Móré Dorottya, Erdmann Stella, Bischoff Arved, Wagner Verena, Kauczor Hans-Ulrich, Liesenfeld Lukas F, Abbasi Dezfouli Katharina, Giannakis Athanasios, Klauß Miriam, Mayer Philipp
Diagnostic and Interventional Radiology, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Institute of Medical Biometry, University of Heidelberg, 69120 Heidelberg, Germany.
Diagnostics (Basel). 2024 Dec 26;15(1):29. doi: 10.3390/diagnostics15010029.
: To evaluate the non-inferiority of non-contrast CT compared to contrast-enhanced CT with both intravenous and rectal contrast application for the diagnosis of acute colonic diverticulitis. : Five readers retrospectively evaluated the non-contrast and contrast-enhanced series of CTs of 205 consecutive patients with clinical suspicion of acute diverticulitis. Two randomized reading sessions, both containing all 205 cases as either contrast-enhanced or non-contrast (1:1) series, were performed with ≥8 weeks washout between them. The non-inferiority margin was set to 0.1. : The pooled prevalence (all readers) of diverticulitis was similar for non-contrast CT (63.9%, range: 60.5-65.0%) and contrast-enhanced CT (64.4%, 61.5-67.8%). Non-contrast CT was non-inferior for the diagnosis of diverticulitis (accuracy 0.90 [95% confidence interval: 0.89, 0.92]) compared to contrast-enhanced CT (0.92 [0.90, 0.94]; the difference in accuracy: -0.01 [-0.04, 0.01]) (normal deviate test: -value = 5.20 × 10). Sensitivities for perforation and abscess were slightly but significantly lower for the non-contrast CT than for the contrast-enhanced CT (differences: -0.15 [-0.20, -0.05], -0.17 [-0.27, -0.07]), while no differences in accuracies and specificities were observed. : Non-contrast CT is non-inferior to contrast-enhanced CT (intravenous and rectal contrast) for the diagnosis of acute colonic diverticulitis. Contrast-enhanced CT is associated with significantly higher sensitivities for the presence of an abscess or perforation.
评估在诊断急性结肠憩室炎时，与静脉内和直肠内造影剂增强CT相比，非增强CT的非劣效性。：五名阅片者回顾性评估了205例临床怀疑为急性憩室炎患者的非增强和增强CT系列。进行了两次随机阅片，两次阅片均包含所有205例病例，分别作为增强或非增强（1:1）系列，两次阅片之间间隔≥8周。非劣效性界限设定为0.1。：非增强CT（63.9%，范围：60.5 - 65.0%）和增强CT（64.4%，61.5 - 67.8%）的憩室炎总体患病率（所有阅片者）相似。与增强CT（0.92 [0.90, 0.94]；准确性差异：-0.01 [-0.04, 0.01]）相比，非增强CT在诊断憩室炎方面非劣效（准确性0.90 [95%置信区间：0.89, 0.92]）（正态偏差检验：P值 = 5.20 × 10）。非增强CT对穿孔和脓肿的敏感性略低于但显著低于增强CT（差异：-0.15 [-0.20, -0.05]，-0.17 [-0.27, -0.07]），而准确性和特异性未观察到差异。：在诊断急性结肠憩室炎时，非增强CT不劣于增强CT（静脉内和直肠内造影剂）。增强CT对脓肿或穿孔的存在具有显著更高的敏感性。
