Frequency, Sensitivity, and Specificity of Individual Signs of  Diverticulitis on Thin-Section Helical CT with Colonic Contrast Material:  Experience with 312 Cases

Kircher, Moritz F.; Rhea, James T.; Kihiczak, Danylo; Novelline, Robert A.

doi:10.2214/ajr.178.6.1781313

Cited by 140 publications

(80 citation statements)

References 22 publications

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“…Computed tomography (CT) has emerged as the imaging modality of choice given its high sensitivity and specificity for the diagnosis of diverticulitis, with some studies reporting up to 100% in either measure. [3][4][5][6][7][8] Computed tomography findings of diverticula, inflammation of pericolic fat, bowel wall thickness greater than 4 mm and/or pericolic fluid/abscess are highly suggestive of acute diverticulitis. 1,8,9 A CT scan also provides prognostic information and guides management by determining whether the diverticulitis is complicated by abscess, fistula formation, stricture/obstruction or free rupture.…”

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confidence: 99%

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Rosenfeld

Brown

et al. 2015

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Background: Computed tomography (CT) scans are commonly used to diagnose acute diverticulitis, but there are overlapping features between diverticulitis and colorectal cancer (CRC) on imaging studies. Hence, colonoscopy is typically recommended after an episode of acute diverticulitis to rule out underlying malignancy. Currently, 64-slice multidetector CT scanners are capable of providing higher-resolution images and may be able to distinguish malignancy from diverticular inflammation. We aimed to determine the prevalence of CRC among patients with CT-diagnosed acute diverticulitis. Methods:We performed a retrospective study of patients with acute diverticulitis diagnosed on CT scan between December 2005 and December 2010 at St. Paul's Hospital, Vancouver, BC. Nonresidents were excluded. We reviewed CT scan reports that included the term "diverticulitis," reports of follow-up colonic evaluation within 1 year of diagnosis and pathology results. We queried the provincial cancer registry to ensure no cases of CRC were missed.Results: A total of 293 patients had acute diverticulitis diagnosed on CT scan, but 8 were nonresidents and were excluded. Of the 285 included in the analysis, the mean age was 59.4 ± 15.1 years, and 167 (58.6%) were men. Among the 114 patients who underwent follow-up evaluation, malignancy was diagnosed in 4 (3.5%). The overall prevalence of malignancy among patients with CT-diagnosed diverticulitis was 1.4%. Conclusion:Routine endoscopic evaluation after an episode of diverticulitis diagnosed with high-resolution CT scan does not appear to be necessary. Selective approach in patients with protracted clinical course or those with mass lesion/ obstruction on CT scan may be of benefit.Contexte : La tomodensitométrie (TDM) est couramment utilisée pour le diagnostic de la diverticulite aiguë, mais des caractéristiques sont communes à la diverticulite et au cancer colorectal (CCR) aux épreuves d'imagerie. On recommande donc en général la coloscopie après un épisode de diverticulite aiguë pour écarter un diagnostic de cancer sous-jacent. À l'heure actuelle, les appareils de TDM multidétecteurs à 64 barrettes peuvent fournir des images de haute résolution et permettent même de distinguer le cancer d'une inflammation diverticulaire. Nous avons voulu déterminer la prévalence du CCR chez les patients ayant présenté une diverticulite aiguë diagnostiquée par TDM. Résultats : En tout, 293 patients ont reçu un diagnostic de diverticulite à l'aide de la TDM; 8 étaient des non-résidents et ont été exclus. Parmi les 285 patients inclus dans l'analyse, l'âge moyen était de 59,4 ± 15,1 ans et 167 (58,6 %) étaient des hommes. Parmi les 114 patients qui ont subi un examen de suivi, le cancer a été diagnostiqué chez 4 (3,5 %). La prévalence globale du cancer chez les patients porteurs d'un diagnostic de diverticulite posé par TDM était de 1,4 %. Conclusion :L'évaluation endoscopique de routine après un épisode de diverticulite diagnostiquée à l'aide d'une TDM de haute résolution ne semble pas nécessaire. Une approc...

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confidence: 99%

Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?

Rosenfeld

Brown

et al. 2015

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“…To our knowledge, only two studies in the literature have shown that fecalith may result in diverticulitis and become calcified and visible [6,7]. In our patient, the fecalith became calcified and visible, and we were therefore able to make an appropriate diagnosis.…”

Section: Discussionmentioning

confidence: 49%

“…Moreover, when administered orally, the contrast material requires at least two hours to fill the colon [6]. Kircher et al [7] used a rectal contrast material instead of an oral or intravenous contrast material in 312 patients and reported 99% sensitivity and specificity in their study. Thickening of the intestinal mucosa and fat stranding are the most specific symptoms of diverticulitis [8].…”

Section: Discussionmentioning

confidence: 99%

Transverse Colon Diverticulitis with Calcified Fecalith

Solak

Genç

et al. 2013

EAJM

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Left colonic diverticula are common in Western populations, whereas right colonic diverticulosis primarily occurs in Oriental populations. Diverticulitis of the transverse colon is very rare, with very few cases reported in the literature. Herein, we report a case of transverse colon diverticulitis caused by a calcified stone in a 69-year-old female. This was a solitary diverticulum. The signs and symptoms of the disease are similar to acute pancreatitis. To the best of our knowledge, this is the first report describing the MRI findings of a patient with transverse colon diverticulitis caused by a calcified stone. Key Words: Diverticulitis, Fecalith, Transverse colon ÖzetDivertiküller sıklıkla batı ülkelerinde sol kolonda doğu ülkelerinde sağ kolonda yerleşirler. Transvers kolonda divertikülit son derece nadirdir ve literatürde çok az olguda bildirilmiştir. Biz burada 69 yaşındaki bayan hastada kalsifiye fekalitin yol açtığı transvers kolon divertikülitini sunuyoruz.Lezyon soliterdir. Hastalığın bulguları akut pankreatite benzemektedir. Bildiğimiz kadarıyla, bu olgu sunumu, kalsifiye fekalitin yol açtığı transvers kolon divertikülitinin MR bulgularının tanımlandığı ilk yazıdır.

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“…This may be associated with the increasing use of CT recently in the emergency radiology. Some studies in the literature also demonstrated that right colonic diverticulitis can be correctly diagnosed using radiologic evaluation [15,16]. Without any further imaging modalities such as CT, right-sided diverticulitis, in particular cecal diverticulitis is quite difficult to distinguish from acute appendicitis before surgery based only on clinical presentations, and the percentage of misdiagnosis is over 90% [17,18].…”

Section: Discussionmentioning

confidence: 99%