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Diagnostic Accuracy of Acute Diverticulitis with Non-Enhanced Low-Dose CT
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Department of Radiology, Västmanlands Hospital, Västerås, Sweden..
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
Department of Diagnostic Radiology, The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK.
Colorectal Unit, Department of Surgery, Landstinget Dalarna, Mora, Sweden..
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2018 (English)In: Article in journal (Other academic) Submitted
Abstract [en]

Purpose: To evaluate the diagnostic accuracy of non-enhanced low-dose computed tomography (LDCT) in acute colonic diverticulitis with contrast-enhanced standard-dose CT (SDCT) as the reference method.

Materials and Methods: Consecutive patients with clinically suspected diverticulitis were included from two hospitals between January and October 2017. All patients underwent LDCT followed by SDCT. All CT examinations were assessed for signs of diverticulitis, complications, and other diagnoses by three independent radiologists (two radiology consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity, specificity, and agreement were calculated.

Results: In total, 149 patients (median age 68, 107 women) were included; 107 had diverticulitis on standard CT. Sensitivity for diverticulitis using LDCT was 100%; the values were 99% for consulting radiologists and 92% for the radiology resident. Specificity was 100% for both consultants and 84% for the resident. Sensitivity for identification of complications was 74%, 60%, and 54%, respectively. Twenty-six patients had other causes of abdominal symptoms on standard CT, 23 (88%) of whom were diagnosed correctly on LDCT. One case of splenic infarction and two cases of segment colitis were missed on LDCT.

Conclusion: The diagnostic accuracy of LDCT was high for acute diverticulitis. Therefore, it is recommended as a standard method that should help to reduce radiation dose and cost. LDCT had lower sensitivity for complications, although discrimination between an inflamed diverticulum and small pericolic abscess accounted for a proportion of the discrepancies.

Place, publisher, year, edition, pages
2018.
National Category
Medical and Health Sciences Radiology, Nuclear Medicine and Medical Imaging
Research subject
Radiology; Surgery
Identifiers
URN: urn:nbn:se:uu:diva-356709OAI: oai:DiVA.org:uu-356709DiVA, id: diva2:1236679
Available from: 2018-08-03 Created: 2018-08-03 Last updated: 2018-08-06Bibliographically approved
In thesis
1. Acute Colonic Diverticulitis: The role of computed tomography in primary diagnosis, prediction of complications and surgical intervention
Open this publication in new window or tab >>Acute Colonic Diverticulitis: The role of computed tomography in primary diagnosis, prediction of complications and surgical intervention
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to expand the current knowledge regarding the advantages and limitations of computed tomography (CT) for patients with acute diverticulitis and evaluate outpatient treatment for uncomplicated diverticulitis.

Paper I: A retrospective evaluation of 602 patients with reported uncomplicated diverticulitis. Scans were re-evaluated and the degree of inflammation was graded. Signs of complications or other diseases were also noted. No radiological findings on CT could predict the development of complications or recurrence in patients with uncomplicated diverticulitis. However, 44 patients (7.3%) had signs of complicated diverticulitis that had been overlooked on the initial assessment. Despite small complications and a non-antibiotic treatment, the majority of patients recovered without incident, further strengthening the non-antibiotic treatment strategy.

Paper II: A retrospective analysis of conservative treatment for perforated diverticulitis (n = 136) during a 5-year period. Twenty-nine of 136 patients were operated on within 24 h and not candidates for conservative management. Patients more than 75 years old, immunosuppressed patients, patients with free intraperitoneal air or free fluid in the abdominal cavity were at higher risk for emergency surgery within the first 24 h. Conservative treatment was successful in 101 of 107 patients (94%) when attempted. The presence of simultaneous abscess increased the risk for conservative treatment failure.

Paper III: The aim of this prospective study was to determine if a non-enhanced low-dose CT was as sensitive as standard CT with intravenous (IV) contrast for patients with suspected acute diverticulitis. The included patients underwent both types of CT examinations. CT images were graded by three independent radiologists for the presence of diverticulitis, complications or other findings that could explain the patient’s symptoms. Sensitivity, specificity and both intra- and inter-reader agreement for low-dose CT were very high. Therefore, we recommend this examination for suspected diverticulitis.

Paper IV: In this prospective study, 155 consecutive patients with CT-verified acute uncomplicated diverticulitis were treated as outpatients without antibiotics. Overall, only four patients (2.6%) returned to the hospital because of treatment failure, all of whom were hospitalized and received antibiotics. Outpatient treatment of uncomplicated diverticulitis is safe and recommended in selected patients.

 

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 65
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1483
Keywords
Colonic diverticulitis, complicated diverticulitis, computed tomography, low-dose CT
National Category
Medical and Health Sciences
Research subject
Radiology; Surgery
Identifiers
urn:nbn:se:uu:diva-356710 (URN)978-91-513-0397-0 (ISBN)
Public defence
2018-09-28, Aulan, entrance 21,, Västmanlands Hospital, Västerås, 13:15 (English)
Opponent
Supervisors
Available from: 2018-09-05 Created: 2018-08-03 Last updated: 2018-09-10

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