High-frequency ultrasonographic imaging of the gastrointestinal wall

Figures & data

Figure 1. Overall histological organization of the digestive tube.

Adapted with permission from [1] © Elsevier.

Figure 2. Relationship between histological and ultrasonographic gastrointestinal wall layers.

(A) The ultrasonographic five-layer and (B) nine-layer gastrointestinal wall structure. The interface echoes of the ultrasound image will appear continuous with the echo-rich wall layers. By thickening of the Mm and a visible interface echo generated between the inner and outer part of the muscularis propria, up to nine different layers can be separated by ultrasonography.

Mm: Muscularis mucosae.

Reproduced with permission from [56].

Figure 3. A five-layered structure of the gastric wall showing Menetriers disease.

A thickened layer 2 corresponding to the gastric mucosa is seen (arrows). Reproduced with permission from [56].

Figure 4. Elastography in Crohn’s disease of the gastrointestinal tract.

(A) Elastogram in which the blue color indicates a hard and thickened anterior and posterior gastrointestinal wall. (B) Corresponding grayscale ultrasound image.

Figure 5. Gastric contraction demonstrated by intraluminal ultrasonography.

(A) An ultrasound miniprobe (p) is placed in the relaxed water-filled antral part of the stomach. (B) A contraction with thickening of the mp is seen.

m: Mucosa; mp: Muscularis propria; p: Probe; sm: Submucosa. Reproduced with permission from [56].

Figure 6. Contrast-enhanced ultrasonography of the gastrointestinal wall.

(A) B-mode image of the terminal ileum where a diseased bowel loop has fused causing a sharp turn and an obstruction. (B) The corresponding image in contrast mode at the time of injection showing only interface echoes in the abdominal wall. (C) Just after the arrival of contrast in the right iliac artery and the bowel submucosa. (D) The contrast enhancement has reached maximum intensity. It is not only brighter in the submucosa but also filling the mucosa and proper muscle.

Image courtesy of K Nylund.

Figure 7. 3D ultrasonography of an infiltrating tumor in the cardia is seen in two scanning planes (b and c).

Scanning plane a goes through the ultrasound probe and is outside the data set of the tumor. The ultrasound probe is indicated by the arrow.

tu: Inflitrating tumor.

Reproduced with permission from [56].

Figure 8. Ultrasound-guided fine-needle puncture. (A–C)

t is seen close to a v. Fine-needle aspiration is performed through the duodenal wall. The echo of the puncture needle is seen (arrow) (C). The final diagnosis was sarcoma.

t: Tumor; v: Vessel.

Reproduced with permission from [56].

Table 1. Ultrasonography layer location and echogenicity of gastrointestinal intramural masses.

US layer	Echogenicity	Diagnosis
2	Hypoechoic	Leiomyoma of muscularis mucosaeGranular cell tumor
2, 3 or 4	Anechoic	Duplication cystVarices (+ Doppler signal)
2 or 3	Hypoechoic	Pancreatic restCarcinoidGranular cell tumorLeiomyoma of muscularis mucosae
3	Hyperechoic	LipomaFibroma
3 or 4	Hypoechoic	Lymphangioma
4	Hypoechoic	GI stromal tumorLeiomyomaSchwannoma
5	Variable	Normal and abnormal extramural organs and pathologic structures (e.g., pseudocyst)

GI: Gastrointestinal; US: Ultrasonography.

Kierszenbaum AL, Tres L. Histology and Cell Biology. An Introduction to Pathology (3rd Edition). Elsevier Saunders, PA, USA (2011).

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