Prognostic Value of the Diverticular Disease Severity Score Based on CT Colonography

Rationale and Objectives

To assess the prognostic value of a diverticular disease severity score (DDSS) based on computed tomography colonography (CTC) after acute diverticulitis (AD).

Materials and Methods

Of 252 patients who had an AD episode, we finally selected 46 patients who underwent both conventional CT at the acute event and CTC after 9 ± 7 weeks. Of these 46 patients, 17 underwent elective surgery after CTC. Disease severity was assessed with a 0–4 modified Hinchey CT-based score and a 1–4 CTC-based DDSS. A phone survey was performed 27 months later (range 4–52) for the 29 patients not surgically treated.

Results

Significant correlation was found between CTC-based DDSS and clinical follow-up ( P = 0.022) or elective surgery ( P = 0.007), but not between clinical follow-up and CT-based score, extraluminal gas, C-reactive protein serum level, age, gender, or first versus recurrent AD episode. CTC demonstrated relevant additional findings in five of 46 (11%) patients: two AD complications (enterocolic and enterotubal fistulae), two colon cancers, and one extracolonic (lung) cancer.

Conclusion s

The CTC-based DDSS showed a prognostic value and correlated with the risk of undergoing surgery, and clinically relevant additional findings were found in more than 10% of patients. CTC could be the preferred test in patients recovering after AD.

Introduction

he appropriate follow-up of patients recovering from an acute episode of colonic diverticulitis is controversial. In particular, some authors are not in favor of further testing because an increased risk of colon cancer was not observed in these patients. On the contrary, others deem follow-up useful because it allows an opportunity to monitor the severity of the diverticular disease, and to confirm the absence of any other mimicking disease (e.g. colorectal cancer), which may not have been diagnosed in the acute stage. Recently, computed tomography colonography (CTC) has been proposed as a useful test in the evaluation of patients recovering from acute diverticulitis (AD) . Advocates point out the advantages of CTC compared to alternative tests routinely performed in the past, namely double-contrast barium enema and conventional colonoscopy. In particular, Flor et al. have proposed a diverticular disease severity score (DDSS) based on CTC findings performed after the acute episode. While some authors aimed at testing the validity and prognostic value of conventional CT examination performed at the time of an acute inflammatory episode , there are no similar evaluation studies for CTC in patients recovering after AD.

Hence, the purpose of our work was to assess the prognostic value of CTC in patients recovering after AD by using the DDSS and to evaluate the clinical relevance of any additional information gained from CTC in this setting.

Materials and Methods

Population

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Imaging Protocol

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CT Colonography

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Image Analysis

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Table 1

Hinchey Modified Diverticular Disease Classification Adapted from Wasvary et al. Based on Conventional CT

0 Mild clinical diverticulitis Mild-Moderate 1a Confined pericolic inflammation—phlegmon 1b Confined pericolic abscess Severe 2 Pelvic, distant intra-abdominal, or retroperitoneal abscess 3 Generalized purulent peritonitis 4 Fecal peritonitis

CT, computed tomography.

Table 2

Diverticular Disease Severity Score Based on CTC

Maximum Wall Thickening (mm) Minimum Lumen Diameter (mm) 1 <3 ≥15 Mild-Moderate 2 3–8 ≥5 3 ≥8 ≥5 Severe 4 ≥8 <5

CTC, computed tomography colonography.

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Clinical Follow-up

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Statistical Analysis

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Results

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Clinical Findings and Laboratory Testing

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Severity of Diverticular Disease Based on Conventional CT at Time of Acute Event

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Severity of Diverticular Disease Based on CTC (DDSS)

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Additional Value Added by CTC

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Elective Surgery for Diverticular Disease

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Survey on Clinical Follow-up

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Discussion

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References

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Prognostic Value of the Diverticular Disease Severity Score Based on CT Colonography

Rationale and Objectives

Materials and Methods

Results

Conclusion s

Introduction

Materials and Methods

Population

Imaging Protocol

CT Colonography

Image Analysis

Clinical Follow-up

Statistical Analysis

Results

Clinical Findings and Laboratory Testing

Severity of Diverticular Disease Based on Conventional CT at Time of Acute Event

Severity of Diverticular Disease Based on CTC (DDSS)

Additional Value Added by CTC

Elective Surgery for Diverticular Disease

Survey on Clinical Follow-up

Discussion

References

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