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Lee, Cho, Kim, Lee, and Jang: Clinical Significance of the Large Intestinal Wall Thickening Detected by Abdominal Computed Tomography
Original Article
Alimentary Tract
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 60(5): 300-305.

Published online: 22 November 2012

DOI: https://doi.org/10.4166/kjg.2012.60.5.300

Clinical Significance of the Large Intestinal Wall Thickening Detected by Abdominal Computed Tomography

Jung Soo Lee, Joon Hyun Cho, Kyeong Ok Kim, Si Hyung Lee, Byung Ik Jang

Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.

Correspondence to: Kyeong Ok Kim, Department of Internal Medicine, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 705-717, Korea. Tel: +82-53-620-3831, Fax: +82-53-654-8386, cello7727@naver.com

Received 23 July 2012       Revised 23 July 2012       Accepted 2 August 2012

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background/Aims

Bowel wall thickening on CT has been reported to reflect colorectal carcinoma and colitis. The aim of this study was to evaluate the clinical significance of the large intestinal wall thickening on CT.

Methods

Between January 2006 and August 2010, medical records of 815 patients who underwent endoscopy after CT scans within 1 month were reviewed retrospectively.

Results

A total of 233 patients were included. The wall thickening was actually associated with abnormal endoscopic findings in 81.1% of the cases. The accuracy rate on diagnosis between CT and endoscopy was 63.5%. The discrepancy in diagnosis was higher in cases with left colon abnormality and short segment lesion. Abdominal pain was significantly more common in cases suspected malignancy on CT compared with colitis (p=0.047). Most of the malignancy diagnosed on CT involved the left side colon and most of the colitis involved the entire colon (p<0.001). The length of lesion was below 5 cm in 86.5% of the malignancy. Malignancy was more common in patients aged over 50 years with hemoglobin below 12 g/dL. The CT findings significantly suggestive of malignancy were lymph node enlargement and length of lesion below 5 cm (p=0.027 and p<0.001).

Conclusions

The large intestinal wall thickening on CT was limited in the differential diagnosis of malignancy and colitis. Additional endoscopic evaluation is needed in patients with bowel wall thickening associated with lymph node enlargement and short segment lesion on CT in order to exclude malignancy.

Keywords: Intestine, Large, Computed tomography, Colonoscopy

Figures and Tables

Table 1
Baseline Characteristics of the Patients
kjg-60-300-i001

Values are presented as number (%) or mean±SD (range).

aConstipation (1); nausea, vomiting (6); distension (1); general weakness (4); etc (7).

Hb, hemoglobin; WBC, white blood cell.

Table 2
Symptom and Findings Associated with Malignancy or Colitis on CT
kjg-60-300-i002

Values are presented as number (%).

Table 3
Clinical Information and CT Findings Associated with Malignancy
kjg-60-300-i003

Values are presented as number or number (%).

Hb, hemoglobin; WBC, white blood cell.

Table 4
Multivariate Analysis of Risk Factors for Malignancy on CT
kjg-60-300-i004
Table 5
Multivariate Analysis of Risk Factors for Colitis on CT
kjg-60-300-i005

Notes

Financial support: None.

Conflict of interest: None.

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