From the Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanagawa-ku, Yokohama 236-0004 Japan (S. Umezawa, S. Uchiyama, T.H., A.N.); Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, Tokyo, Japan (N.N., T.S., S.M.); Department of Gastroenterology, Hiratsuka Citizen Hospital, Kanagawa, Japan (J.A.); Department of Gastroenterology, St. Luke's International Hospital, Tokyo, Japan (K.N., N.I.); Department of Endoscopy, Koritsu Showa Hospital, Tokyo, Japan (Y.T.); Department of Gastroenterology, Yokohama Rosai Hospital, Kanagawa, Japan (H.N.); Department of Gastroenterology, Yokohama Municipal Citizen's Hospital, Kanagawa, Japan (H.K.); and Department of Gastroenterology, Keiyu Hospital, Kanagawa, Japan (A.M.).
Radiology. 2018 Sep;288(3):755-761. doi: 10.1148/radiol.2018172910. Epub 2018 Jun 12.
Purpose To demonstrate the usefulness of precolonoscopy intravenous contrast material-enhanced CT for colonic diverticular bleeding (CDB). Materials and Methods A prospective, multicenter, observational study was performed. Patients with acute-onset hematochezia who were admitted to hospital were included, and those without CDB were excluded. CT was performed before colonoscopy. A Mann-Whitney U test, χ test, and multivariable logistic regression analysis were performed to determine the accuracy of CT before colonoscopy. Results A total of 442 patients (mean age, 71.2 years; 302 male patients; 68.3% men) were included between January 2014 and December 2015, and 202 patients were diagnosed as having CDB. The positive extravasation rate during CT was 50 of 202 (24.7%) among all patients and five of nine (55.6%) among patients who underwent CT within 1 hour of the last hematochezia. At multivariable analysis, the interval from the last hematochezia until CT was a predictor of extravasation (beta coefficient, -.0038 ± 0.0014 [standard deviation]). Extravasation at CT had a sensitivity of 38 of 66 (57.6%; 95% confidence interval: 44.8%, 69.7%) and a specificity of 124 of 136 (91.2%; 95% confidence interval: 85.1%, 95.4%) for the prediction of stigmata of recent hemorrhage of diverticula during colonoscopy. The sensitivity was higher in patients who underwent CT examination within 4 hours of hematochezia, compared with those examined after 4 hours (64.7% [33 of 51] vs 33.3% [five of 15]; P < .01). Conclusion Extravasation findings for CT with intravenous contrast material had high specificity for the prediction of stigmata of recent hemorrhage of diverticula during colonoscopy, regardless of the timing of the CT examination. Although the sensitivity was relatively low, it was higher when the CT examination was performed within 4 hours after the last hematochezia. Therefore, urgent precolonoscopy CT may contribute to decision making regarding whether an urgent colonoscopy should be performed.
目的 展示结肠镜检查前静脉对比增强 CT 对结肠憩室出血（CDB）的应用价值。
材料与方法 进行了一项前瞻性、多中心、观察性研究。纳入因急性血便入院的患者，排除无 CDB 的患者。所有患者均在结肠镜检查前行 CT 检查。采用 Mann-Whitney U 检验、卡方检验和多变量逻辑回归分析来确定结肠镜检查前 CT 的准确性。
结果 2014 年 1 月至 2015 年 12 月期间，共纳入 442 例患者（平均年龄 71.2 岁；男性 302 例；男性占 68.3%），其中 202 例诊断为 CDB。所有患者中 CT 检查阳性外渗率为 50/202（24.7%），9 例中 CT 检查距末次血便时间 1 小时内的患者中阳性外渗率为 5/9（55.6%）。多变量分析显示，从末次血便到 CT 的时间间隔是外渗的预测因素（β系数，-.0038±0.0014[标准差]）。CT 检查的外渗对预测结肠镜检查时憩室近期出血的征象有 38/66（57.6%；95%置信区间：44.8%，69.7%）的敏感性和 124/136（91.2%；95%置信区间：85.1%，95.4%）的特异性。与 CT 检查在血便后 4 小时以上进行相比，CT 检查在血便后 4 小时内进行时敏感性更高（64.7%[33/51]比 33.3%[5/15]；P<.01）。
结论 静脉对比增强 CT 检查的外渗征象对预测结肠镜检查时憩室近期出血的征象具有很高的特异性，无论 CT 检查的时间如何。虽然敏感性相对较低，但在末次血便后 4 小时内进行 CT 检查时敏感性更高。因此，紧急结肠镜检查前 CT 检查可能有助于决定是否应紧急进行结肠镜检查。
