Limberg score

Last revised by Dr Bálint Botz on 26 Sep 2021

Limberg score is a semiquantitative color Doppler ultrasound assessment of the bowel wall vascularity in inflammatory bowel disease

  • grade 0: normal bowel wall with no thickening (<4 mm), well-delineated mural stratification, no mural flow (no color Doppler signal)    
  • grade 1: wall thickening (hypoechoic wall thickening and partially obscured mural stratification) and absent mural flow 
  • ​grade 2 ("hypo-flow"): wall thickening with intermittent (or "spot") increases in vascularity
  • grade 3 ("hyper-flow"): wall thickening with protracted stretches of increased vascularity
  • grade 4 ("hyper-flow"): color flow Doppler signals in both the bowel wall and surrounding mesenteric fat

Practical points

  • increased vascularization (Limberg score 2 or above) is considered abnormal 
  • hyperemia or increased vascularization is defined based on color Doppler signal with the patient’s breath held in expiration
  • vascularity should be assessed with a high frequency linear array probe
  • the original study used retrograde water instillation (hydrocolonic sonography), however more recent investigators successfully applied the scoring system to ultrasonography without such preparations 2
  • it has been shown that the Limberg score demonstrates good correlation with endoscopic and gross surgical disease severity 2

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