To Fill or Not to Fill? – Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon

Abstract

Purpose To assess the value of the administration of positive rectal contrast at CT in patients referred for suspected diverticular disease (DD) of the colon.

Materials and Methods 460 patients (253 male, 207 female; median age 62 years; interquartile range 24) with clinical suspicion of DD of the colon were included in this retrospective IRB-approved study. CT was performed with i. v. contrast only (n = 328, group M1), i. v. + positive rectal contrast (n = 82, group M2), neither i. v. nor rectal contrast (n = 32, group S1), or positive rectal contrast only (n = 19, group S2). Two readers in consensus evaluated all CT datasets concerning diagnosis of DD (yes/no) and categorized findings (classification of diverticular disease (CDD)). Sensitivity, specificity, positive (PPV) and negative (NPV) predictive values for the diagnosis of DD were calculated for all groups, using either clinical follow-up (n = 335) or intraoperative findings (n = 125) as the reference standard. In patients undergoing surgery, radiological staging of DD was correlated with the histopathology (weighted Cohen-k).

Results 224 patients (48.7 %) were diagnosed with DD. The sensitivity, specificity, PPV, and NPV were as follows. Group M1 / M2: 92 %/92 %, 97 %/94 %, 96 %/96 %, 94 %/89 %, respectively; group S1 / S2: 94 %/86 %, 93 %/80 %, 94 %/92 %, 93 %/67 %, respectively. Radiological staging and histopathology correlated substantially in all groups (k = 0.748–0.861).

Conclusion Abdominal CT had a high sensitivity and specificity for the diagnosis of DD. Disease staging correlated well with the findings at surgery. Additional positive rectal contrast administration did not have a significant advantage and may therefore be omitted in patients with suspected DD.

Key Points:

• CT has a high sensitivity and specificity for diagnosis of DD.

• CT staging using the CDD algorithm correlates very well with surgery.

• Positive rectal contrast administration does not improve diagnosis and radiological staging.

Citation Format

• Meyer S, Schmidbauer M, Wacker FK et al. To Fill or Not to Fill? – Value of the Administration of Positive Rectal Contrast for CT Evaluation of Diverticular Disease of the Colon. Fortschr Röntgenstr 2021; 193: 804 – 812

Zusammenfassung

Ziel Evaluation der rektalen Gabe positiven KM im Rahmen der CT bei Patienten mit klinischem Verdacht auf Divertikelkrankheit des Dickdarms (DD).

Material und Methoden 460 Patienten (253 Männer, 207 Frauen; medianes Alter 62 Jahre; Interquartilsabstand 24) mit klinischem Verdacht auf DD wurden in diese retrospektive, durch die Ethikkommission genehmigte Studie eingeschlossen. Die CT wurde nur mit i. v. KM (n = 328, Gruppe M1), i. v. und positivem rektalem KM (n = 82, Gruppe M2), weder i. v. noch positivem rektalem KM (n = 32, Gruppe S1) oder nur positivem rektalem KM (n = 18, Gruppe S2) durchgeführt. Die CT-Untersuchungen wurden von 2 Radiologen gemeinsam im Hinblick auf die Diagnose DD (ja/nein) evaluiert und, falls zutreffend, basierend auf der Klassifikation der Divertikelkrankheit (CDD) kategorisiert. Als Referenzstandard dienten der klinische Verlauf (n = 335) sowie der operative/histologische Befund (n = 125). Sensitivität, Spezifität, positiver (PPV) und negativer prädiktiver Wert (NPV) wurden für alle Gruppe berechnet. Im Fall einer Operation wurde das CT-Stadium mit dem histopathologischen Ergebnis korreliert (gewichtete Cohen-k).

Ergebnisse Bei 224 Patienten (48,7 %) wurde eine DD diagnostiziert. Sensitivität, Spezifität, PPV und NPV für die CT waren wie folgt: Gruppe M1 / M2: 92 %/92 %, 97 %/94 %, 96 %/96 %, 94 %/89 %; Gruppe S1 / S2: 94 %/86 %, 93 %/80 %, 94 %/92 %, 93 %/67 %. Das CT-Stadium korrelierte in allen Gruppen sehr gut mit dem histopathologischen Befund (k = 0,748–0,861).

Schlussfolgerung Die CT hat eine hohe Sensitivität und Spezifität für die Diagnose einer Divertikelkrankheit des Dickdarms. Das radiologische Krankheitsstadium korrelierte sehr gut mit dem intraoperativen Befund. Die ergänzende rektale Applikation von positivem KM hat jedoch in der vorliegenden Studie keinen signifikanten Vorteil gezeigt, sodass im Rahmen der klinischen Routine auf diese verzichtet werden kann.

Kernaussagen:

• Die CT hat eine hohe Sensitivität/Spezifität für die Diagnose DD.

• Das CT-Stadium (CDD Algorithmus) korreliert sehr gut mit dem operativen Befund.

• Die Gabe von positivem rektalen KM verbessert weder Diagnose noch Stadieneinteilung.

Key words

diverticular disease - diverticulitis - colon - contrast - CT

Publication History

Received: 23 September 2020

Accepted: 02 December 2020

Article published online:
03 February 2021

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