Nicola Flor1, Perry J Pickhardt2, Giovanni Maconi3, Silvia Panella4, Monica Falleni5,6, Valeria Merlo7, Giovanni Di Leo8,9. 1. Unità Operativa di Radiologia, L. Sacco University Hospital, ASST Fatebenefratelli Sacco, Via Giovanni Battista Grassi, 74, 20157, Milan, Italy. nicola.flor@unimi.it. 2. Department of Radiology, School of Medicine & Public Health, University of Wisconsin, E3/311 Clinical Science Center, 600 Highland Ave, Madison, WI, 53792-3252, USA. 3. Gastroenterology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy. 4. Unità Operativa Radiologia Diagnostica e Interventistica, ASST Santi Paolo e Carlo, Presidio San Paolo, Milan, Italy. 5. Unità Operativa di Anatomia Patologica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, 20142, Milan, Italy. 6. Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, 20142, Milan, Italy. 7. Postgraduation School in Radiodiagnostics, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy. 8. Unità di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy. 9. Dipartimento di Scienze Biomediche della Salute, Università degli Studi di Milano, Piazza E. Malan, 20097, San Donato Milanese, Italy.
Abstract
PURPOSE: To perform a radiologic-pathologic correlation analysis of sigmoid colon in patients undergoing pre-operative CT Colonography (CTC) after an episode of acute diverticulitis (AD). METHODS: Fifty-nine consecutive patients (31/28 M/F; 58 ± 13 years) underwent CTC 55 ± 18 days after AD, 8 ± 4 weeks before surgery. Thirty-seven patients (63%) underwent conventional abdominal CT at time of AD. An experienced blinded radiologist retrospectively analyzed all images: disease severity was graded according to the Ambrosetti classification on conventional CT and according to the diverticular disease severity score (DDSS) on CTC. A GI pathologist performed a dedicated analysis, evaluating the presence of acute and chronic inflammation, and fibrosis, using 0-3 point scale for each variable. RESULTS: Of 59 patients, 41 (69%) had at least one previous AD episode; twenty-six patients (44%) had a complicated AD. DDSS was mild-moderate in 34/59 (58%), and severe in 25/59 (42%). All patients had chronic inflammation, while 90% had low-to-severe fibrosis. Patients with moderate/severe fibrosis were older than those with no/mild fibrosis (61 ± 13 versus 54 ± 13). We found a significant correlation between DDSS and chronic inflammation (p = 0.004), as well as DDSS and fibrosis (p = 0.005). Furthermore, fibrosis was correlated with complicated acute diverticulitis (p = 0.0.27), and with age (p = 0.067). At multivariate analysis, complicated diverticulitis was the best predictor of fibrosis (odds ratio 4.4). Patient age and DDSS were other independent predictors. CONCLUSION: DDSS-based assessment on preoperative CTC was a good predictor of chronic colonic inflammation and fibrosis. In addition, the presence of complicated diverticulitis on CT during the acute episode was most predictive of fibrosis.
PURPOSE: To perform a radiologic-pathologic correlation analysis of sigmoid colon in patients undergoing pre-operative CT Colonography (CTC) after an episode of acute diverticulitis (AD). METHODS: Fifty-nine consecutive patients (31/28 M/F; 58 ± 13 years) underwent CTC 55 ± 18 days after AD, 8 ± 4 weeks before surgery. Thirty-seven patients (63%) underwent conventional abdominal CT at time of AD. An experienced blinded radiologist retrospectively analyzed all images: disease severity was graded according to the Ambrosetti classification on conventional CT and according to the diverticular disease severity score (DDSS) on CTC. A GI pathologist performed a dedicated analysis, evaluating the presence of acute and chronic inflammation, and fibrosis, using 0-3 point scale for each variable. RESULTS: Of 59 patients, 41 (69%) had at least one previous AD episode; twenty-six patients (44%) had a complicated AD. DDSS was mild-moderate in 34/59 (58%), and severe in 25/59 (42%). All patients had chronic inflammation, while 90% had low-to-severe fibrosis. Patients with moderate/severe fibrosis were older than those with no/mild fibrosis (61 ± 13 versus 54 ± 13). We found a significant correlation between DDSS and chronic inflammation (p = 0.004), as well as DDSS and fibrosis (p = 0.005). Furthermore, fibrosis was correlated with complicated acute diverticulitis (p = 0.0.27), and with age (p = 0.067). At multivariate analysis, complicated diverticulitis was the best predictor of fibrosis (odds ratio 4.4). Patient age and DDSS were other independent predictors. CONCLUSION:DDSS-based assessment on preoperative CTC was a good predictor of chronic colonic inflammation and fibrosis. In addition, the presence of complicated diverticulitis on CT during the acute episode was most predictive of fibrosis.
Authors: Nicola Flor; Giovanni Maconi; Francesco Sardanelli; Maria Antonietta Lombardi; Bernardo Colombo; Giovanni Di Leo; Monica Falleni; Gianpaolo Cornalba; Perry J Pickhardt Journal: Acad Radiol Date: 2015-10-09 Impact factor: 3.173
Authors: Pierre-Alexandre Poletti; Alexandra Platon; Olivier Rutschmann; Karen Kinkel; Vince Nyikus; Serban Ghiorghiu; Philippe Morel; François Terrier; Christoph D Becker Journal: AJR Am J Roentgenol Date: 2004-05 Impact factor: 3.959
Authors: Anne F Peery; Evan S Dellon; Jennifer Lund; Seth D Crockett; Christopher E McGowan; William J Bulsiewicz; Lisa M Gangarosa; Michelle T Thiny; Karyn Stizenberg; Douglas R Morgan; Yehuda Ringel; Hannah P Kim; Marco Dacosta DiBonaventura; Charlotte F Carroll; Jeffery K Allen; Suzanne F Cook; Robert S Sandler; Michael D Kappelman; Nicholas J Shaheen Journal: Gastroenterology Date: 2012-08-08 Impact factor: 22.682