When a BWT Reading Without Stratification Is Clinically Incomplete
A bowel wall thickness of 4.2mm means something different depending on whether stratification is preserved. A thickened wall with preserved layering suggests a different disease process than the same measurement with loss of stratification — the latter is associated with more advanced transmural inflammation, fibrosis, or in some contexts malignant infiltration. Reporting only BWT without the stratification finding is like reporting a peak FEV1 without the ratio: technically a number, but not the diagnosis.
This template structures the IUS report so that BWT1 and BWT2 measurements travel with stratification status and mesenteric fat findings for each bowel segment — sigmoid, descending, transverse, ascending colon, terminal ileum, and rectum. Each segment section is self-contained. The clinician reading the record sees the complete picture for each segment, not a list of numbers that have to be mentally mapped back to their anatomical context.
The Doppler Lacroix Score Across Segments
The Doppler field in each segment section uses the LS0 through LS3 Lacroix scoring system. LS0 means no detectable flow signal. LS3 means extensive vascular signal throughout the bowel wall thickness. The significance of this is direct: Doppler activity at LS2 or LS3 in the terminal ileum of a Crohn's patient correlates with active transmural inflammation and a higher likelihood of clinical relapse on current therapy. It's one of the key parameters IBD specialists use to guide escalation decisions without putting the patient through a colonoscopy.
Recording Doppler by segment rather than as a global impression allows tracking of segmental disease activity over serial scans. A patient with quiescent sigmoid disease but LS2 activity in the ascending colon on a previous scan, now showing LS2 in the terminal ileum as well, has a proximal disease extension pattern that a single global impression would obscure entirely.
Complications and the Structured Approach to IBD Complications
The Complications multichoice field — Strictures, Fistulas, Abscesses, None — is the differential that changes everything downstream about patient management. A stricture in the terminal ileum of a Crohn's patient determines whether surgery is on the table and what kind of surgery makes sense. A perianal fistula finding, combined with a pelvic abscess on the same scan, is an acute finding that routes directly to colorectal surgery consultation. None is a defined state, not an absence of entry. The distinction matters when you're reviewing records and need to know whether the complication field was completed or simply not filled.
The Indications field anchors the report to its clinical question. Crohn's Disease, Ulcerative Colitis, IBS, Pouchitis, Diverticulitis, Intestinal TB — each of these indications sets a different interpretive frame for the BWT readings. A BWT of 3.5mm in a segment that was 2.8mm at the previous scan means more when the indication is Crohn's monitoring than when the indication is IBS workup, because the threshold for clinical significance differs between them.
The Old report file attachment field is the continuity link. Serial IUS monitoring in IBD is only interpretable as a trend. The previous report sitting in the same record as the current findings is what makes the serial comparison possible without switching systems or hunting through separate archives.