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The value of initial sonography compared to supplementary CT for diagnosing right-sided colonic diverticulitis

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Abstract

Purpose

The purpose of the study was to assess the value of initial sonography in the diagnosis of right-sided colonic diverticulitis in comparison with supplementary CT.

Materials and methods

A total of 183 consecutive adult patients with right lower quadrant pain (73 diverticulitis, and 110 non-diverticulitis) who underwent both initial sonography and subsequent CT within 24 h were enrolled in this study. Two reviewers retrospectively assessed imaging findings of diverticula, colonic wall thickening, inflammatory pericolic fat, and pericolic abscess for each sonography and CT and then classified each case as non-diverticulitis, simple diverticulitis or complicated diverticulitis. Sonography and CT were independently reviewed at 2-week intervals. The value of initial sonography was assessed through head-to-head comparison with CT results.

Results

Sensitivity, specificity and accuracy for diagnosing diverticulitis were not significantly different between the two modalities (p = 0.366, 0.605 and 0.259, respectively). In addition, the net sensitivity (97.26%) of both sonography and CT was not significantly different from the sensitivity (89.04%) of sonography alone (p = 0.101). Agreement between sonography and CT for the classification of diverticulitis and the four imaging findings was excellent (all κ > 0.8).

Conclusion

Initial sonography can be as effective as CT for the diagnosis of right-sided colonic diverticulitis. Supplementary CT is only needed when sonography is inconclusive.

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Abbreviations

RLQ:

Right lower quadrant

MDCT:

Multidetector CT

References

  1. Sugihara K, Muto T, Morioka Y, Asano A, Yamamoto T. Diverticular disease of the colon in Japan. A review of 615 cases. Dis Colon Rectum. 1984;27:531–7.

    Article  CAS  PubMed  Google Scholar 

  2. Pradel JA, Adell JF, Taourel P, Djafari M, Monnin-Delhom E, Bruel JM. Acute colonic diverticulitis: prospective comparative evaluation with US and CT. Radiology. 1997;205:503–12.

    Article  CAS  PubMed  Google Scholar 

  3. Buckley O, Geoghegan T, O’Riordain DS, Lyburn ID, Torreggiani WC. Computed tomography in the imaging of colonic diverticulitis. Clin Radiol. 2004;59:977–83.

    Article  CAS  PubMed  Google Scholar 

  4. Puylaert JB. Ultrasound of colon diverticulitis. Dig Dis. 2012;30:56–9.

    Article  PubMed  Google Scholar 

  5. Laméris W, van Randen A, Bipat S, Bossuyt PM, Boermeester MA, Stoker J. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008;18:2498–511.

    Article  PubMed  Google Scholar 

  6. Bruel JM. Acute colonic diverticulitis: CT or ultrasound? Eur Radiol. 2003;13:2557–9.

    Article  PubMed  Google Scholar 

  7. Ripollés T, Agramunt M, Martínez MJ, Costa S, Gómez-Abril SA, Richart J. The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients. Eur Radiol. 2003;13:2587–95.

    Article  PubMed  Google Scholar 

  8. King WC, Shuaib W, Vijayasarathi A, Fajardo CG, Cabrera WE, Costa JL. Benefits of sonography in diagnosing suspected uncomplicated acute diverticulitis. J Ultrasound Med. 2015;34:53–8.

    Article  PubMed  Google Scholar 

  9. Liljegren G, Chabok A, Wickbom M, Smedh K, Nilsson K. Acute colonic diverticulitis: a systematic review of diagnostic accuracy. Colorectal Dis. 2007;9:480–8.

    Article  CAS  PubMed  Google Scholar 

  10. Helou N, Abdalkader M, Abu-Rustum RS. Sonography: first-line modality in the diagnosis of acute colonic diverticulitis? J Ultrasound Med. 2013;32:1689–94.

    Article  PubMed  Google Scholar 

  11. Koo HS, Kim HC, Yang DM, Kim SW, Park SJ, Ryu JK. Does computed tomography have any additional value after sonography in patients with suspected acute appendicitis? J Ultrasound Med. 2013;32:1397–403.

    Article  PubMed  Google Scholar 

  12. Doria AS, Moineddin R, Kellenberger CJ, Epelman M, Beyene J, Schuh S, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 2006;241:83–94.

    Article  PubMed  Google Scholar 

  13. Poortman P, Lohle PN, Schoemaker CM, Oostvogel HJ, Teepen HJ, Zwinderman KA, et al. Comparison of CT and sonography in the diagnosis of acute appendicitis: a blinded prospective study. Am J Roentgenol. 2003;181:1355–9.

    Article  Google Scholar 

  14. Johansson EP, Rydh A, Riklund KA. Ultrasound, computed tomography, and laboratory findings in the diagnosis of appendicitis. Acta Radiol. 2007;48:267–73.

    Article  CAS  PubMed  Google Scholar 

  15. Chou YH, Chiou HJ, Tiu CM, Chen JD, Hsu CC, Lee CH, et al. Sonography of acute right side colonic diverticulitis. Am J Surg. 2001;181:122–7.

    Article  CAS  PubMed  Google Scholar 

  16. Valentino M, Serra C, Ansaloni L, Mantovani G, Pavlica P, Barozzi L. Sonographic features of acute colonic diverticulitis. J Clin Ultrasound. 2009;37:457–63.

    Article  PubMed  Google Scholar 

  17. Lee IK, Jung SE, Gorden DL, Lee YS, Jung DY, Oh ST, et al. The diagnostic criteria for right colonic diverticulitis: prospective evaluation of 100 patients. Int J Colorectal Dis. 2008;23:1151–7.

    Article  PubMed  Google Scholar 

  18. Law WL, Lo CY, Chu KW. Emergency surgery for colonic diverticulitis: differences between right-sided and left-sided lesions. Int J Colorectal Dis. 2001;16:280–4.

    Article  CAS  PubMed  Google Scholar 

  19. Komuta K, Yamanaka S, Okada K, Kamohara Y, Ueda T, Makimoto N, et al. Toward theurapeutic guidelines for patients with acute right colonic diverticulitis. Am J Surg. 2004;187:233–7.

    Article  PubMed  Google Scholar 

  20. Puylaert JB. Acute appendicitis: US evaluation using graded compression. Radiology. 1986;158:355–60.

    Article  CAS  PubMed  Google Scholar 

  21. Mazzei MA, CioffiSquitieri N, Guerrini S, Stabile Ianora AA, Cagini L, Macarini L, et al. Sigmoid diverticulitis: US findings. Crit Ultrasound J. 2013;5(Suppl 1):S5.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Wiersma F, Toorenvliet BR, Bloem JL, Allema JH, Holscher HC. US examination of the appendix in children with suspected appendicitis: the additional value of secondary signs. Eur Radiol. 2009;19:455–61.

    Article  PubMed  Google Scholar 

  23. Stewart JK, Olcott EW, Jeffrey RB. Sonography for appendicitis: nonvisualization of the appendix is an indication for active clinical observation rather than direct referral for computed tomography. J Clin Ultrasound. 2012;40:455–61.

    Article  PubMed  Google Scholar 

  24. Brenner DJ, Hall EJ. Computed tomography–an increasing source of radiation exposure. N Engl J Med. 2007;357:2277–84.

    Article  CAS  PubMed  Google Scholar 

  25. Rubin GD. Computed tomography: revolutionizing the practice of medicine for 40 years. Radiology. 2014;273:S45–74.

    Article  PubMed  Google Scholar 

  26. Katz DS, Lane MJ, Ross BA, Gold BM, Jeffrey RB Jr, Mindelzun RE. Diverticulitis of the right colon revisited. Am J Roentgenol. 1998;171:151–6.

    Article  CAS  Google Scholar 

  27. Niikura R, Nagata N, Shimbo T, Akiyama J, Uemura N. Colonoscopy can miss diverticula of the left colon identified by barium enema. World J Gastroenterol. 2013;19:2362–7.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Wasvary H, Turfah F, Kadro O, Beauregard W. Same hospitalization resection for acute diverticulitis. Am Surg. 1999;65:632–5.

    CAS  PubMed  Google Scholar 

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Correspondence to Hyun Cheol Kim.

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Min, J.H., Kim, H.C., Kim, S.W. et al. The value of initial sonography compared to supplementary CT for diagnosing right-sided colonic diverticulitis. Jpn J Radiol 35, 358–365 (2017). https://doi.org/10.1007/s11604-017-0646-7

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  • DOI: https://doi.org/10.1007/s11604-017-0646-7

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