From the Division of Abdominal Radiology, Department of Radiology (E.C.D., J.H.E., M.S.D., M.A., R.H.C.); Division of Emergency Radiology, Department of Radiology (S.T.C., M.B.M.), Michigan Institute for Clinical and Health Research (K.W.), Department of Biostatistics, School of Public Health (B.N.), Division of Gastroenterology, Department of Internal Medicine (R.R.), and Division of Colorectal Surgery, Division of General Surgery, Department of Surgery (A.M.M.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109-5030.
Radiology. 2017 Dec;285(3):850-858. doi: 10.1148/radiol.2017161374. Epub 2017 Aug 24.
Purpose To identify computed tomographic (CT) findings that are predictive of recurrence of colonic diverticulitis. Materials and Methods Institutional review board approval was obtained for this HIPAA-compliant, retrospective cohort study. Six abdominal fellowship-trained radiologists reviewed the CT studies of 440 consecutive subjects diagnosed with acute colonic diverticulitis between January 2004 and May 2008 to determine the involved segments, maximum wall thickness in the inflamed segment, severity of diverticulosis, presence of complications (abscess, fistula, stricture, or perforation), and severity of the inflammation. Electronic medical records were reviewed for a 5-year period after the patients' first CT study to determine clinical outcomes. Predictors of diverticulitis recurrence were assessed with univariate and multiple Cox proportional hazard regression models. Results Colonic diverticulitis most commonly involved the rectosigmoid (70%, 309 of 440) and descending (30%, 133 of 440) colon segments. Complicated diverticulitis was present in 22% (98 of 440) of patients. On the basis of the results of univariate analysis, significant predictors of diverticulitis recurrence were determined to be maximum colonic wall thickness in the inflamed segment (hazard ratio [HR], 1.07 per every millimeter of increase in wall thickness; P < .001), presence of a complication (HR, 1.75; P = .002), and subjective severity of inflammation (HR, 1.36 for every increase in severity category; P value for linear trend = .003). The difference in maximum wall thickness in the inflamed segment (HR, 1.05 per millimeter; P = .016) and subjective inflammation severity (HR, 1.29 per category; P = .018)remained statistically significant in a Cox multiple regression model. Conclusion Maximum colonic wall thickness and subjective severity of acute diverticulitis allow prediction of recurrent diverticulitis and may be useful for stratifying patients according to the need for elective partial colectomy. RSNA, 2017 Online supplemental material is available for this article.
确定预测结肠憩室炎复发的计算机断层扫描（CT）表现。
本研究经 HIPAA 合规性机构审查委员会批准，为回顾性队列研究。6 名具有腹部 fellowship培训背景的放射科医生对 2004 年 1 月至 2008 年 5 月间诊断为急性结肠憩室炎的 440 例连续患者的 CT 研究进行了回顾性分析，以确定受累节段、炎症节段的最大壁厚、憩室病严重程度、并发症（脓肿、瘘管、狭窄或穿孔）的存在情况以及炎症的严重程度。在患者首次 CT 检查后 5 年内对电子病历进行了回顾，以确定临床结果。使用单变量和多 Cox 比例风险回归模型评估憩室炎复发的预测因素。
结肠憩室炎最常累及直肠乙状结肠（70%，440 例中的 309 例）和降结肠（30%，440 例中的 133 例）。22%（98 例）的患者存在复杂的憩室炎。基于单变量分析的结果，确定憩室炎复发的显著预测因素为炎症节段的最大结肠壁厚度（每毫米壁厚度增加的危险比 [HR]，1.07；P<0.001）、并发症的存在（HR，1.75；P=0.002）和炎症的主观严重程度（每增加一个严重程度类别，HR 增加 1.36；P 值线性趋势=0.003）。在 Cox 多回归模型中，炎症节段的最大壁厚差异（HR，每毫米增加 1.05；P=0.016）和主观炎症严重程度（HR，每类别增加 1.29；P=0.018）仍然具有统计学意义。
最大结肠壁厚度和急性憩室炎的主观严重程度可预测憩室炎的复发，并且可能有助于根据选择性部分结肠切除术的需要对患者进行分层。
RSNA，2017 年
在线补充材料可在本文的相关网页上获取。
