Notes
Categories
- grade 0:
- normal bowel wall with no thickening
- well-delineated mural stratification
- no mural flow (no signal on color Doppler)
- grade 1:
- wall thickening (hypoechoic wall thickening and partially obscured mural stratification)
- absent mural flow on color Doppler
- grade 2 (“hypo-flow”):
- wall thickening
- intermittent, spot-like focal increases in vascularity
- grade 3 (“hyper-flow”):
- wall thickening
- diffusely increased mural vascularity
- grade 4 (“hyper-flow”):
- wall thickening
- increased color Doppler signal in both the bowel wall and the adjacent mesenteric fat
Practical points
- A score of 2 and above is considered abnormal.
- Vascularity should be assessed during expiration and with color Doppler. Note that the score predates more advanced mircovascular flow imaging techniques (superb microvascular imaging etc.) and was not designed with these techniques in mind.
- The bowel should be interrogated with a linear array probe.
- The range of velocity should allow visualization of slow flow (~4cm/s), and color gain should be at the highest possible level without noise.
- Wall thickening is defined as >4 mm thickness.
- This score was designed for the assesment of Crohn’s disease and ulcerative colitis. It has been shown that mural stratification is most commonly lost in Crohn’s disease, while it is typically spared in ulcerative colitis.
- The original approach involved retrograde water instillation (hydrocolonic sonography), which is however rarely used in the current clinical practice.
- In more recent studies the Limberg score has been successfully used without such preparations, likely due to the marked improvements in ultrasound technology since the original publication.
- It has been also shown that the Limberg score correlates well with endoscopic and macroscopic surgical inflammation severity.
- Sasaki T, Kunisaki R, Kinoshita H, Yamamoto H, Kimura H, Hanzawa A, Shibata N, Yonezawa H, Miyajima E, Sakamaki K, Numata K, Tanaka K, Maeda S. Use of color Doppler ultrasonography for evaluating vascularity of small intestinal lesions in Crohn’s disease: correlation with endoscopic and surgical macroscopic findings. Scand J Gastroenterol. 2014 Mar;49(3):295-301. doi: 10.3109/00365521.2013.871744. Epub 2013 Dec 18. PMID: 24344807.
- [the above article contains excellent illustrations of the various grades of the score]
- For a brief overview make sure to visit the radiopaedia.org article.
Last updated: 2021-09-26