Appendiceal involvement in Crohn's disease: gray-scale sonography and color Doppler flow features.
OBJECTIVE
The objective of our study was to evaluate appendiceal involvement in Crohn's disease with gray-scale and color Doppler sonography and differentiate it from acute appendicitis.


METHODS
Analysis of the sonographic examinations was performed over 5 years in 190 patients with an established diagnosis of Crohn's disease. Data analyzed were as follows: visualization of the appendix; thickness and color Doppler signal (grade 0, 1, or 2) of the appendix and adjacent intestinal loop (cecum, terminal ileum, or both); involvement of other intestinal segments; and abscesses. The findings were compared with those of 49 consecutive patients with sonographic findings of acute appendicitis.


RESULTS
Thirty-nine patients with Crohn's disease (21%) had appendicular involvement. All but one patient showed thickening of the terminal ileum, and 46% of patients also showed thickening of the cecum. The thickness of the ileum was more than 5 mm (only the anterior wall) in 64% of patients. Appendicular hyperemia was seen in 72% of patients. Involvement of other segments was seen in 23 patients (59%) and adjacent abscesses in six (15%). Irregular thickness of the submucosa was seen in nine cases (23%) and fibrofatty proliferation in 19 (49%). In patients with ileocecal regional disease, ileum thickness of more than 5 mm and visible color in the ileum were the most valuable signs, both for the diagnosis of Crohn's disease and to differentiate it from acute appendicitis (positive predictive value, 96%; negative predictive value, 74%).


CONCLUSIONS
Appendicular involvement in Crohn's disease is a relatively frequent event (21%). Sonography and color Doppler sonography may be useful for differentiating Crohn's disease with appendicular involvement from acute appendicitis.
Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Ave., Valencia 46017, Spain. ripolles_tom@gva.es
Tomás
T
Ripollés
María Jesus
MJ
Martínez
Virgilio
V
Morote
José
J
Errando
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000209:etiology*; D001065:Appendix; D002429:Cecal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology*; D003424:Crohn Disease / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018615:Ultrasonography, Doppler, Color