Ultraschall Med 2017; 38(03): e1-e15
DOI: 10.1055/s-0042-115853
Guidelines & Recommendations
© Georg Thieme Verlag KG Stuttgart · New York

EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound - Part 1: Examination Techniques and Normal Findings (Long version)

EFSUMB-Empfehlungen und Leitlinien des Gastrointestinalen Ultraschalls - Teil 1: Untersuchungstechniken und Normalbefund (Langversion)
Kim Nylund
1   National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
Giovanni Maconi
2   Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” University Hospital, Milan, Italy
Alois Hollerweger
3   Department of Radiology, Hospital Barmherzige Brüder, Salzburg, Austria
Tomas Ripolles
4   Department of Radiology, Hospital Universitario Doctor Peset, Valencia, Spain
Nadia Pallotta
5   Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Roma, Italy
Antony Higginson
6   Department of Radiology, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom of Great Britain and Northern Ireland
Carla Serra
7   Department of Digestive System, Sant'Orsola-Malpighi Hospital and University of Bologna, Italy
Christoph F. Dietrich
8   Department of Internal Medicine 2, Caritas Krankenhaus, Bad Mergentheim, Germany
Ioan Sporea
9   Dept. of Gastroenterology and Hepatology, "Victor Babes", University of Medicine and Pharmacy Timisoara, Romania
Adrian Saftoiu
10   Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania
Klaus Dirks
11   Gastroenterology and Internal Medicine, Rems-Murr-Klinikum Winnenden, Germany
Trygve Hausken
12   Department of Clinical Medicine, University of Bergen, and Department of Medicine, Haukeland University Hospital, Bergen, Norway
Emma Calabrese
13   Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy
Laura Romanini
14   Dept. of Radiology, Radiologia 1, Spedali Civili di Brescia, Italy
Christian Maaser
15   Outpatients Department of Gastroenterology, University Teaching Hospital Lueneburg, Germany
Dieter Nuernberg
16   Department of Internal Medicine and Gastroenterology, Brandenburg Medical School, Neuruppin, Germany
Odd Helge Gilja
17   National Centre of Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Norway
› Author Affiliations
Further Information

Publication History

24 June 2016

09 August 2016

Publication Date:
07 September 2016 (online)


In October 2014 the European Federation of Societies for Ultrasound in Medicine and Biology formed a Gastrointestinal Ultrasound (GIUS) task force group to promote the use of GIUS in a clinical setting. One of the main objectives of the task force group was to develop clinical recommendations and guidelines for the use of GIUS under the auspices of EFSUMB. The first part, gives an overview of the examination techniques for GIUS recommended by experts in the field. It also presents the current evidence for the interpretation of normal sonoanatomical and physiological features as examined with different ultrasound modalities.


Im Oktober 2014 bildete die „European Federation of Societies for Ultrasound in Medicine and Biology“ einen Arbeitskreis „Gastrointestinaler Ultraschall“ (GIUS), um den Einsatz des GIUS in der klinischen Praxis voranzutreiben. Eines der Hauptziele des Arbeitskreises war die Erarbeitung klinischer Empfehlungen und Leitlinien für den Einsatz des GIUS unter der Schirmherrschaft des EFSUMB. Der erste Teil gibt einen Überblick über die Untersuchungsmethoden des GIUS, wie er von Experten auf diesem Gebiet empfohlen wurde. Außerdem wird die derzeit aktuelle Evidenz für die Interpretation normaler sonoanatomischer und physiologischer Merkmale, wie sie mit unterschiedlichen Ultraschallmethoden untersucht wurden, präsentiert.

  • References

  • 1 Panes J. Bouzas R. Chaparro M. et al. Systematic review: the use of ultrasonography, computed tomography and magnetic resonance imaging for the diagnosis, assessment of activity and abdominal complications of Crohn's disease. Aliment Pharmacol Ther 2011; 34: 125-145
  • 2 Panes J. Bouhnik Y. Reinisch W. et al. Imaging techniques for assessment of inflammatory bowel disease: joint ECCO and ESGAR evidence-based consensus guidelines. J Crohns Colitis 2013; 7: 556-585
  • 3 Bamber J. Cosgrove D. Dietrich CF. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology. Ultraschall in Med 2013; 34: 169-184
  • 4 Claudon M. Dietrich CF. Choi BI. et al. Guidelines and good clinical practice recommendations for Contrast Enhanced Ultrasound (CEUS) in the liver – update 2012: A WFUMB-EFSUMB initiative in cooperation with representatives of AFSUMB, AIUM, ASUM, FLAUS and ICUS. Ultrasound Med Biol 2013; 39: 187-210
  • 5 Cosgrove D. Piscaglia F. Bamber J. et al. EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 2: Clinical applications. Ultraschall in Med 2013; 34: 238-253
  • 6 Dietrich CF. Lorentzen T. Sidhu PS. et al. An Introduction to the EFSUMB Guidelines on Interventional Ultrasound (INVUS). Ultraschall in Med 2015; 36: 460-463
  • 7 Jenssen C. Brkljacic B. Hocke M. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part VI – Ultrasound-Guided Vascular Interventions. Ultraschall in Med 2015; Nov 18. DOI: 10.1055/s-0035-1553450.
  • 8 Jenssen C. Hocke M. Fusaroli P. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part IV – EUS-guided interventions: General Aspects and EUS-guided Sampling (Short Version). Ultraschall in Med 2016; 37: 157-169
  • 9 Lorentzen T. Nolsoe CP. Ewertsen C. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part I. General Aspects (Short Version). Ultraschall in Med 2015; 36: 464-472
  • 10 Piscaglia F. Nolsoe C. Dietrich CF. et al. The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): Update 2011 on non-hepatic applications. Ultraschall in Med 2011; 33: 33-59
  • 11 Sidhu PS. Brabrand K. Cantisani V. et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part II. Ultraschall in Med 2015; 36: E15-E35
  • 12 Howick J. Chalmers I. Glasziou P. et al. The Oxford Levels of Evidence 2. OCEBM Levels of Evidence Working Group, Oxford Centre for Evidence-Based Medicine. 2009 Available from: http://www.cebm.net/index.aspx?o=5653
  • 13 Haber HP. Stern M. Intestinal ultrasonography in children and young adults: bowel wall thickness is age dependent. J Ultrasound Med 2000; 19: 315-321
  • 14 Nylund K. Hausken T. Odegaard S. et al. Gastrointestinal wall thickness measured with transabdominal ultrasonography and its relationship to demographic factors in healthy subjects. Ultraschall in Med 2012; 33: E225-E232
  • 15 Aibe T. Fuji T. Okita K. et al. A fundamental study of normal layer structure of the gastrointestinal wall visualized by endoscopic ultrasonography. Scand J Gastroenterol Suppl 1986; 123: 6-15
  • 16 Boscaini M. Moscini PL. Montori A. Transrectal ultrasonography: interpretation of normal intestinal wall structure for the preoperative staging of rectal cancer. Scand J Gastroenterol Suppl 1986; 123: 87-98
  • 17 Kimmey MB. Martin RW. Haggitt RC. et al. Histologic correlates of gastrointestinal ultrasound images. Gastroenterology 1989; 96: 433-441
  • 18 Rompel O. Huelsse B. Bodenschatz K. et al. Harmonic US imaging of appendicitis in children. Pediatr Radiol 2006; 36: 1257-1264
  • 19 Schmidt T. Hohl C. Haage P. et al. Phase-inversion tissue harmonic imaging compared to fundamental B-mode ultrasound in the evaluation of the pathology of large and small bowel. Eur Radiol 2005; 15: 2021-2030
  • 20 Ying M. Sin MH. Comparison of extended field of view and dual image ultrasound techniques: accuracy and reliability of distance measurements in phantom study. Ultrasound Med Biol 2005; 31: 79-83
  • 21 Troger J. Darge K. SieScape--a new dimension of ultrasound imaging in pediatric radiology. Radiologe 1998; 38: 417-419
  • 22 Giovagnorio F. Diacinti D. Vernia P. Doppler sonography of the superior mesenteric artery in Crohn's disease. Am J Roentgenol 1998; 170: 123-126
  • 23 Maconi G. Parente F. Bollani S. et al. Factors affecting splanchnic haemodynamics in Crohn's disease: a prospective controlled study using Doppler ultrasound. Gut 1998; 43: 645-650
  • 24 Mirk P. Palazzoni G. Gimondo P. Doppler sonography of hemodynamic changes of the inferior mesenteric artery in inflammatory bowel disease: preliminary data. Am J Roentgenol 1999; 173: 381-387
  • 25 Van Oostayen JA. Wasser MN. van Hogezand RA. et al. Activity of Crohn disease assessed by measurement of superior mesenteric artery flow with Doppler US. Radiology 1994; 193: 551-554
  • 26 Dietrich CF. Jedrzejczyk M. Ignee A. Sonographic assessment of splanchnic arteries and the bowel wall. Eur J Radiol 2007; 64: 202-212
  • 27 Ignee A. Boerner N. Bruening A. et al. Duplexsonography of the mesenteric vessels – a critical evaluation of inter observer variability. Z Gastroenterol 2016; 54: 304-311
  • 28 Nylund K. Hausken T. Gilja OH. Ultrasound and inflammatory bowel disease. Ultrasound Q 2010; 26: 3-15
  • 29 Van Oostayen JA. Wasser MN. Griffioen G. et al. Activity of Crohn's disease assessed by measurement of superior mesenteric artery flow with Doppler ultrasound. Neth J Med 1998; 53: S3-S8
  • 30 Ruess L. Blask AR. Bulas DI. et al. Inflammatory bowel disease in children and young adults: correlation of sonographic and clinical parameters during treatment. Am J Roentgenol 2000; 175: 79-84
  • 31 Spalinger J. Patriquin H. Miron MC. et al. Doppler US in patients with crohn disease: vessel density in the diseased bowel reflects disease activity. Radiology 2000; 217: 787-791
  • 32 Patriquin HB. Garcier JM. Lafortune M. et al. Appendicitis in children and young adults: Doppler sonographic-pathologic correlation. Am J Roentgenol 1996; 166: 629-633
  • 33 Ripolles T. Simo L. Martinez-Perez MJ. et al. Sonographic findings in ischemic colitis in 58 patients. Am J Roentgenol 2005; 184: 777-785
  • 34 Drews BH. Barth TF. Hanle MM. et al. Comparison of sonographically measured bowel wall vascularity, histology, and disease activity in Crohn's disease. Eur Radiol 2009; 19: 1379-1386
  • 35 Neye H. Voderholzer W. Rickes S. et al. Evaluation of criteria for the activity of Crohn's disease by power Doppler sonography. Dig Dis 2004; 22: 67-72
  • 36 Esteban JM. Maldonado L. Sanchiz V. et al. Activity of Crohn's disease assessed by colour Doppler ultrasound analysis of the affected loops. Eur Radiol 2001; 11: 1423-1428
  • 37 Ripolles T. Martinez MJ. Morote V. et al. Appendiceal involvement in Crohn's disease: gray-scale sonography and color Doppler flow features. Am J Roentgenol 2006; 186: 1071-1078
  • 38 Cosgrove D. Ultrasound contrast agents: an overview. Eur J Radiol 2006; 60: 324-330
  • 39 Greis C. Technology overview: SonoVue (Bracco, Milan). Eur Radiol 2004; 14 (Suppl. 08) 11-15
  • 40 Rapaccini GL. Pompili M. Orefice R. et al. Contrast-enhanced power doppler of the intestinal wall in the evaluation of patients with Crohn disease. Scand J Gastroenterol 2004; 39: 188-194
  • 41 Robotti D. Cammarota T. Debani P. et al. Activity of Crohn disease: value of Color-Power-Doppler and contrast-enhanced ultrasonography. Abdom Imaging 2004; 29: 648-652
  • 42 Serra C. Menozzi G. Labate AM. et al. Ultrasound assessment of vascularization of the thickened terminal ileum wall in Crohn's disease patients using a low-mechanical index real-time scanning technique with a second generation ultrasound contrast agent. Eur J Radiol 2007; 62: 114-121
  • 43 Incesu L. Yazicioglu AK. Selcuk MB. et al. Contrast-enhanced power Doppler US in the diagnosis of acute appendicitis. Eur J Radiol 2004; 50: 201-209
  • 44 Kratzer W. Schmidt SA. 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: 985-991
  • 45 Pauls S. Gabelmann A. Schmidt SA. et al. Evaluating bowel wall vascularity in Crohn's disease: a comparison of dynamic MRI and wideband harmonic imaging contrast-enhanced low MI ultrasound. Eur Radiol 2006; 16: 2410-2417
  • 46 Schreyer AG. Finkenzeller T. Gossmann H. et al. Microcirculation and perfusion with contrast enhanced ultrasound (CEUS) in Crohn's disease: first results with linear contrast harmonic imaging (CHI). Clin Hemorheol Microcirc 2008; 40: 143-155
  • 47 Cui XW. Ignee A. Jedrzejczyk M. et al. Dynamic Vascular Pattern (DVP), a quantification tool for contrast enhanced ultrasound. Z Gastroenterol 2013; 51: 427-431
  • 48 Dietrich CF. Averkiou MA. Correas JM. et al. An EFSUMB introduction into Dynamic Contrast-Enhanced Ultrasound (DCE-US) for quantification of tumour perfusion. Ultraschall in Med 2012; 33: 344-351
  • 49 Frohlich E. Muller R. Cui XW. et al. Dynamic contrast-enhanced ultrasound for quantification of tissue perfusion. J Ultrasound Med 2015; 34: 179-196
  • 50 Jirik R. Nylund K. Gilja O. et al. Ultrasound perfusion analysis combining bolus-tracking and burst-replenishment. IEEE Trans Ultrason Ferroelectr Freq Control 2013; 60: 310-319
  • 51 Nylund K. Jirik R. Mezl M. et al. Quantitative contrast-enhanced ultrasound comparison between inflammatory and fibrotic lesions in patients with Crohn's disease. Ultrasound Med Biol 2013; 39: 1197-1206
  • 52 Romanini L. Passamonti M. Navarria M. et al. Quantitative analysis of contrast-enhanced ultrasonography of the bowel wall can predict disease activity in inflammatory bowel disease. Eur J Radiol 2014; 83: 1317-1323
  • 53 Esteban JM. Aleixandre A. Hurtado MJ. et al. Contrast-enhanced power Doppler ultrasound in the diagnosis and follow-up of inflammatory abdominal masses in Crohn's disease. Eur J Gastroenterol Hepatol 2003; 15: 253-259
  • 54 Ripolles T. Martinez-Perez MJ. Paredes JM. et al. Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn's disease and other abdominal conditions. Eur J Radiol 2013; 82: e525-e531
  • 55 Liu C. Xu XR. Xu HX. et al. Conventional ultrasound and contrast-enhanced ultrasound in evaluating the severity of Crohn's disease. Int J Clin Exp Med 2015; 8: 123-134
  • 56 Migaleddu V. Scanu AM. Quaia E. et al. Contrast-enhanced ultrasonographic evaluation of inflammatory activity in Crohn's disease. Gastroenterology 2009; 137: 43-52
  • 57 Zink F. Kratzer W. Schmidt S. et al. Comparison of Two High-End Ultrasound Systems for Contrast-Enhanced Ultrasound Quantification of Mural Microvascularity in Crohn's Disease. Ultraschall in Med 2016; 37: 74-81
  • 58 Lampaskis M. Averkiou M. Investigation of the relationship of nonlinear backscattered ultrasound intensity with microbubble concentration at low MI. Ultrasound Med Biol 2010; 36: 306-312
  • 59 Havre R. Gilja OH. Elastography and strain rate imaging of the gastrointestinal tract. Eur J Radiol 2014; 83: 438-441
  • 60 Giannetti A. Biscontri M. Matergi M. Feasibility of real-time strain elastography in colonic diseases. J Ultrasound 2014; 17: 321-330
  • 61 Waage JE. Leh S. Rosler C. et al. Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas. Colorectal Dis 2015; 17: 124-131
  • 62 Waage JE. Bach SP. Pfeffer F. et al. Combined endorectal ultrasonography and strain elastography for the staging of early rectal cancer. Colorectal Dis 2015; 17: 50-56
  • 63 Allgayer H. Ignee A. Zipse S. et al. Endorectal ultrasound and real-time elastography in patients with fecal incontinence following anorectal surgery: a prospective comparison evaluating short- and long-term outcomes in irradiated and non-irradiated patients. Z Gastroenterol 2012; 50: 1281-1286
  • 64 Allgayer H. Ignee A. Dietrich CF. Endosonographic elastography of the anal sphincter in patients with fecal incontinence. Scand J Gastroenterol 2010; 45: 30-38
  • 65 Baumgart DC. Muller HP. Grittner U. et al. US-based Real-time Elastography for the Detection of Fibrotic Gut Tissue in Patients with Stricturing Crohn Disease. Radiology 2015; 275: 889-899
  • 66 Fraquelli M. Branchi F. Cribiu FM. et al. The Role of Ultrasound Elasticity Imaging in Predicting Ileal Fibrosis in Crohn's Disease Patients. Inflamm Bowel Dis 2015; 21: 2605-2612
  • 67 Gilja OH. Education and Practical Standards Committee, EFSUMB. Minimum Training recommendations for the practice of medical ultrasound. Ultraschall in Med 2006; 27: 79-105
  • 68 Pinto PN. Chojniak R. Cohen MP. et al. Comparison of three types of preparations for abdominal sonography. J Clin Ultrasound 2011; 39: 203-208
  • 69 Heldwein W. Sommerlatte T. Hasford J. et al. Evaluation of the usefulness of dimethicone and/or senna extract in improving the visualization of abdominal organs. J Clin Ultrasound 1987; 15: 455-458
  • 70 Sinan T. Leven H. Sheikh M. Is fasting a necessary preparation for abdominal ultrasound?. BMC Med Imaging 2003; 3: 1
  • 71 Ehrenstein BP. Froh S. Schlottmann K. et al. To eat or not to eat? Effect of fasting prior to abdominal sonography examinations on the quality of imaging under routine conditions: A randomized, examiner-blinded trial. Scand J Gastroenterol 2009; 44: 1048-1054
  • 72 Dauzat M. Lafortune M. Patriquin H. et al. Meal induced changes in hepatic and splanchnic circulation: a noninvasive Doppler study in normal humans. Eur J Appl Physiol Occup Physiol 1994; 68: 373-380
  • 73 Matheson PJ. Wilson MA. Garrison RN. Regulation of intestinal blood flow. J Surg Res 2000; 93: 182-196
  • 74 Qamar MI. Read AE. Effects of ingestion of carbohydrate, fat, protein, and water on the mesenteric blood flow in man. Scand J Gastroenterol 1988; 23: 26-30
  • 75 Sidery MB. Macdonald IA. Blackshaw PE. Superior mesenteric artery blood flow and gastric emptying in humans and the differential effects of high fat and high carbohydrate meals. Gut 1994; 35: 186-190
  • 76 Stubbs TA. Macdonald IA. Within- and between-day variability in transcutaneous Doppler ultrasound measurements of superior mesenteric artery blood flow (SMABF) in the fasted state. Physiol Meas 1998; 19: 181-187
  • 77 Qamar MI. Read AE. Effects of exercise on mesenteric blood flow in man. Gut 1987; 28: 583-587
  • 78 Hollerweger A. Dirks K. Szopinski K. Transabdominal ultrasound of the gastrointestinal tract. In: Dietrich CF. editor EFSUMB Course Book on Ultrasound. 2012: 233-271
  • 79 Maconi G. Rigazio C. Ercole E. Bowel Ultrasound: Investigation Technique and Normal Findings. In: Maconi G. Bianchi Porro G. editors. Ultrasound of the Gastrointestinal tract. 2nd ed. Springer; 2014: 7-17
  • 80 Hollerweger A. Wustner M. Dirks K. Bowel Obstruction: Sonographic Evaluation. Ultraschall in Med 2015; 36: 216-235
  • 81 Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology 1986; 158: 355-360
  • 82 Puylaert JB. Rutgers PH. Lalisang RI. et al. A prospective study of ultrasonography in the diagnosis of appendicitis. N Engl J Med 1987; 317: 666-669
  • 83 Jeffrey Jr RB. Laing FC. Lewis FR. Acute appendicitis: high-resolution real-time US findings. Radiology 1987; 163: 11-14
  • 84 Niekel RA. Lampmann LE. Graded compression sonography in acute appendicitis. Rofo 1986; 145: 441-445
  • 85 Carroll PJ. Gibson D. El-Faedy O. et al. Surgeon-performed ultrasound at the bedside for the detection of appendicitis and gallstones: systematic review and meta-analysis. Am J Surg 2013; 205: 102-108
  • 86 Siegel MJ. Friedland JA. Hildebolt CF. Bowel wall thickening in children: differentiation with US. Radiology 1997; 203: 631-635
  • 87 Schwerk WB. Schwarz S. Rothmund M. Sonography in acute colonic diverticulitis. A prospective study. Dis Colon Rectum 1992; 35: 1077-1084
  • 88 Lameris W. van RA. Bipat S. et al. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol 2008; 18: 2498-2511
  • 89 Parra DA. Navarro OM. Sonographic diagnosis of intestinal polyps in children. Pediatr Radiol 2008; 38: 680-684
  • 90 Worlicek H. Dunz D. Engelhard K. Ultrasonic examination of the wall of the fluid-filled stomach. J Clin Ultrasound 1989; 17: 5-14
  • 91 Limberg B. Diagnosis and staging of colonic tumors by conventional abdominal sonography as compared with hydrocolonic sonography. N Engl J Med 1992; 327: 65-69
  • 92 Hirooka N. Ohno T. Misonoo M. et al. Sono-enterocolonography by oral water administration. J Clin Ultrasound 1989; 17: 585-589
  • 93 Pallotta N. Baccini F. Corazziari E. Ultrasonography of the small bowel after oral administration of anechoic contrast solution. Lancet 1999; 353: 985-986
  • 94 Schiller LR. Santa Ana CA. Porter J. et al. Validation of polyethylene glycol 3350 as a poorly absorbable marker for intestinal perfusion studies. Dig Dis Sci 1997; 42: 1-5
  • 95 Pallotta N. Civitelli F. Di NG. et al. Small intestine contrast ultrasonography in pediatric Crohn's disease. J Pediatr 2013; 163: 778-784
  • 96 Folvik G. Bjerke-Larssen T. Odegaard S. et al. Hydrosonography of the small intestine: comparison with radiologic barium study. Scand J Gastroenterol 1999; 34: 1247-1252
  • 97 European Commitee for MEdical Ultrasound Safety (ECMUS). EFSUMB clinical safety statement for diagnostic ultrasound (2015). European Commitee for Medical Ultrasound Safety (ECMUS). 2015 Available from: http://www.efsumb.org/guidelines/ss2015clinical.pdf
  • 98 ter Haar G. Ultrasound bio-effects and safety considerations. Front Neurol Neurosci 2015; 36: 23-30
  • 99 Piscaglia F. Bolondi L. The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 2006; 32: 1369-1375
  • 100 ter Haar G. Safety and bio-effects of ultrasound contrast agents. Med Biol Eng Comput 2009; 47: 893-900
  • 101 Wiersema MJ. Wiersema LM. High-resolution 25-megahertz ultrasonography of the gastrointestinal wall: histologic correlates. Gastrointest Endosc 1993; 39: 499-504
  • 102 Goldstein NS. Soman A. Sacksner J. Disparate surgical margin lengths of colorectal resection specimens between in vivo and in vitro measurements – The effects of surgical resection and formalin fixation on organ shrinkage. Am J Clin Pathol 1999; 111: 349-351
  • 103 Chiorean L. Schreiber-Dietrich D. Braden B. et al. Transabdominal ultrasound for standardized measurement of bowel wall thickness in normal children and those with Crohn's disease. Med Ultrason 2014; 16: 319-324
  • 104 Dialer I. Hundt C. Bertele-Harms RM. et al. Sonographic evaluation of bowel wall thickness in patients with cystic fibrosis. J Clin Gastroenterol 2003; 37: 55-60
  • 105 Haber HP. 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: 1239-1240
  • 106 Huh CH. Bhutani MS. Farfan EB. et al. Individual variations in mucosa and total wall thickness in the stomach and rectum assessed via endoscopic ultrasound. Physiol Meas 2003; 24: N15-N22
  • 107 Sandek A. Bauditz J. Swidsinski A. et al. Altered intestinal function in patients with chronic heart failure. J Am Coll Cardiol 2007; 50: 1561-1569
  • 108 Ferri E. Bonvicini U. Pisani M. Ultrasonography of normal vermiform appendix. Chir Ital 2001; 53: 231-238
  • 109 Simonovsky V. Sonographic detection of normal and abnormal appendix. Clin Radiol 1999; 54: 533-539
  • 110 Simonovsky V. Normal appendix: is there any significant difference in the maximal mural thickness at US between pediatric and adult populations?. Radiology 2002; 224: 333-337
  • 111 Kimmey MB. Hwang JH. Assessment of the Layered Structure of the Gastrointestinal Tract. In: Ødegaard S. Gilja OH. Gregersen H. editors Basic and New Aspects of Gastrointestinal Ultrasonography. Singapore: World Scientific; 2005: 167-188
  • 112 Odegaard S. Kimmey MB. Location of the muscularis mucosae on high frequency gastrointestinal ultrasound images. Eur J Ultrasound 1994; 1: 39-50
  • 113 Silverstein F. Kimmey M. Martin R. et al. Ultrasound and the intestinal wall: experimental methods. Scand J Gastroenterol Suppl 1986; 123: 34-40
  • 114 Jorgensen CS. Dall FH. Jensen SL. et al. A new combined high-frequency ultrasound-impedance planimetry measuring system for the quantification of organ wall biomechanics in vivo. J Biomech 1995; 28: 863-867
  • 115 Odegaard S. Kimmey MB. Martin RW. et al. The effects of applied pressure on the thickness, layers, and echogenicity of gastrointestinal wall ultrasound images. Gastrointest Endosc 1992; 38: 351-356
  • 116 Cosar S. Oktar SO. Cosar B. et al. Doppler and gray-scale ultrasound evaluation of morphological and hemodynamic changes in liver vascualture in alcoholic patients. Eur J Radiol 2005; 54: 393-399
  • 117 Erden A. Cumhur T. Olcer T. Superior mesenteric artery blood flow in patients with small bowel diseases: evaluation with duplex Doppler sonography. J Clin Ultrasound 1998; 26: 37-41
  • 118 Gentile AT. Moneta GL. Lee RW. et al. Usefulness of fasting and postprandial duplex ultrasound examinations for predicting high-grade superior mesenteric artery stenosis. Am J Surg 1995; 169: 476-479
  • 119 Kalantzis N. Rouvella P. Tarazis S. et al. Doppler US of superior mesenteric artery in the assessment of ulcerative colitis. A prospective study. Hepatogastroenterology 2002; 49: 168-171
  • 120 Schaberle W. Seitz K. Duplex ultrasound measurement of blood flow in the superior mesenteric artery. Ultraschall in Med 1991; 12: 277-282
  • 121 Sigirci A. Baysal T. Kutlu R. et al. Doppler sonography of the inferior and superior mesenteric arteries in ulcerative colitis. J Clin Ultrasound 2001; 29: 130-139
  • 122 Sjekavica I. Barbaric-Babic V. Krznaric Z. et al. Assessment of Crohn's disease activity by doppler ultrasound of superior mesenteric artery and mural arteries in thickened bowel wall: cross-sectional study. Croat Med J 2007; 48: 822-830
  • 123 Dinc H. Sari A. Resit GH. et al. Portal and splanchnic haemodynamics in patients with advanced post-hepatitic cirrhosis and in healthy adults. Assessment with duplex Doppler ultrasound. Acta Radiol 1998; 39: 152-156
  • 124 Ludwig D. Wiener S. Bruning A. et al. Mesenteric blood flow is related to disease activity and risk of relapse in Crohn's disease: a prospective follow-up study. Am J Gastroenterol 1999; 94: 2942-2950
  • 125 Piscaglia F. Zironi G. Gaiani S. et al. Relationship between splanchnic, peripheral and cardiac haemodynamics in liver cirrhosis of different degrees of severity. Eur J Gastroenterol Hepatol 1997; 9: 799-804
  • 126 Qamar MI. Read AE. Skidmore R. et al. Transcutaneous Doppler ultrasound measurement of superior mesenteric artery blood flow in man. Gut 1986; 27: 100-105
  • 127 Ray-Chaudhuri K. Ryder SA. Thomaides T. et al. The relationship between blood flow and pulsatility index in the superior mesenteric artery at rest and during constrictor stimuli in normal subjects. J Clin Ultrasound 1994; 22: 149-160
  • 128 Sato S. Ohnishi K. Sugita S. et al. Splenic artery and superior mesenteric artery blood flow: nonsurgical Doppler US measurement in healthy subjects and patients with chronic liver disease. Radiology 1987; 164: 347-352
  • 129 Ergun T. Lakadamyali H. Doppler ultrasound evaluation of morphological and hemodynamical changes of hepatic and mesenteric structures in end-stage renal disease patients on regular hemodialysis. Int Urol Nephrol 2010; 42: 205-210
  • 130 Sigirci A. Senol M. Aydin E. et al. Doppler waveforms and blood flow parameters of the superior and inferior mesenteric arteries in patients having Behcet disease with and without gastrointestinal symptoms: preliminary data. J Ultrasound Med 2003; 22: 449-457
  • 131 Odegaard S. Kimmey MB. Cheung AHS. et al. High frequency endosonography of gastrointestinal arteries: potential and limitations in vitro. Eur J Ultrasound 1995; 2: 313-319
  • 132 Heyne R. Rickes S. Bock P. et al. Non-invasive evaluation of activity in inflammatory bowel disease by power Doppler sonography. Z Gastroenterol 2002; 40: 171-175
  • 133 Scholbach T. Herrero I. Scholbach J. Dynamic color Doppler sonography of intestinal wall in patients with Crohn disease compared with healthy subjects. J Pediatr Gastroenterol Nutr 2004; 39: 524-528
  • 134 Yekeler E. Danalioglu A. Movasseghi B. et al. Crohn disease activity evaluated by Doppler ultrasonography of the superior mesenteric artery and the affected small-bowel segments. J Ultrasound Med 2005; 24: 59-65
  • 135 Ahn H. Lindhagen J. Nilsson GE. et al. Assessment of blood flow in the small intestine with laser Doppler flowmetry. Scand J Gastroenterol 1986; 21: 863-870
  • 136 Ahn H. Lindhagen J. Lundgren O. Measurement of colonic blood flow with laser Doppler flowmetry. Scand J Gastroenterol 1986; 21: 871-880
  • 137 Hulten L. Jodal M. Lindhagen J. et al. Blood flow in the small intestine of cat and man as analyzed by an inert gas washout technique. Gastroenterology 1976; 70: 45-51
  • 138 Hulten L. Jodal M. Lindhagen J. et al. Colonic blood flow in cat and man as analyzed by an inert gas washout technique. Gastroenterology 1976; 70: 36-44
  • 139 Tateishi S. Arima S. Futami K. Assessment of blood flow in the small intestine by laser Doppler flowmetry: comparison of healthy small intestine and small intestine in Crohn's disease. J Gastroenterol 1997; 32: 457-463
  • 140 Hollerweger A. Colonic diseases: the value of US examination. Eur J Radiol 2007; 64: 239-249
  • 141 Oldfield AL. Wilbur AC. Retrogastric colon: CT demonstration of anatomic variations. Radiology 1993; 186: 557-561
  • 142 Hollerweger A. Acute appendicitis: sonographic evaluation. Ultraschall in Med 2006; 27: 412-426
  • 143 Gilja OH. Braden B. Piscaglia F. et al. Functional ultrasound of the gastrointestinal tract. In: Dietrich CF. editor EFSUMB Course book on ultrasound. 1 ed. London: EFSUMB; 2015: 597-620
  • 144 Rettenbacher T. Hollerweger A. Macheiner P. et al. Outer diameter of the vermiform appendix as a sign of acute appendicitis: evaluation at US. Radiology 2001; 218: 757-762
  • 145 Lee YY. Erdogan A. Rao SS. How to assess regional and whole gut transit time with wireless motility capsule. J Neurogastroenterol Motil 2014; 20: 265-270
  • 146 Nylund K. Odegaard S. Hausken T. et al. Sonography of the small intestine. World J Gastroenterol 2009; 15: 1319-1330
  • 147 Rettenbacher T. Hollerweger A. Macheiner P. et al. Adult celiac disease: US signs. Radiology 1999; 211: 389-394
  • 148 Phillips SF. Functions of the large bowel: an overview. Scand J Gastroenterol Suppl 1984; 93: 1-12
  • 149 Walker TG. Mesenteric vasculature and collateral pathways. Semin Intervent Radiol 2009; 26: 167-174
  • 150 Schmutz GR. Benko A. Fournier L. et al. Small bowel obstruction: role and contribution of sonography. Eur Radiol 1997; 7: 1054-1058
  • 151 Pallotta N. Baccini F. Corazziari E. Small intestine contrast ultrasonography. J Ultrasound Med 2000; 19: 21-26
  • 152 Jaffe T. Thompson WM. Large-Bowel Obstruction in the Adult: Classic Radiographic and CT Findings, Etiology, and Mimics. Radiology 2015; 275: 651-663
  • 153 Taniguchi DK. Martin RW. Myers J. et al. Measurement of the ultrasonic attenuation of fat at high frequency. Acad Radiol 1994; 1: 114-120
  • 154 Liu KH. Chan YL. Chan WB. et al. Mesenteric fat thickness is an independent determinant of metabolic syndrome and identifies subjects with increased carotid intima-media thickness. Diabetes Care 2006; 29: 379-384
  • 155 Gottschalk U. Nitzsche C. Felber J. et al. Enteroscopy and imaging in sclerosing mesenteritis. Z Gastroenterol 2012; 50: 1013-1017
  • 156 Maconi G. Greco S. Duca P. et al. Prevalence and clinical significance of sonographic evidence of mesenteric fat alterations in Crohn's disease. Inflamm Bowel Dis 2008; 14: 1555-1561
  • 157 Puylaert JB. Ultrasound of colon diverticulitis. Dig Dis 2012; 30: 56-59
  • 158 Roson N. Garriga V. Cuadrado M. et al. Sonographic findings of mesenteric panniculitis: correlation with CT and literature review. J Clin Ultrasound 2006; 34: 169-176
  • 159 Vanhoenacker F. Vanwambeke K. Jacomen G. Amyloidosis: an unusual cause of mesenteric, omental and lymph node calcifications. JBR -BTR 2014; 97: 283-286
  • 160 Schreiber-Dietrich D. Braden B. Chiorean L. et al. Sonografische Darstellung mesenterialer Lymphknoten bei gesunden Kindern. Endo heute 2015; 28: 149-152
  • 161 Macari M. Hines J. Balthazar E. et al. Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients. Am J Roentgenol 2002; 178: 853-858
  • 162 Sivit CJ. Newman KD. Chandra RS. Visualization of enlarged mesenteric lymph nodes at US examination. Clinical significance. Pediatr Radiol 1993; 23: 471-475
  • 163 Watanabe M. Ishii E. Hirowatari Y. et al. Evaluation of abdominal lymphadenopathy in children by ultrasonography. Pediatr Radiol 1997; 27: 860-864
  • 164 Dietrich CF. Zeuzem S. Caspary WF. et al. Ultrasound lymph node imaging in the abdomen and retroperitoneum of healthy probands. Ultraschall in Med 1998; 19: 265-269
  • 165 Karmazyn B. Werner EA. Rejaie B. et al. Mesenteric lymph nodes in children: what is normal?. Pediatr Radiol 2005; 35: 774-777
  • 166 Lucey BC. Stuhlfaut JW. Soto JA. Mesenteric lymph nodes: detection and significance on MDCT. Am J Roentgenol 2005; 184: 41-44
  • 167 Cui XW. Jenssen C. Saftoiu A. et al. New ultrasound techniques for lymph node evaluation. World J Gastroenterol 2013; 19: 4850-4860
  • 168 Chiorean L. Barr RG. Braden B. et al. Transcutaneous Ultrasound: Elastographic Lymph Node Evaluation. Current Clinical Applications and Literature Review. Ultrasound Med Biol 2016; 42: 16-30
  • 169 Fraquelli M. Colli A. Colucci A. et al. Accuracy of ultrasonography in predicting celiac disease. Arch Intern Med 2004; 164: 169-74
  • 170 Hollerweger A. Macheiner P. Neureiter D. et al. Uncommon cystic appearance of lymph nodes in malignant lymphoma. Ultraschall in Med 2008; 29: 308-310
  • 171 Maconi G. Di SA. Ardizzone S. et al. Prevalence and clinical significance of sonographic detection of enlarged regional lymph nodes in Crohn's disease. Scand J Gastroenterol 2005; 40: 1328-1333
  • 172 Tarantino L. Giorgio A. De SG. et al. Disseminated mycobacterial infection in AIDS patients: abdominal US features and value of fine-needle aspiration biopsy of lymph nodes and spleen. Abdom Imaging 2003; 28: 602-608
  • 173 Standards for the provision of an ultrasound service. The Royal College of Radiologists, The society and college of Radiographers. 2014 Available from: https://www.rcr.ac.uk/sites/default/files/documents/BFCR(14)17_Standards_ultrasound.pdf
  • 174 Terasawa T. Blackmore CC. Bent S. et al. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 2004; 141: 537-546
  • 175 van Randen A. Bipat S. Zwinderman AH. et al. Acute appendicitis: meta-analysis of diagnostic performance of CT and graded compression US related to prevalence of disease. Radiology 2008; 249: 97-106
  • 176 Le J. Kurian J. Cohen HW. et al. Do clinical outcomes suffer during transition to an ultrasound-first paradigm for the evaluation of acute appendicitis in children?. Am J Roentgenol 2013; 201: 1348-1352
  • 177 Parker L. Nazarian LN. Gingold EL. et al. Cost and radiation savings of partial substitution of ultrasound for CT in appendicitis evaluation: a national projection. Am J Roentgenol 2014; 202: 124-135
  • 178 Atema JJ. Gans SL. van RA. et al. Comparison of Imaging Strategies with Conditional versus Immediate Contrast-Enhanced Computed Tomography in Patients with Clinical Suspicion of Acute Appendicitis. Eur Radiol 2015; 25: 2445-2452
  • 179 Andeweg CS. Wegdam JA. Groenewoud J. et al. Toward an evidence-based step-up approach in diagnosing diverticulitis. Scand J Gastroenterol 2014; 49: 775-784
  • 180 Andeweg CS. Mulder IM. Felt-Bersma RJ. et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg 2013; 30: 278-292
  • 181 Kruis W. Germer CT. Leifeld L. Diverticular disease: guidelines of the german society for gastroenterology, digestive and metabolic diseases and the german society for general and visceral surgery. Digestion 2014; 90: 190-207
  • 182 Gasche C. Moser G. Turetschek K. et al. Transabdominal bowel sonography for the detection of intestinal complications in Crohn's disease. Gut 1999; 44: 112-117
  • 183 Grunshaw ND. Renwick IG. Scarisbrick G. et al. Prospective evaluation of ultrasound in distal ileal and colonic obstruction. Clin Radiol 2000; 55: 356-362
  • 184 Unluer EE. Yavasi O. Eroglu O. et al. Ultrasonography by emergency medicine and radiology residents for the diagnosis of small bowel obstruction. Eur J Emerg Med 2010; 17: 260-264
  • 185 Hirche TO. Russler J. Schroder O. et al. The value of routinely performed ultrasonography in patients with Crohn disease. Scand J Gastroenterol 2002; 37: 1178-1183
  • 186 Dietrich CF. Lembcke B. Jenssen C. et al. Intestinal Ultrasound in Rare Gastrointestinal Diseases, Update, Part 2. Ultraschall in Med 2015; 36: 428-456
  • 187 Dietrich CF. 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: 242-247
  • 188 Maconi G. Radice E. Bareggi E. et al. Hydrosonography of the gastrointestinal tract. Am J Roentgenol 2009; 193: 700-708