Balthazar E J, Megibow A, Schinella R A, Gordon R
Department of Radiology, New York University Medical Center, Bellevue Hospital Medical Center, NY 10016.
AJR Am J Roentgenol. 1990 Feb;154(2):281-5. doi: 10.2214/ajr.154.2.2105015.
Pitfalls in CT diagnosis of acute diverticulitis were investigated in 16 patients with the disease who had misleading or equivocal CT features. The CT appearance was correlated with contrast enemas (13 cases) and with surgical assessment and pathologic evaluation of resected specimens (12 cases). Limitations in the CT diagnosis were related to (1) marked thickening of the colonic wall, between 1 and 3 cm in cross section simulating colonic neoplasm (all patients); (2) inability to visualize small amounts of fibropurulent exudate in the absence of pericolic inflammatory changes (eight patients); (3) failure to detect discrete intramural abscess (five patients). Resected surgical specimens available in 12 cases proved that colonic wall thickening was caused by muscular hypertrophy and various degrees of submucosal inflammation, edema, fibrosis, or focal organized inflammatory tissue. Contrast enema was useful in 10 out of 13 patients by excluding carcinoma of the colon and confirming the diagnosis of acute diverticulitis.
对16例具有误导性或不明确CT特征的急性憩室炎患者进行了CT诊断陷阱的研究。将CT表现与钡剂灌肠检查结果（13例）以及手术评估和切除标本的病理评估结果（12例）进行了对比。CT诊断的局限性包括：（1）结肠壁显著增厚，横截面积在1至3厘米之间，类似结肠肿瘤（所有患者）；（2）在无结肠周围炎症改变的情况下无法显示少量纤维脓性渗出物（8例患者）；（3）未能检测到离散的壁内脓肿（5例患者）。12例患者的手术切除标本证实，结肠壁增厚是由肌肉肥大以及不同程度的黏膜下炎症、水肿、纤维化或局灶性机化性炎症组织引起的。13例患者中有10例通过排除结肠癌并确诊急性憩室炎，钡剂灌肠检查很有用。
