title: High-frequency ultrasound imaging of the duodenum and colon in patients with symptomatic giardiasis in comparison to amebiasis and healthy subjects.
abstract: OBJECTIVE
  The application of ultrasound may be suitable for evaluating the effects of intestinal cytoskeletal rearrangement of the duodenum and colon as a result of exposure to live Giardia lamblia trophozoites. We studied the sonographic appearance of the duodenum and colon in giardiasis compared with amebiasis and healthy subjects.
  
  
  METHODS
  Sonographic images obtained from 100 consecutive patients with symptomatic giardiasis were compared to those taken from 40 patients with amebiasis and 40 healthy subjects. B-mode ultrasound examination of the duodenum and colon was performed using a 7.5 MHz annular array transducer. Gray scale images with water contrast were acquired.
  
  
  RESULTS
  Normal duodenum and colon echoanatomy were demonstrated. Giardial lesions of the duodenum and colon were associated with increased wall thickness when compared with healthy subjects (P < 0.05). Furthermore, giardial lesions were characterized by increased wall echogenicity, flattening or loss of duodenal folds and/or colonic haustration, hyperechoic floating foci (HFF) demonstrating chaotic motility, increased peri-lesional tissue echogenicity, and altered colonic peristalsis. In amebiasis, focal hyperechoic wall thickening was seen at lesion sites identified as amebomas with increased wall echogenicity, but otherwise normal duodenal folds and colonic haustration. There were no HFF with chaotic motility, rather intestinal contents showed bulk motility in patients with amebiasis. There was no focal colonic wall motion abnormality observed.
  
  
  CONCLUSIONS
  B-mode imaging with water contrast demonstrated details of duodenal and colonic echoanatomy. There were sonographic features of giardial lesions of the duodenum and colon that were distinct from those in amebiasis and healthy subjects.
authors.affiliation: Institute of Non-invasive Imaging for Parasitology, International Institutes of Advanced, Research and Training, Chidicon Medical Center, Owerri, Imo State, Nigeria. philip.njemanze@chidicon.com
authors.forename: Philip C
authors.initials: PC
authors.lastname: Njemanze
authors.forename: Josephine
authors.initials: J
authors.lastname: Njemanze
authors.forename: Alana
authors.initials: A
authors.lastname: Skelton
authors.forename: Anoka
authors.initials: A
authors.lastname: Akudo
authors.forename: Onyinyechi
authors.initials: O
authors.lastname: Akagha
authors.forename: Adaeze A
authors.initials: AA
authors.lastname: Chukwu
authors.forename: Constance
authors.initials: C
authors.lastname: Peters
authors.forename: Ozioma
authors.initials: O
authors.lastname: Maduka
mesh_terms: D000328:Adult; D003106:Colon / Q000000981:diagnostic imaging* / Q000469:parasitology; D003937:Diagnosis, Differential; D004386:Duodenum / Q000000981:diagnostic imaging* / Q000469:parasitology; D004404:Dysentery, Amebic / Q000000981:diagnostic imaging*; D005260:Female; D005873:Giardiasis / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018615:Ultrasonography, Doppler, Color