The gut signature sign is an ultrasound term used to describe the appearance of the gastrointestinal wall.
Radiographic features
Ultrasound
The bowel wall has five layers, composed of alternating hyperechoic and hypoechoic appearances. Anatomically these layers are as follows (innermost to outermost) 1,2:
superficial mucosa: echogenic
muscularis mucosa: hypoechoic
submucosa: echogenic (this is the thickest layer 1)
muscularis propria: hypoechoic
serosa: echogenic
The gut signature can be used to differentiate benign conditions, where gut signature is preserved and long segments of bowel are involved from malignant conditions where there is destruction of gut signature usually short segments of bowel 2.
It can also be used to identify the appendix, enteric duplication cysts, or differentiate bowel from intra-abdominal fluid collections.
Differential diagnosis
An intussusception may demonstrate prominent bowel walls on ultrasound with a differing configuration from the normal five layers:
target sign (cross-sectional) and pseudokidney sign (longitudinal)
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