Nicola Flor1, Giovanni Maconi2, Francesco Sardanelli3, Maria Antonietta Lombardi4, Bernardo Colombo4, Giovanni Di Leo3, Monica Falleni5, Gianpaolo Cornalba6, Perry J Pickhardt7. 1. Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, Milan 20142, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, Milan 20142, Italy. Electronic address: nicola.flor@unimi.it. 2. Gastroenterology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy. 3. Unità di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Dipartimento di Scienze Biomediche della Salute, Università degli Studi di Milano, San Donato Milanese 20097, Italy. 4. Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan 20122, Italy. 5. Unità Operativa di Anatomia Patologica, Azienda Ospedaliera San Paolo, Milan 20142, Italy. 6. Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, Milan 20142, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, Milan 20142, Italy. 7. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, Milan 20142, Italy; Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan 20122, Italy; Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI 53792-3252, USA.
Abstract
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. CONCLUSIONS: 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.
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. CONCLUSIONS: 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.
Authors: Nicola Flor; Perry J Pickhardt; Giovanni Maconi; Silvia Panella; Monica Falleni; Valeria Merlo; Giovanni Di Leo Journal: Abdom Radiol (NY) Date: 2020-08-03