2006;  98 (10) 747-754
• 10 Giovannini M, Ardizzone S. Anorectal ultrasound for neoplastic and inflammatory lesions.  Best Pract Res Clin Gastroenterol. 2006;  20 (1) 113-135
• 11 Roche B, Deleaval J, Fransioli A. et al . Comparison of transanal and external perineal ultrasonography.  Eur Radiol. 2001;  11 (7) 1165-1170
• 12 Dietrich C F, Lembke B, Rees C. et al . Lassen sich sonographische Darmwandveränderungen als Hinweis aus aszendierenede Infektion bei Patienten mit PBC nachweisen?.  Ultraschall in Med. 1997;  18 28
• 13 Meckler U, Herzog P. Sonographic structure of the intestinal wall - significance for the diagnosis of inflammatory intestinal diseases.  Ultraschall in Med. 1989;  10 (3) 152-157
• 14 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
• 15 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
• 16 Rispo A, Bucci L, Pesce G. et al . Bowel sonography for the diagnosis and grading of postsurgical recurrence of Crohn’s disease.  Inflamm Bowel Dis. 2006;  12 (6) 486-490
• 17 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
• 18 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
• 19 Haber H P, Busch A, Ziebach R. et al . Bowel wall thickness measured by ultrasound as a marker of Crohn’s disease activity in children.  Lancet. 2000;  355 (9211) 1239-1240
• 20 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
• 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 Meckler U, Caspary W F, Clement T. et al . Sonography in Crohn disease - the conclusions of an experts’ group.  Z Gastroenterol. 1991;  29 (7) 355-359
• 24 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
• 25 Borner N, Clement T, Behringer U. et al . Die Farbduplexsonographie zur Aktivitätsbeurteilung chronisch entzündlicher Darmerkrankungen.  Z Gastroenterol. 1998;  36 725
• 26 Buljevac M, Busic Z, Cabrijan Z. Sonographic diagnosis of gallstone ileus.  J Ultrasound Med. 2004;  23 (10) 1395-1398
• 27 Dite P, Lata J, Novotny I. Intestinal obstruction and perforation - the role of the gastroenterologist.  Dig Dis. 2003;  21 (1) 63-67
• 28 Grassi R, Romano S, D’Amario F. et al . The relevance of free fluid between intestinal loops detected by sonography in the clinical assessment of small bowel obstruction in adults.  Eur J Radiol. 2004;  50 (1) 5-14
• 29 Heistermann H P, Joosten U, Krawzak H W. et al . Effect of intestinal ultrasound on choice of surgical procedure in acute abdominal pain.  Ultraschall in Med. 1995;  16 (6) 288-292
• 30 Meiser G, Waclawiczek H W, Heinerman M. et al . Intermittent incomplete ileus of the small intestine. Sonographic diagnosis and trends.  Chirurg. 1990;  61 (9) 651-655
• 31 Schmutz G R, Benko A, Fournier L. et al . Small bowel obstruction: role and contribution of sonography.  Eur Radiol. 1997;  7 (7) 1054-1058
• 32 Seitz K, Merz M. Ultrasound ileus diagnosis.  Ultraschall in Med. 1998;  19 (6) 242-249
• 33 Truong S, Arlt G, Pfingsten F. et al . Importance of sonography in diagnosis of ileus. A retrospective study of 459 patients.  Chirurg. 1992;  63 (8) 634-640
• 34 Zielke A, Forster R, Klotter H J. et al . Ileocolic invagination in adults. The sonographic characteristics.  Dtsch Med Wochenschr. 1991;  116 (38) 1424-1427
• 35 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
• 36 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
• 37 Riccabona M, Rossipal E. Sonographic findings in celiac disease.  J Pediatr Gastroenterol Nutr. 1993;  17 (2) 198-200
• 38 Riccabona M, Rossipal E. Value of ultrasound in diagnosis of celiac disease.  Ultraschall in Med. 1996;  17 (1) 31-33
• 39 Wright D H, Jones D B, Clark H. et al . Is adult-onset coeliac disease due to a low-grade lymphoma of intraepithelial T lymphocytes?.  Lancet. 1991;  337 (8754) 1373-1374
• 40 Dietrich C F, Brunner V, Lembcke B. Intestinal ultrasound in rare small and large intestinal diseases.  Z Gastroenterol. 1998;  36 (11) 955-970
• 41 Briskin B S, Smakov G M, Borodin A S. et al . Occlusive ileus in colonic cancer.  Khirurgiia (Mosk). 1999;  55 (5) 37-40
• 42 Nakai T, Shimomura T, Nakai H. et al . Pedunculated gastrointestinal stromal tumor presenting as bowel volvulus: usefulness of color Doppler ultrasonography for strangulated ileus.  Dig Dis Sci. 2003;  48 (2) 291-294
• 43 Heistermann H P, Joosten U, Rupp K D. et al . Reliability of ultrasound ileus diagnosis.  Bildgebung. 1995;  62 (3) 194-198
• 44 Musoke F, Kawooya M G, Kiguli-Malwadde E. Comparison between sonographic and plain radiography in the diagnosis of small bowel obstruction at Mulago Hospital, Uganda.  East Afr Med J. 2003;  80 (10) 540-545
• 45 Lassandro F, Gagliardi N, Scuderi M. et al . Gallstone ileus analysis of radiological findings in 27 patients.  Eur J Radiol. 2004;  50 (1) 23-29
• 46 Bonkoungou G, Traore S S, Kirakoya B. et al . Intestinal invaginations in children: 24 cases treated at the Yalgado National University Hospital in Ouedraogo.  Sante. 1999;  9 (4) 215-217
• 47 Kurtz B, Steidle B, Molzahn E. Invagination in adults.  Fortschr Röntgenstr. 1993;  158 (4) 314-319
• 48 Tellado M G, Liras J, Mendez R. et al . Ultrasound-guided hydrostatic reduction for the treatment of idiopathic intestinal invagination.  Cir Pediatr. 2003;  16 (4) 166-168
• 49 Doi O, Aoyama K, Hutson J M. Twenty-one cases of small bowel intussusception: the pathophysiology of idiopathic intussusception and the concept of benign small bowel intussusception.  Pediatr Surg Int. 2004;  20 (2) 140-143
• 50 Lagalla R, Caruso G, Novara V. et al . Color Doppler ultrasonography in pediatric intussusception.  J Ultrasound Med. 1994;  13 (3) 171-174
• 51 Lim H K, Bae S H, Lee K H. et al . Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography.  Radiology. 1994;  191 (3) 781-785
• 52 Linke F, Eble F, Berger S. Postoperative intussusception in childhood.  Pediatr Surg Int. 1998;  14 (3) 175-177
• 53 Chadha D, Kedar R P, Malde H M. Sonographic detection of pneumoperitoneum: an experimental and clinical study.  Australas Radiol. 1993;  37 (2) 182-185
• 54 Seitz K, Reising K D. Sonographic detection of free air in the abdominal cavity.  Ultraschall in Med. 1982;  3 (1) 4-6
• 55 Chang-Chien C S, Lin H H, Yen C L. et al . Sonographic demonstration of free air in perforated peptic ulcers: comparison of sonography with radiography.  J Clin Ultrasound. 1989;  17 (2) 95-100
• 56 Chen S C, Wang H P, Chen W J. et al . Selective use of ultrasonography for the detection of pneumoperitoneum.  Acad Emerg Med. 2002;  9 (6) 643-645
• 57 Goerg C. Gas: „Acoustic key” to the diagnosis.  Ultraschall in Med. 2002;  23 (4) 233-238
• 58 Kainberger P, Zukriegel M, Sattlegger P. et al . Ultrasound detection of pneumoperitoneum based on typical ultrasound morphology.  Ultraschall in Med. 1994;  15 (3) 122-125
• 59 Wallstabe L, Veitt R, Korner T. Diagnosis of perforated gastric ulcers by ultrasound.  Z Gastroenterol. 2002;  40 (10) 877-880
• 60 Catalano O. Computed tomography in the study of gastrointestinal perforation.  Radiol Med (Torino). 1996;  91 (3) 247-252
• 61 Chen C H, Yang C C, Yeh Y H. Role of upright chest radiography and ultrasonography in demonstrating free air of perforated peptic ulcers.  Hepatogastroenterology. 2001;  48 (40) 1082-1084
• 62 Lee C W, Yip A W, Lam K H. Pneumogastrogram in the diagnosis of perforated peptic ulcer.  Aust N Z J Surg. 1993;  63 (6) 459-461
• 63 Tonnessen T, Carlsen E. Perforated ulcer.  Tidsskr Nor Laegeforen. 2001;  121 (7) 790-792
• 64 Yeung K W, Chang M S, Hsiao C P. et al . CT evaluation of gastrointestinal tract perforation.  Clin Imaging. 2004;  28 (5) 329-333
• 65 Meiser G, Meissner K. Sonographic diagnosis of complicated peptic ulcer.  Ultraschall in Med. 1986;  7 (6) 268-274
• 66 Hainaux B, Agneessens E, Bertinotti R. et al . Accuracy of MDCT in predicting site of gastrointestinal tract perforation.  Am J Roentgenol. 2006;  187 (5) 1179-1183
• 67 Coulier B, Maldague P, Broze B. Gastric ulcer penetrating the anterior abdominal wall: ultrasound diagnosis.  Abdom Imaging. 2003;  28 (2) 248-251
• 68 Ranschaert E, Rigauts H. Confined gastric perforation: ultrasound and computed tomographic diagnosis.  Abdom Imaging. 1993;  18 (4) 318-319
• 69 Deans G T, Sedman P, Martin D F. et al . Are complications of endoscopic sphincterotomy age related?.  Gut. 1997;  41 (4) 545-548
• 70 Freeman M L, Nelson D B, Sherman S. et al . Complications of endoscopic biliary sphincterotomy.  N Engl J Med. 1996;  335 (13) 909-918
• 71 Oschatz E, Strasser G, Schober E. et al . „Disappearance” of retroperitoneal vessels - a case report.  Ultraschall in Med. 2003;  24 (6) 410-412
• 72 Sezgin O, Ulker A, Temucin G. Retroperitoneal duodenal perforation during endoscopic sphincterotomy: sonographic findings.  J Clin Ultrasound. 2000;  28 (6) 303-306
• 73 Simonovsky V. Sonographic detection of normal and abnormal appendix.  Clin Radiol. 1999;  54 (8) 533-539
• 74 Yabunaka K, Katsuda T, Sanada S. et al . Sonographic appearance of the normal appendix in adults.  J Ultrasound Med. 2007;  26 (1) 37-43
• 75 Lee J H, Jeong Y K, Park K B. et al . Operator-dependent techniques for graded compression sonography to detect the appendix and diagnose acute appendicitis.  Am J Roentgenol. 2005;  184 (1) 91-97
• 76 Peletti A B, Baldisserotto M. Optimizing US examination to detect the normal and abnormal appendix in children.  Pediatr Radiol. 2006;  36 (11) 1171-1176
• 77 Wiersma F, Sramek A, Holscher H C. US features of the normal appendix and surrounding area in children.  Radiology. 2005;  235 (3) 1018-1022
• 78 Worrell J A, Drolshagen L F, Kelly T C. et al . Graded compression ultrasound in the diagnosis of appendicitis. A comparison of diagnostic criteria.  J Ultrasound Med. 1990;  9 (3) 145-150
• 79 Lee W, Ong C L, Chong C C. et al . Omental infarction in children: imaging features with pathological correlation.  Singapore Med J. 2005;  46 (7) 328-332
• 80 Perello M J, Albasini J L, Aledo V. et al . Omental torsion: imaging techniques can prevent unnecessary surgical interventions.  Gastroenterol Hepatol. 2002;  25 (8) 493-496
• 81 Kerkhove van E, Coenegrachts K, Steyaert L. et al . Omental infarction in childhood.  JBR -BTR. 2006;  89 (4) 198-200
• 82 Baldisserotto M, Maffazzoni D R, Dora M D. Sonographic findings of Meckel’s diverticulitis in children.  Am J Roentgenol. 2003;  180 (2) 425-428
• 83 Baldisserotto M. Color Doppler sonographic findings of inflamed and perforated Meckel diverticulum.  J Ultrasound Med. 2004;  23 (6) 843-848
• 84 Miele V, De Cicco M L, Andreoli C. et al . US and CT findings in complicated Meckel diverticulum.  Radiol Med (Torino). 2001;  101 (4) 230-234
• 85 Beyer D, Schulte B, Kaiser C. et al . Sonography of acute appendicitis. A 5-year prospective study of 2074 patients.  Radiologe. 1993;  33 (7) 399-406
• 86 Kaiser S, Frenckner B, Jorulf H K. Suspected appendicitis in children: US and CT - a prospective randomized study.  Radiology. 2002;  223 (3) 633-638
• 87 Kessler N, Cyteval C, Gallix B. et al . Appendicitis: evaluation of sensitivity, specificity, and predictive values of US, Doppler US, and laboratory findings.  Radiology. 2004;  230 (2) 472-478
• 88 Doria A S, Moineddin R, Kellenberger C J. et al . US or CT for Diagnosis of Appendicitis in Children and Adults? A Meta-Analysis.  Radiology. 2006;  241 (1) 83-94
• 89 Keyzer C, Zalcman M, De M V. et al . Comparison of US and unenhanced multi-detector row CT in patients suspected of having acute appendicitis.  Radiology. 2005;  236 (2) 527-534
• 90 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
• 91 Hanson J M, Kam A W. Paracolic echogenic mass in a man with lower abdominal pain. Is epiploic appendagitis more common than previously thought?.  Emerg Med J. 2006;  23 (2) e17
• 92 Hollerweger A, Macheiner P, Hubner E. et al . Epiploic appendagitis: sonographic findings in 28 cases.  Ultraschall in Med. 2002;  23 (4) 239-244
• 93 Hollerweger A, Macheiner P, Rettenbacher T. et al . Primary epiploic appendagitis: sonographic findings with CT correlation.  J Clin Ultrasound. 2002;  30 (8) 481-495
• 94 Poves P I, Catala F J, Miquel C S. et al . Primary epiploic appendix inflammation.  Rev Clin Esp. 2004;  204 (1) 45-46
• 95 Breda van V, Puylaert J B. Epiploic appendagitis and omental infarction: pitfalls and look-alikes.  Abdom Imaging. 2002;  27 (1) 20-28
• 96 Roche J, Vancina S, Tohoubi W. et al . Ultrasonographic findings in peridiverticulitis of the appendix.  Gastroenterol Clin Biol. 1992;  16 (1) 97-98
• 97 Kori T, Nemoto M, Maeda M. et al . Sonographic features of acute colonic diverticulitis: the „dome sign”.  J Clin Ultrasound. 2000;  28 (7) 340-346
• 98 Vijayaraghavan S B. High-resolution sonographic spectrum of diverticulosis, diverticulitis, and their complications.  J Ultrasound Med. 2006;  25 (1) 75-85
• 99 Seitz K, Reuss J. Sonographic detection of fistulas in Crohn disease.  Ultraschall in Med. 1986;  7 (6) 281-283
• 100 Seitz K. Sonographic diagnosis of diverticulitis: the burdensome way to acceptance.  Ultraschall in Med. 2004;  25 (5) 335-336
• 101 Takada T, Nakagawa S, Hashimoto K. et al . Preoperative diagnosis of colouterine fistula secondary to diverticulitis by sonohysterography with contrast medium.  Ultrasound Obstet Gynecol. 2004;  24 (6) 682-683
• 102 Alberti A, Dattola P, Parisi A. et al . Role of ultrasonographic imaging in the surgical management of acute diverticulitis of the colon.  Chir Ital. 2002;  54 (1) 71-75
• 103 Berndt P, Niekisch G. Colonic diverticulitis. Primary clinical and ultrasound diagnosis - report of 47 cases from general practice.  Z Arztl Fortbild Qualitatssich. 1997;  91 (2) 171-174
• 104 Bruel J M. Acute colonic diverticulitis: CT or ultrasound?.  Eur Radiol. 2003;  13 (12) 2557-2559
• 105 Farag S M, Wustner M, Sturm J. et al . Primary diagnostics of acute diverticulitis of the sigmoid.  Ultraschall in Med. 2004;  25 (5) 342-347
• 106 Moll R, Mittelkotter U, Reith H B. et al . Which imaging in case of sigmoid diverticulitis? The value of ultrasound (Conventional B-mode in combination with hydrocolonsonography and colour flow Doppler) in comparison to the well-established modalities like contrast enema and helical computertomography.  Zentralbl Chir. 2002;  127 (4) 297-301
• 107 Ripolles T, Agramunt M, Martinez M J. et al . The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients.  Eur Radiol. 2003;  13 (12) 2587-2595
• 108 Schwerk W B, Schwarz S, Rothmund M. et al . Colon diverticulitis: imaging diagnosis with ultrasound - a prospective study.  Z Gastroenterol. 1993;  31 (5) 294-300
• 109 Zielke A, Hasse C, Nies C. et al . Prospective evaluation of ultrasonography in acute colonic diverticulitis.  Br J Surg. 1997;  84 (3) 385-388
• 110 Pradel J A, Adell J F, Taourel P. et al . Acute colonic diverticulitis: prospective comparative evaluation with US and CT.  Radiology. 1997;  205 (2) 503-512
• 111 Barc R M, Rousset J, Maignien B. et al . Diverticula of the appendix and their complications: value of sonography (review of 21 cases).  J Radiol. 2005;  86 (3) 299-309
• 112 Chou Y H, Chiou H J, Tiu C M. et al . Sonography of acute right side colonic diverticulitis.  Am J Surg. 2001;  181 (2) 122-127
• 113 Kubota T, Omori T, Yamamoto J. et al . Sonographic findings of acute appendiceal diverticulitis.  World J Gastroenterol. 2006;  12 (25) 4104-4105
• 114 Macheiner P, Rettenbacher T, Hollerweger A. et al . Diverticulitis of the appendix vermiformis: ultrasonographic appearance.  Ultraschall in Med. 1999;  20 (3) 115-117
• 115 Oudenhoven L F, Koumans R K, Puylaert J B. Right colonic diverticulitis: US and CT findings - new insights about frequency and natural history.  Radiology. 1998;  208 (3) 611-618
• 116 Ripolles T, Martinez-Perez M J, Morote V. et al . Diseases that simulate acute appendicitis on ultrasound.  Br J Radiol. 1998;  71 (841) 94-98
• 117 Dietrich C F, Sarrazin C, Zeuzem S. et al . Sprue-assoziiertes T-Zell-Lymphom der Leber - Ultraschall als wegweisender Befund.  Ultraschall in Med. 1997;  18 22
• 118 Lembcke B, Pohl M, Krackhardt B. et al .Ökosystem Darm VII. Berlin Heidelberg NewYork; Springer Verlag 1997
• 119 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
• 120 Fraquelli M, Sciola V, Villa C. et al . The role of ultrasonography in patients with celiac disease.  World J Gastroenterol. 2006;  12 (7) 1001-1004
• 121 Peck R J, Jackson A, Gleeson D. Case report: ultrasound of coeliac disease with demonstration of response to treatment.  Clin Radiol. 1997;  52 (3) 244-245
• 122 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
• 123 Grun R, Wagner E, Tomsik H. et al . Ultrasonic diagnosis of tumors of the cecum and ascending colon.  Z Gastroenterol. 1991;  29 (2) 65-67
• 124 Worlicek H. Sonographic diagnosis of colon cancer.  Ultraschall in Med. 1991;  12 (4) 164-168
• 125 Martinez-Ares D, Martin-Granizo B I, Souto-Ruzo J. et al . The value of abdominal ultrasound in the diagnosis of colon cancer.  Rev Esp Enferm Dig. 2005;  97 (12) 877-886
• 126 Gossmann H, Gorlitz T, Beck A. et al . Intestinal small bowel lymphomas-diagnosis and treatment.  Rontgenpraxis. 2006;  56 (2) 67-72
• 127 Dixit R, Chowdhury V, Kumar N. Hydrocolonic sonography in the evaluation of colonic lesions.  Abdom Imaging. 1999;  24 (5) 497-505
• 128 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
• 129 Loftus W K, Metreweli C, Sung J J. et al . Ultrasound, CT and colonoscopy of colonic cancer.  Br J Radiol. 1999;  72 (854) 144-148
• 130 Vignault F, Filiatrault D, Brandt M L. et al . Acute appendicitis in children: evaluation with US.  Radiology. 1990;  176 (2) 501-504
• 131 Schwerk W B, Wichtrup B, Ruschoff J. et al . Acute and perforated appendicitis: current experience with ultrasound-aided diagnosis.  World J Surg. 1990;  14 (2) 271-276
• 132 Bendeck S E, Nino-Murcia M, Berry G J. et al . Imaging for suspected appendicitis: negative appendectomy and perforation rates.  Radiology. 2002;  225 (1) 131-136
• 133 Sun S S, Wu H S, Wang J J. et al . Comparison between technetium 99 m hexamethylpropyleneamine oxide labeled white blood cell abdominal scan and abdominal sonography to detect appendicitis in adult patients with atypical clinical presentation.  Abdom Imaging. 2002;  27 (6) 734-738
• 134 Chang C C, Tsai C Y, Lin C C. et al . Comparison between technetium-99 m hexamethylpropyleneamineoxide labeled white blood cell abdomen scan and abdominal sonography to detect appendicitis in children with an atypical clinical presentation.  Hepatogastroenterology. 2003;  50 (50) 426-429
• 135 Poortman P, Lohle P N, Schoemaker C M. et al . Comparison of CT and sonography in the diagnosis of acute appendicitis: a blinded prospective study.  Am J Roentgenol. 2003;  181 (5) 1355-1359
• 136 Rettenbacher T, Hollerweger A, Macheiner P. et al . Ovoid shape of the vermiform appendix: a criterion to exclude acute appendicitis - evaluation with US.  Radiology. 2003;  226 (1) 95-100
• 137 Chan I, Bicknell S G, Graham M. Utility and diagnostic accuracy of sonography in detecting appendicitis in a community hospital.  Am J Roentgenol. 2005;  184 (6) 1809-1812
• 138 Klein M D. Clinical approach to a child with abdominal pain who might have appendicitis.  Pediatr Radiol. 2007;  37 (1) 11-14
• 139 Hollerweger A, Macheiner P, Rettenbacher T. et al . Colonic diverticulitis: diagnostic value and appearance of inflamed diverticula-sonographic evaluation.  Eur Radiol. 2001;  11 (10) 1956-1963
• 140 Rettenbacher T, Hollerweger A, Macheiner P. et al . Adult celiac disease: US signs.  Radiology. 1999;  211 (2) 389-394
• 141 Fraquelli M, Colli A, Colucci A. et al . Accuracy of ultrasonography in predicting celiac disease.  Arch Intern Med. 2004;  164 (2) 169-174