title: Diverticular disease severity score based on CT colonography.
abstract: OBJECTIVE
  We propose a diverticular disease severity score (DDSS) based on CT colonography (CTC) findings.
  
  
  METHODS
  Seventy-nine patients (62 ± 14.5 years) underwent CTC after recovering from an episode of acute diverticulitis. Two independent readers classified each case using a four-point scale (DDSS), based on maximum sigmoid colon wall thickness (MSCWT) and minimum lumen diameter at CTC: 1 = MSCWT <3 mm, lumen diameter ≥15 mm; 2 = MSCWT 3-8 mm, lumen diameter ≥5 mm; 3 = MSCWT ≥8 mm, lumen diameter ≥5 mm; 4 = MSCWT ≥8 mm, lumen diameter <5 mm. Intra- and interobserver reproducibility was evaluated. Of 79 patients, 32 (40 %) underwent surgery after CTC; MSCWT was directly measured on the pathological specimen.
  
  
  RESULTS
  Intra- and interobserver reproducibility of DDSS were almost perfect (k = 0.90-0.84). DDSS significantly correlated with the probability of surgery (P = 0.001). After surgery, histopathology revealed acute/chronic diverticular inflammation only in 29 cases, and superimposed sigmoid cancer (n = 2) or Crohn's disease (n = 1) in 3 patients with a DDSS of 4. MSCWT at histopathology correlated with DDSS (P = 0.008).
  
  
  CONCLUSIONS
  DDSS is highly reproducible and correlates with pathological MSCWT. Nearly 1 in 3 patients with a DDSS of 4 had significant superimposed histopathology. CTC with DDSS can provide colorectal surgeons with valuable information.
  
  
  CONCLUSIONS
  • A diverticular disease severity score (DDSS) based on CT colonography is proposed. • This DDSS is based on sigmoid colon wall thickness and lumen diameter. • High scores may be associated with relevant coexisting lesions. • A CTC-based DDSS may influence therapeutic decision-making.
authors: Unità Operativa Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, via A di Rudinì 8, 20142, Milano, Italy, nicola.flor@ao-sanpaolo.it.
authors: Nicola
authors: N
authors: Flor
authors: Paolo
authors: P
authors: Rigamonti
authors: Andrea
authors: A
authors: Pisani Ceretti
authors: Solange
authors: S
authors: Romagnoli
authors: Federica
authors: F
authors: Balestra
authors: Francesco
authors: F
authors: Sardanelli
authors: Gianpaolo
authors: G
authors: Cornalba
authors: Perry J
authors: PJ
authors: Pickhardt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D023881:Colonography, Computed Tomographic / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
references: Abdom Imaging. 2011 Oct;36(5):538-44
references: 21184064
references: Abdom Imaging. 2012 Dec;37(6):1101-9
references: 22366853
references: Radiology. 2007 Feb;242(2):456-62
references: 17255417
references: Eur Radiol. 2002 May;12(5):1145-9
references: 11976860
references: Colorectal Dis. 2012 Jan;14(1):e1-e11
references: 21848896
references: Eur Radiol. 2013 Mar;23(3):720-9
references: 22983280
references: Radiology. 2012 May;263(2):383-90
references: 22517956
references: Br J Surg. 2005 Feb;92(2):133-42
references: 15685694
references: N Engl J Med. 2003 Dec 4;349(23):2191-200
references: 14657426
references: Clin Radiol. 2007 Jul;62(7):645-50
references: 17556033
references: Eur Radiol. 2003 Dec;13 Suppl 4:L62-74
references: 15018168
references: Dig Liver Dis. 2004 Jul;36(7):435-45
references: 15285520
references: AJR Am J Roentgenol. 1994 Jul;163(1):81-3
references: 8010253
references: Abdom Imaging. 2013 Feb;38(1):82-97
references: 22539045
references: Br J Surg. 2011 Nov;98(11):1630-4
references: 21713756
references: Eur J Radiol. 2012 Mar;81(3):e250-4
references: 21354735
references: Clin Radiol. 2004 Nov;59(11):977-83
references: 15488845
references: Surg Laparosc Endosc Percutan Tech. 2003 Oct;13(5):325-7
references: 14571169
references: Clin Gastroenterol Hepatol. 2006 Aug;4(8):1039-47
references: 16793347
references: Adv Surg. 1978;12:85-109
references: 735943
references: Colorectal Dis. 2012 Aug;14(8):e439-46
references: 22404743
references: Radiology. 1999 Feb;210(2):429-35
references: 10207426
references: Am J Surg. 1986 Feb;151(2):269-71
references: 3946763