Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114, USA.
AJR Am J Roentgenol. 2013 Jun;200(6):1269-74. doi: 10.2214/AJR.12.9539.
The purpose of this study was to establish CT criteria as an indication for colonoscopy in patients with acute diverticulitis.
The study was composed of patients diagnosed with acute diverticulitis on contrast-enhanced CT (CECT) from January 2000 to December 2004. Patients without subsequent colonoscopy were excluded. Findings on CT were correlated with patient outcomes over follow-up. Sensitivity, specificity, and predictive values of the imaging parameters for prediction of colon cancer were calculated. Outcomes were also compared between men and women.
Of 1034 patients with a CT diagnosis of diverticulitis, 402 (235 women and 167 men; mean age, 63.3 years) had available endoscopic colonic evaluation after CECT. The mean follow-up was 5.3 years. Seventy-eight patients had polyps (71% adenomatous) and nine patients (2.2%) were diagnosed with colon cancer (seven women, two men). The odds ratio for diagnosis of colon cancer was 23.35 in patients with mesenteric or retroperitoneal lymphnodes, 4.67 for abscess, and 24.43 in patients with obstruction and localized mass reported on CT. A significant correlation was found between the location of diverticulitis and cancer (p < 0.001). The diagnosis of cancer was made within 6 months from the date of CECT in eight patients. The odds of cancer were 2.5 times higher in women.
On the basis of the significant correlation of complicated diverticulitis or presence of lymph nodes with new diagnoses of colon cancer, we recommend early colonoscopy in patients with wall thickness more than 6 mm, abscess, obstruction, or lymph nodes seen on CECT.
本研究旨在建立 CT 标准，作为合并急性憩室炎患者行结肠镜检查的指征。
本研究纳入了 2000 年 1 月至 2004 年 12 月行增强 CT（CECT）诊断为急性憩室炎的患者。排除未行后续结肠镜检查的患者。将 CT 结果与随访期间的患者结局相关联。计算了影像学参数预测结肠癌的敏感性、特异性和预测值。还比较了男性和女性患者的结局。
在 1034 例 CT 诊断为憩室炎的患者中，402 例（235 例女性和 167 例男性；平均年龄 63.3 岁）在 CECT 后接受了内镜结肠评估。平均随访时间为 5.3 年。78 例患者有息肉（71%为腺瘤性），9 例（2.2%）诊断为结肠癌（7 例女性，2 例男性）。肠系膜或腹膜后淋巴结、脓肿、CT 报告的梗阻和局限性肿块患者诊断为结肠癌的比值比分别为 23.35、4.67 和 24.43。憩室炎的位置与癌症之间存在显著相关性（p < 0.001）。8 例患者在 CECT 后 6 个月内确诊为癌症。女性癌症的风险是男性的 2.5 倍。
基于复杂憩室炎或存在淋巴结与新诊断结肠癌之间的显著相关性，我们建议对 CECT 显示壁厚度大于 6mm、脓肿、梗阻或淋巴结的患者行早期结肠镜检查。
