title: Sigmoid stenosis caused by diverticulitis vs. carcinoma: usefulness of sonographic features for their differentiation in the emergency setting.
abstract: OBJECTIVE
  To retrospectively evaluate the accuracy of ultrasound as a diagnostic method for differentiating acute diverticulitis from colon cancer in patients with sigmoid colon stenosis.
  
  
  METHODS
  Ultrasound examinations of 91 consecutive patients with sigmoid stenosis (50 diverticulitis and 41 colon cancers) were reviewed by two trained radiologists. Sixty-five (71%) patients presented with acute abdominal symptoms. Thirteen sonographic criteria retrieved from the literature were evaluated to differentiate benign from malignant strictures. A score including all parameters which showed significant differences between benign vs. malignant was built. Sensitivity, specificity, accuracy, and positive or negative predictive values of each sonographic sign, the overall diagnosis, and sonographic score were calculated.
  
  
  RESULTS
  Loss of the bowel wall stratification was the most reliable criteria for the diagnosis of malignancy (92% and 94% of sensitivity and specificity, respectively), and the best inter-radiologist agreement (κ = 0.848). Adjacent lymph nodes were the most specific feature (98%) for colon cancer, but its sensitivity was low. Global assessment could differentiate both diseases with high sensitivity (92-94.9%) and specificity (98-100%). Sonographic score >3 enabled differentiation of carcinoma from diverticulitis with 95% sensitivity and 92-94% specificity, with an area under the ROC curve of 0.98-0.987. There were no significant differences in the results between patients with acute and nonacute abdominal symptoms.
  
  
  CONCLUSIONS
  The combination of several morphological sonographic findings using a score can differentiate most cases of diverticulitis from colon carcinoma in sigmoid strictures.
authors.affiliation: Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017, Valencia, Spain. ripolles_tom@gva.es.
authors.forename: Tomás
authors.initials: T
authors.lastname: Ripollés
authors.affiliation: Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017, Valencia, Spain. chusjmartinez@gmail.com.
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Martínez-Pérez
authors.affiliation: Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017, Valencia, Spain. Dianapgv@gmail.com.
authors.forename: Diana Patricia
authors.initials: DP
authors.lastname: Gómez Valencia
authors.affiliation: Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017, Valencia, Spain. vizujose@gmail.com.
authors.forename: José
authors.initials: J
authors.lastname: Vizuete
authors.affiliation: Department of Radiology, Hospital Universitario Dr. Peset, 90 Gaspar Aguilar Avenue, 46017, Valencia, Spain. gregojb@hotmail.com.
authors.forename: Gregorio
authors.initials: G
authors.lastname: Martín
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D003106:Colon / Q000000981:diagnostic imaging; D003110:Colonic Neoplasms / Q000000981:diagnostic imaging*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D004239:Diverticulitis, Colonic / Q000000981:diagnostic imaging*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012810:Sigmoid Diseases / Q000000981:diagnostic imaging*; D014463:Ultrasonography; D055815:Young Adult
keywords: Cancer; Colon; Diverticulitis; Sigmoid; Stenosis; Ultrasound