Magnetic resonance imaging based colonography for diagnosis and assessment of diverticulosis and diverticulitis

Schreyer, A.; Fürst, Alois; Agha, Ayman; Kikinis, Ron; Scheibl, Karl; Schölmerich, Jürgen; Feuerbach, Stefan; Herfarth, Hans H; Seitz, Johannes

doi:10.1007/s00384-004-0587-3

Cited by 43 publications

(44 citation statements)

References 28 publications

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“…The technique was evaluated only in small, mainly selected patient populations [59,60]. The results of the studies allow the conclusion only that MRI with oral or rectal contrast enhancement and intravenous contrast administration yields similar results to CT. By way of reservation, however, it must be mentioned that there are no robust studies of complicated diverticulitis and of small quantities of free air in the case of concealed perforation.…”

Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 93%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

132

117

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Background: Diverticular disease is one of the most common disorders of the gastrointestinal tract. 28-45% of the population develop colonic diverticula, while about 25% suffer symptoms and about 5% complications. Aim: To create formal guidelines for diagnosis and management. Methods: Six working groups with 44 participants analyzed key questions in subject areas assigned to them. Following a systematic literature search, 451 publications were included. Consensus was obtained by agreement within the working groups, two Delphi processes and a guideline conference. Results: Targeted management of diverticular disease requires a classificatory diagnosis. A new classification was created. In addition to the clinical examination, intestinal ultrasound or computed tomography is the determining factor. Interval colonoscopy is recommended to exclude comorbidities. A low-fiber diet, obesity, lack of exercise, smoking and immunosuppression have an adverse impact on diverticulosis. This can lead to diverticulitis. Antibiotics are no longer recommended in uncomplicated diverticulitis if no risk factors such as immunosuppression are present. If close monitoring is ensured, uncomplicated diverticulitis can be treated on an outpatient basis. Complicated diverticulitis should be treated in hospital, involving broad-spectrum antibiotic therapy, where necessary abscess drainage, and surgery, if possible laparoscopically. In the case of chronic relapsing diverticulitis, the risk of perforation decreases with each episode, so that surgery is no longer recommended after the second episode but only following individual assessment. Conclusions: New findings on diverticular disease call into question the overuse of antibiotics and excessive indications for surgery. Targeted treatment requires a precise diagnosis and intensive interdisciplinary cooperation. i 2014 S. Karger AG, Basel

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Section: History-taking Basic Diagnostic Procedures Differential DImentioning

confidence: 93%

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Kruis

Germer²,

Leifeld³

et al. 2014

Digestion

132

117

View full text Add to dashboard Cite

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“…MRI has the advantage that no ionizing radiation and intravenous contrast medium are needed to reach a higher soft tissue contrast than CT. MRI is increasingly used in the acute setting for patients with acute abdominal pain, but accuracy data are still limited. Based on studies with small numbers of patients, sensitivity and specificity of MRI for diagnosing ACD vary between 86 and 100% and 88 and 100% (level B [67,68] and level C [69,70]).…”

Section: Clinical Diagnosis and Radiological Imagingmentioning

confidence: 99%

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Andeweg¹,

Mulder²,

et al. 2013

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Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. Methods: A multidisciplinary working group, representing experts of relevant specialties, was involved in the guideline development. A systematic literature search was conducted to collect scientific evidence on epidemiology, classification, diagnostics and treatment of diverticulitis. Literature was assessed using the classification system according to an evidence-based guideline development method, and levels of evidence of the conclusions were assigned to each topic. Final recommendations were given, taking into account the level of evidence of the conclusions and other relevant considerations such as patient preferences, costs and availability of facilities. Results: The natural history of diverticulitis is usually mild and treatment is mostly conservative. Although younger patients have a higher risk of recurrent disease, a higher risk of complications compared to older patients was not found. In general, the clinical diagnosis of ACD is not accurate enough and therefore imaging is indicated. The triad of pain in the lower left abdomen on physical examination, the absence of vomiting and a C-reactive protein >50 mg/l has a high predictive value to diagnose ACD. If this triad is present and there are no signs of complicated disease, patients may be withheld from further imaging. If imaging is indicated, conditional computed tomography, only after a negative or inconclusive ultrasound, gives the best results. There is no indication for routine endoscopic examination after an episode of diverticulitis. There is no evidence for the routine administration of antibiotics in patients with clinically mild uncomplicated diverticulitis. Treatment of pericolic or pelvic abscesses can initially be treated with antibiotic therapy or combined with percutaneous drainage. If this treatment fails, surgical drainage is required. Patients with a perforated ACD resulting in peritonitis should undergo an emergency operation. There is an ongoing debate about the optimal surgical strategy. Conclusion: Scientific evidence is scarce for some aspects of ACD treatment (e.g. natural history of ACD, ACD in special patient groups, prevention of ACD, treatment of uncomplicated ACD and medical treatment of recurrent ACD), leading to treatment being guided by the surgeon's personal preference. Other aspects of the management of patients with ACD have been more thoroughly researched (e.g. imaging techniques, treatment of complicated ACD and elective surgery of ACD). This guideline of the diagnostics and treatment of ACD can be used as a reference for clinicians who treat patients with ACD.

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“…BMI ͑kg/m 2 ͒ ϭ weight in kilograms/height in meters 2 The mean BMI amounted to 26.9 (range ϭ 16 -37).…”

Section: Patientsmentioning

confidence: 99%

“…This modality is very accurate for the depiction of colorectal masses as well as inflammatory processes (1,2). Furthermore, MRC may provide important information in patients with incomplete optical colonoscopy (3,4).…”

mentioning

confidence: 99%

MR colonography with fecal tagging: Do individual patient characteristics influence image quality?

Kinner¹,

Kuehle²,

Langhorst³

et al. 2007

Magnetic Resonance Imaging

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Purpose:To evaluate if different patient characteristics influence performance of fecal tagging (a new MR colonography (MRC) technique to label stool to avoid bowel cleansing) and, consecutively, MR image quality. Materials and Methods:A total of 333 patients (mean age ϭ 61 years) underwent MRC with fecal tagging. Four segments of the large bowel (ascending, transverse, descending, and sigmoid colon) were assessed as for the presence of nontagged stool particles, which can impede an assessment of the colonic wall. Ratings were correlated with patients' characteristics including patient age (Ͻ55 vs. Ն55 years), body mass index (BMI) (Ͻ25 vs. Ն25), gender, and acceptance levels for fecal tagging. Statistical analysis was performed using a Mann-Whitney U-test.Results: A total of 1332 colonic segments were evaluated. Among them, 327 segments (25%) did not contain any visible stool particles. Considerably reduced image quality was found in 61 segments (5%). Best image quality was found in the sigmoid colon (mean value ϭ 1.9), while image quality of the ascending colon turned out to be worst (mean value ϭ 2.6). Fecal tagging effectiveness showed a reverse correlation with patient age. However, all other characteristics did not have a statistically significant influence on fecal tagging outcome.Conclusion: MRC in conjunction with barium-based fecal tagging led to diagnostic image quality in 95% of all colonic segments. Since tagging results were significantly decreased in patients Ն55 years, tagging protocols should to be modified in this group, i.e., by increasing the time interval of tagging administration.

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Magnetic resonance imaging based colonography for diagnosis and assessment of diverticulosis and diverticulitis

Cited by 43 publications

References 28 publications

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Diverticular Disease: Guidelines of the German Society for Gastroenterology, Digestive and Metabolic Diseases and the German Society for General and Visceral Surgery

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

MR colonography with fecal tagging: Do individual patient characteristics influence image quality?

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