Min Ju Hwa, Kim Hyun Cheol, Kim Sang Won, Yang Dal Mo, Rhee Sun Jung, Oh Jiyoung, Ahn Sung Eun
Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea.
Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, 23 Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
Jpn J Radiol. 2017 Jul;35(7):358-365. doi: 10.1007/s11604-017-0646-7. Epub 2017 May 9.
The purpose of the study was to assess the value of initial sonography in the diagnosis of right-sided colonic diverticulitis in comparison with supplementary CT.
A total of 183 consecutive adult patients with right lower quadrant pain (73 diverticulitis, and 110 non-diverticulitis) who underwent both initial sonography and subsequent CT within 24 h were enrolled in this study. Two reviewers retrospectively assessed imaging findings of diverticula, colonic wall thickening, inflammatory pericolic fat, and pericolic abscess for each sonography and CT and then classified each case as non-diverticulitis, simple diverticulitis or complicated diverticulitis. Sonography and CT were independently reviewed at 2-week intervals. The value of initial sonography was assessed through head-to-head comparison with CT results.
Sensitivity, specificity and accuracy for diagnosing diverticulitis were not significantly different between the two modalities (p = 0.366, 0.605 and 0.259, respectively). In addition, the net sensitivity (97.26%) of both sonography and CT was not significantly different from the sensitivity (89.04%) of sonography alone (p = 0.101). Agreement between sonography and CT for the classification of diverticulitis and the four imaging findings was excellent (all κ > 0.8).
Initial sonography can be as effective as CT for the diagnosis of right-sided colonic diverticulitis. Supplementary CT is only needed when sonography is inconclusive.
本研究旨在评估初始超声检查与补充CT相比，在诊断右侧结肠憩室炎中的价值。
本研究纳入了183例连续的成年右下象限疼痛患者（73例憩室炎患者和110例非憩室炎患者），这些患者在24小时内先后接受了初始超声检查和后续CT检查。两名评估人员回顾性评估了每次超声检查和CT检查中憩室、结肠壁增厚、结肠周围炎性脂肪和结肠周围脓肿的影像学表现，然后将每个病例分类为非憩室炎、单纯性憩室炎或复杂性憩室炎。超声检查和CT检查每两周独立复查一次。通过与CT结果进行直接比较来评估初始超声检查的价值。
两种检查方式在诊断憩室炎方面的敏感性、特异性和准确性无显著差异（p分别为0.366、0.605和0.259）。此外，超声检查和CT检查的总体敏感性（97.26%）与单独超声检查的敏感性（89.04%）无显著差异（p = 0.101）。超声检查和CT检查在憩室炎分类及四项影像学表现方面的一致性极佳（所有κ>0.8）。
初始超声检查在诊断右侧结肠憩室炎方面与CT一样有效。仅在超声检查结果不明确时才需要补充CT检查。
