Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.
Rofo. 2021 Jul;193(7):804-812. doi: 10.1055/a-1339-2157. Epub 2021 Feb 3.
To assess the value of the administration of positive rectal contrast at CT in patients referred for suspected diverticular disease (DD) of the colon.
460 patients (253 male, 207 female; median age 62 years; interquartile range 24) with clinical suspicion of DD of the colon were included in this retrospective IRB-approved study. CT was performed with i. v. contrast only (n = 328, group M1), i. v. + positive rectal contrast (n = 82, group M2), neither i. v. nor rectal contrast (n = 32, group S1), or positive rectal contrast only (n = 19, group S2). Two readers in consensus evaluated all CT datasets concerning diagnosis of DD (yes/no) and categorized findings (classification of diverticular disease (CDD)). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the diagnosis of DD were calculated for all groups, using either clinical follow-up (n = 335) or intraoperative findings (n = 125) as the reference standard. In patients undergoing surgery, radiological staging of DD was correlated with the histopathology (weighted Cohen-k).
224 patients (48.7 %) were diagnosed with DD. The sensitivity, specificity, PPV, and NPV were as follows. Group M1 / M2: 92 %/92 %, 97 %/94 %, 96 %/96 %, 94 %/89 %, respectively; group S1 / S2: 94 %/86 %, 93 %/80 %, 94 %/92 %, 93 %/67 %, respectively. Radiological staging and histopathology correlated substantially in all groups (k = 0.748-0.861).
Abdominal CT had a high sensitivity and specificity for the diagnosis of DD. Disease staging correlated well with the findings at surgery. Additional positive rectal contrast administration did not have a significant advantage and may therefore be omitted in patients with suspected DD.
· CT has a high sensitivity and specificity for diagnosis of DD.. · CT staging using the CDD algorithm correlates very well with surgery.. · Positive rectal contrast administration does not improve diagnosis and radiological staging..
· Meyer S, Schmidbauer M, Wacker FK et al. To Fill or Not to Fill? - Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon. Fortschr Röntgenstr 2021; 193: 804 - 812.
评估 CT 下直肠阳性对比剂在疑似结肠憩室病（DD）患者中的应用价值。
本回顾性 IRB 批准研究纳入了 460 例（男 253 例，女 207 例；中位年龄 62 岁；四分位间距 24）有疑似结肠 DD 临床症状的患者。CT 检查仅静脉注射对比剂（n = 328，M1 组）、静脉注射+直肠阳性对比剂（n = 82，M2 组）、均未静脉注射和直肠对比剂（n = 32，S1 组）或仅直肠阳性对比剂（n = 19，S2 组）。两位读者共同评估所有 CT 数据集，以评估 DD 的诊断（是/否）和分类发现（憩室疾病分类（CDD））。使用临床随访（n = 335）或术中发现（n = 125）作为参考标准，计算所有组中 DD 诊断的敏感性、特异性、阳性（PPV）和阴性（NPV）预测值。在接受手术的患者中，DD 的放射学分期与组织病理学相关（加权 Cohen-k）。
224 例患者（48.7%）被诊断为 DD。M1/M2 组的敏感性、特异性、PPV 和 NPV 分别为 92%/92%、97%/94%、96%/96%、94%/89%，S1/S2 组分别为 94%/86%、93%/80%、94%/92%、93%/67%。所有组中放射学分期和组织病理学均高度相关（k = 0.748-0.861）。
腹部 CT 对 DD 的诊断具有高敏感性和特异性。疾病分期与手术结果密切相关。额外的直肠阳性对比剂给药没有显著优势，因此在疑似 DD 的患者中可以省略。
· CT 对 DD 的诊断具有高敏感性和特异性。
· 使用 CDD 算法进行 CT 分期与手术非常吻合。
· 直肠阳性对比剂给药并不能提高诊断和放射学分期的效果。
