Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn's disease and other abdominal conditions

Aim: To evaluate the diagnostic accuracy of the contrast-enhanced ultrasound (CEUS) to differentiate between intra-abdominal phlegmon and abscess. Methods: We retrospectively reviewed all contrast-enhanced ultrasound performed between June 2006 and May 2012 to identify patients with the terms inflammatory mass, phlegmon or abscess on the sonographic report. The initial CEUS report was used for the diagnosis of phlegmon or abscess. Results: 71 inflammatory masses in 50 patients were identified in CEUS examination. 57 masses, 21 phlegmons and 36 abscesses, were confirmed by other imaging techniques, percutaneous drainage or surgery. CEUS specificity for the diagnosis of abscess was 100%. Kappa coefficient between CEUS and other techniques in the diagnosis of phlegmon or abscess was excellent (kappa = 0.972). Only in one patient surgery detected a small abscess (<2 cm) within a phlegmon that not was detected by CEUS. Statistically significant differences were found between the size of the abscesses before and after contrast agent injection. The interobserver agreement in the diagnosis of phlegmon or abscess was excellent (kappa = 0.953). Conclusions: CEUS is an accurate method for differentiating between intra-abdominal phlegmon and abscess in gastrointestinal conditions, especially in CD. Its use may help to better define the size of the collections and avoid other techniques that use ionizing radiation. CEUS should be used to confirm an inflammatory mass identified at US. (C) 2013 Elsevier Ireland Ltd. All rights reserved.