The CDD System in Computed Tomographic Diagnosis of Diverticular Disease

Daniel Pustelnik; Fabian Henry Jürgen Elsholtz; Christian Bojarski; Bernd Hamm; Stefan Markus Niehues

doi:10.1055/s-0043-110770

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, Table of Contents

Rofo 2017; 189(08): 740-747
DOI: 10.1055/s-0043-110770

Abdomen

The CDD System in Computed Tomographic Diagnosis of Diverticular Disease

Article in several languages: English | deutsch

Daniel Pustelnik

¹Institute of Radiology, Charité – Universitätsmedizin Berlin, Germany

,

Fabian Henry Jürgen Elsholtz

¹Institute of Radiology, Charité – Universitätsmedizin Berlin, Germany

,

Christian Bojarski

²Medical Department, Division of Gastroenterology, Infectiology and Rheumatology, Charité Universitätsmedizin Berlin Campus Benjamin Franklin, Berlin, Germany

,

Bernd Hamm

¹Institute of Radiology, Charité – Universitätsmedizin Berlin, Germany

,

Stefan Markus Niehues

¹Institute of Radiology, Charité – Universitätsmedizin Berlin, Germany

› Author Affiliations

Abstract

Purpose This overview sums up the Classification of Diverticular Disease (CDD) with regard to its application in computed tomographic diagnosis and briefly recapitulates its targeted advantages over preliminary systems. Primarily, application of the CDD in computed tomography diagnostics is described. Differences with respect to the categories of the older systems are pointed out on the level of each CDD type using imaging examples.

Materials and Methods The presented images are derived from our institute according to the S2k criteria. Literature was researched on PubMed.

Results The CDD constitutes an improvement compared to older systems for categorizing the stages of diverticular disease. It provides more discriminatory power on the descriptive-morphological level and defines as well as differentiates more courses of the disease. Furthermore, the categories translate more directly into state-of-the-art decision-making concerning hospitalization and therapy.

Conclusion The CDD should be applied routinely in the computed tomographic diagnosis of diverticular disease. Typical imaging patterns are presented.

Key points

The CDD is superior to its predecessors. It better stratifies categories of diverticular disease by morphology, course and modern options for treatment of the disease.
Computed tomography is the dominant imaging modality. Different stages show typical imaging patterns.
Non-abscessed phlegmonous peridiverticulitis is now interpreted as an uncomplicated course.
Minimal paracolic air does not constitute a full-fledged perforation in terms of a pneumoperitoneum (CDD type 2c).

Citation Format

Pustelnik D, Elsholtz FH, Bojarski C et al. The CDD System in Computed Tomographic Diagnosis of Diverticular Disease. Fortschr Röntgenstr 2017; 189: 740 – 747

Key words

diverticulitis - diverticulosis - CDD - CT - diverticular disease

Full Text

References

References
1 Weizman AV, Nguyen GC. Diverticular disease: epidemiology and management. Can J Gastroenterol 2011; 25: 385-389
2 Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg 1978; 12: 85-109
3 Wasvary H, Turfah F, Kadro O. et al. Same hospitalization resection for acute diverticulitis/Discussion. The American surgeon 1999; 65: 632
4 Hansen O, Stock W. Prophylaktische Operation bei der Divertikelkrankheit des Kolons–Stufenkonzept durch exakte Stadieneinteilung. Langenbecks Arch Chir 1999; 1257-1260
5 Leifeld L, Germer C, Böhm S. et al. S2k-Leitlinie Divertikelkrankheit/Divertikulitis. Zeitschrift für Gastroenterologie 2014; 52: 663-710
6 Schreyer AG, Layer G. German Society of D. et al. S2k Guidlines for Diverticular Disease and Diverticulitis: Diagnosis, Classification, and Therapy for the Radiologist. Fortschr Röntgenstr 2015; 187: 676-684
7 Böhm SK. Diagnostik und Klassifikation der Divertikelkrankheit. Visceral Medicine 2012; 28: 171-181
8 Becker V. Pathologic-anatomic aspects of the formation and complications of diverticula. Langenbecks Arch Chir 1976; 342: 401-409
9 Becker V. Diverticulosis. Anatomical aspects. Radiologe 1983; 23: 533-539
10 Granlund J, Svensson T, Olen O. et al. The genetic influence on diverticular disease – a twin study. Aliment Pharmacol Ther 2012; 35: 1103-1107
11 Aldoori WH, Giovannucci EL, Rimm EB. et al. A prospective study of diet and the risk of symptomatic diverticular disease in men. Am J Clin Nutr 1994; 60: 757-764
12 Böhm S. Epidemiologie, natürlicher Verlauf, Prognose. In: Kruis WLL. Hrsg. Divertikelkrankheit. Bremen: Uni-Med; 2010
13 Carlson AJ, Hoelzel F. Relation of diet to diverticulosis of the colon in rats. Gastroenterology 1949; 12: 108-115
14 Commane DM, Arasaradnam RP, Mills S. et al. Diet, ageing and genetic factors in the pathogenesis of diverticular disease. World J Gastroenterol 2009; 15: 2479-2488
15 Etzioni DA, Mack TM, Beart Jr. RW. et al. Diverticulitis in the United States: 1998–2005: changing patterns of disease and treatment. Ann Surg 2009; 249: 210-217
16 Fisher N, Berry CS, Fearn T. et al. Cereal dietary fiber consumption and diverticular disease: a lifespan study in rats. Am J Clin Nutr 1985; 42: 788-804
17 Masoomi H, Buchberg BS, Magno C. et al. Trends in diverticulitis management in the United States from 2002 to 2007. Arch Surg 2011; 146: 400-406
18 Painter NS, Burkitt DP. Diverticular disease of the colon: a deficiency disease of Western civilization. Br Med J 1971; 2: 450-454
19 Petruzziello L, Iacopini F, Bulajic M. et al. Review article: uncomplicated diverticular disease of the colon. Aliment Pharmacol Ther 2006; 23: 1379-1391
20 Strate LL. Lifestyle factors and the course of diverticular disease. Dig Dis 2012; 30: 35-45
21 Aldoori WH, Giovannucci EL, Rimm EB. et al. Use of acetaminophen and nonsteroidal anti-inflammatory drugs – A prospective study and the risk of symptomatic diverticular disease in men. Archives of Family Medicine 1998; 7: 255-260
22 Hjern F, Wolk A, Hakansson N. Obesity, physical inactivity, and colonic diverticular disease requiring hospitalization in women: a prospective cohort study. Am J Gastroenterol 2012; 107: 296-302
23 Kopylov U, Ben-Horin S, Lahat A. et al. Obesity, metabolic syndrome and the risk of development of colonic diverticulosis. Digestion 2012; 86: 201-205
24 Rosemar A, Angeras U, Rosengren A. Body mass index and diverticular disease: a 28-year follow-up study in men. Dis Colon Rectum 2008; 51: 450-455
25 Sakuta H, Suzuki T. Prevalence rates of type 2 diabetes and hypertension are elevated among middle-aged Japanese men with colonic diverticulum. Environmental health and preventive medicine 2007; 12: 97-100
26 Strate LL, Liu YL, Aldoori WH. et al. Physical activity decreases diverticular complications. Am J Gastroenterol 2009; 104: 1221-1230
27 Lembcke B. Diagnosis, differential diagnoses, and classification of diverticular disease. Visceral Medicine 2015; 31: 95-102
28 Klarenbeek BR, de Korte N, van der Peet DL. et al. Review of current classifications for diverticular disease and a translation into clinical practice. International Journal of Colorectal Disease 2012; 27: 207-214
29 Tack D, Bohy P, Perlot I. et al. Suspected Acute Colon Diverticulitis: Imaging with Low-Dose Unenhanced Multi–Detector Row CT 1. Radiology 2005; 237: 189-196
30 Werner A, Diehl S, Farag-Soliman M. et al. Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients. European radiology 2003; 13: 2596-2603
31 Sessa B, Galluzzo M, Ianniello S. et al. Acute perforated diverticulitis: assessment with multidetector computed tomography. Seminars in Ultrasound, CT and MRI: Elsevier 2016: 37-48
32 Öistämö E, Hjern F, Blomqvist L. et al. Cancer and diverticulitis of the sigmoid colon. Differentiation with computed tomography versus magnetic resonance imaging: preliminary experiences. Acta radiologica 2013; 54: 237-241
33 Thorisson A, Smedh K, Torkzad M. et al. CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis. International journal of colorectal disease 2016; 31: 451-457
34 Ambrosetti P. Acute left-sided colonic diverticulitis: clinical expressions, therapeutic insights, and role of computed tomography. Clinical and experimental gastroenterology 2016; 9: 249
35 Andeweg CS, Wegdam JA, Groenewoud J. et al. Toward an evidence-based step-up approach in diagnosing diverticulitis. Scandinavian journal of gastroenterology 2014; 49: 775-784
36 Karidis NP, Dimitroulis D, Kouraklis G. The role of abdominal imaging in cases with a high probability of acute left-sided colonic diverticulitis based on a clinical scoring system. Annals of surgery 2013; 258: e14
37 Rao P, Rhea J, Novelline R. et al. Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. Am J Roentgenol American journal of roentgenology 1998; 170: 1445-1449
38 Kircher MF, Rhea JT, Kihiczak D. et al. Frequency, sensitivity, and specificity of individual signs of diverticulitis on thin-section helical CT with colonic contrast material: experience with 312 cases. American Journal of Roentgenology 2002; 178: 1313-1318
39 Buckley O, Geoghegan T, O'Riordain D. et al. Computed tomography in the imaging of colonic diverticulitis. Clinical radiology 2004; 59: 977-983
40 Lohrmann C, Ghanem N, Pache G. et al. CT in acute perforated sigmoid diverticulitis. European journal of radiology 2005; 56: 78-83
41 Strate LL, Modi R, Cohen E. et al. Diverticular Disease as a Chronic Illness: Evolving Epidemiologic and Clinical Insights. American Journal of Gastroenterology 2012; 107: 1486-1493
42 Kruis W, Meier E, Schumacher M. et al. Randomised clinical trial: mesalazine (Salofalk granules) for uncomplicated diverticular disease of the colon–a placebo‐controlled study. Alimentary pharmacology & therapeutics 2013; 37: 680-690
43 Onur MR, Akpinar E, Karaosmanoglu AD. et al. Diverticulitis: a comprehensive review with usual and unusual complications. Insights into Imaging 2017; 8: 19-27