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, subsequent investigators have 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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