Heverhagen Johannes T, Sitter Helmut, Zielke Andreas, Klose Klaus J
Department of Diagnostic Radiology, Philipps University Marburg, Marburg, Germany.
Dis Colon Rectum. 2008 Dec;51(12):1810-5. doi: 10.1007/s10350-008-9330-4. Epub 2008 Apr 29.
The purpose of this study was to prospectively investigate patients with suspected acute colonic diverticulitis and to provide sensitivity, specificity, and interobserver agreement in a blinded trial.
Fifty-five patients (29 men; 59 +/- 13 (range, 29-76) years) who reported to the emergency room with clinically suspected acute colonic diverticulitis were prospectively included in the study. All patients underwent magnetic resonance imaging scans of their abdomen before and after contrast agent administration. Two assessors blinded to all clinical, laboratory, and radiologic results evaluated the images separately.
The assessors reported colonic wall thickening, segmental narrowing of the colon, presence of diverticula, pericolic fatty infiltration, ascites, and abscesses. The assessors had to diagnose or rule out acute colonic diverticulitis. Sensitivities, specificities, positive, and negative likelihood ratios were derived. To determine interobserver agreement, a Cohen's kappa coefficient was calculated. The two assessors exhibited sensitivities of more than 94 percent, specificities of 88 percent, positive likelihood ratios of more than 7.5, and negative likelihood ratios of less than 0.07. The kappa coefficient showed a significant, strong correlation between both assessors (kappa = 0.68).
Magnetic resonance imaging is investigator independent and provides high sensitivity and specificity for the diagnosis of acute colonic diverticulitis.
本研究旨在对疑似急性结肠憩室炎患者进行前瞻性调查，并在一项盲法试验中提供敏感性、特异性和观察者间一致性。
前瞻性纳入55例（29例男性；年龄59±13岁（范围29 - 76岁））因临床疑似急性结肠憩室炎到急诊室就诊的患者。所有患者在注射造影剂前后均接受腹部磁共振成像扫描。两名对所有临床、实验室和影像学结果均不知情的评估者分别对图像进行评估。
评估者报告了结肠壁增厚、结肠节段性狭窄、憩室存在、结肠周围脂肪浸润、腹水和脓肿情况。评估者需诊断或排除急性结肠憩室炎。得出敏感性、特异性、阳性和阴性似然比。为确定观察者间一致性，计算了科恩kappa系数。两名评估者的敏感性均超过94%，特异性为88%，阳性似然比超过7.5，阴性似然比小于0.07。kappa系数显示两名评估者之间存在显著的强相关性（kappa = 0.68）。
磁共振成像独立于研究者，对急性结肠憩室炎的诊断具有高敏感性和特异性。
