Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017, Valencia, Spain.
Department of Surgery, Hospital Universitario Dr. Peset, Valencia, Spain.
Abdom Radiol (NY). 2021 Aug;46(8):3826-3834. doi: 10.1007/s00261-021-03060-5. Epub 2021 Mar 25.
To prospectively assess the diagnostic value of intestinal ultrasound (US) compared to computerized tomography (CT) in differentiating uncomplicated and complicated acute colonic diverticulitis (ACD).
During a period of 14 months patients referred to the department of Radiology with clinical suspicion of ACD underwent an US examination. All confirmed US ACD diagnosis were included and subsequently underwent an emergency abdominal CT, used as gold standard. The WSES (World Society for Emergent Surgery) classification of diverticulitis was used. Diverticulitis was prospectively classified as either uncomplicated or complicated. Sensitivity, specificity, positive predictive value, and negative predictive values of US were evaluated. Before CT scan, the radiologist indicated whether they would have required or not a complementary CT scan, based on US findings.
Of the 240 patients included in our study, 71 (29.6%) were Stage 0, 127 (53%) Stage 1A, and 42 (17.5%) were moderate-severe ACD (stages 1B, 2A, 2B, 3 and 4). The sensitivity of US for diagnosing complicated ACD was 84% and specificity of 95.8%. Most patients (24 of 27) misclassified by US as uncomplicated diverticulitis were classified on CT as stage 1A. From the 148 cases in which the radiologist considered CT unnecessary, only 3 of these revealed signs of complicated ACD on CT; none of them required emergency surgery.
US is an effective technique to differentiate complicated from uncomplicated ACD. Our results suggest that US, may be a valuable alternative to CT for the initial radiologic evaluation in patients with clinical suspicion of ACD.
前瞻性评估肠超声（US）与计算机断层扫描（CT）在鉴别单纯性和复杂性急性结肠憩室炎（ACD）中的诊断价值。
在 14 个月的时间内，因临床怀疑 ACD 而转至放射科的患者接受了 US 检查。所有经 US 确诊的 ACD 患者均接受了紧急腹部 CT 检查，并将其作为金标准。使用 WSES（世界急诊外科学会）憩室炎分类。前瞻性地将憩室炎分为单纯性或复杂性。评估 US 的敏感性、特异性、阳性预测值和阴性预测值。在进行 CT 扫描之前，放射科医生根据 US 结果判断是否需要进行补充 CT 扫描。
在我们的研究中，240 例患者中，71 例（29.6%）为 0 期，127 例（53%）为 1A 期，42 例（17.5%）为中度-重度 ACD（1B、2A、2B、3 和 4 期）。US 诊断复杂性 ACD 的敏感性为 84%，特异性为 95.8%。US 误诊为单纯性憩室炎的 27 例患者中，24 例在 CT 上被归类为 1A 期。在放射科医生认为无需进行 CT 检查的 148 例患者中，仅 3 例 CT 显示有复杂性 ACD 征象，无一例需要紧急手术。
US 是鉴别单纯性和复杂性 ACD 的有效方法。我们的结果表明，US 可能是 ACD 患者初始放射学评估的一种有价值的 CT 替代方法。
