Laura Beatrice 1, Junwei Föhr 1, Paula Grest 2, Maja Ruetten 3, Manfred Henrich 4, Simona Vincenti 5, Karolin Campbell 6, Peter Hendrik Kook 1
Background
Feline chronic enteropathy, encompassing LPE and LGITL, presents similarly clinically, making differentiation challenging. Diagnostic uncertainty remains, particularly between histology/immunohistochemistry (IHC) and clonality testing. Ultrasonography is routinely used but its efficacy in distinguishing between these conditions is unclear. This study aimed to determine if ultrasonographic measurements differ based on diagnostic method and to assess changes post-treatment.
Methods
Sixteen cats underwent comprehensive diagnostics including full-thickness intestinal biopsies and ultrasonography. Diagnoses were made via histology/IHC and clonality testing. Ultrasonographic measurements were taken from the duodenum, jejunum, ileum, and mesenteric lymph nodes. Ratios of intestinal wall layers were calculated. Follow-up ultrasonography was performed at 12 and 24 weeks after treatment—prednisolone for LPE and prednisolone plus chlorambucil for LGITL. Statistical analyses included linear mixed models and repeated measures ANOVA.
Results
No significant differences in ultrasonographic measurements were observed between LPE and LGITL, regardless of whether histology/IHC or clonality was used as the diagnostic standard. Among cats with LPE, a significant decrease in the muscularis-to-total wall thickness ratio was observed at both 12 and 24 weeks of treatment. No other ultrasonographic variable showed significant change over time. Discordant diagnoses between histology/IHC and clonality occurred in 38% of cats, impacting clinical outcomes and treatment choices.
Limitations
The study's small sample size, particularly for follow-up assessments, limited statistical power. Additionally, ultrasonographic and histological sampling sites could not be precisely matched, which may have introduced measurement variability. The study's design also precluded evaluation of ultrasonographic changes in untreated or differently treated cohorts.
Conclusions
Ultrasonographic measurements and wall layering do not distinguish between LPE and LGITL in cats, irrespective of diagnostic method. However, a decrease in the muscularis-to-wall thickness ratio in LPE during treatment may represent a marker of response. Larger studies are needed to validate these findings and explore their clinical utility.
Ultrasonographic transversal image of the jejunum (white arrow; 8–12 MHz linear transducer). The red marking indicates the total wall thickness, the purple marking the lamina muscularis, the green marking the submucosa, and the orange marking the mucosa.
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