Prognostic Value of the Diverticular Disease Severity Score Based on CT Colonography: Follow-up in Patients Recovering from Acute Diverticulitis.
OBJECTIVE
To assess the prognostic value of a diverticular disease severity score (DDSS) based on computed tomography colonography (CTC) after acute diverticulitis (AD).


METHODS
Of 252 patients who had an AD episode, we finally selected 46 patients who underwent both conventional CT at the acute event and CTC after 9 ± 7 weeks. Of these 46 patients, 17 underwent elective surgery after CTC. Disease severity was assessed with a 0-4 modified Hinchey CT-based score and a 1-4 CTC-based DDSS. A phone survey was performed 27 months later (range 4-52) for the 29 patients not surgically treated.


RESULTS
Significant correlation was found between CTC-based DDSS and clinical follow-up (P = 0.022) or elective surgery (P = 0.007), but not between clinical follow-up and CT-based score, extraluminal gas, C-reactive protein serum level, age, gender, or first versus recurrent AD episode. CTC demonstrated relevant additional findings in five of 46 (11%) patients: two AD complications (enterocolic and enterotubal fistulae), two colon cancers, and one extracolonic (lung) cancer.


CONCLUSIONS
The CTC-based DDSS showed a prognostic value and correlated with the risk of undergoing surgery, and clinically relevant additional findings were found in more than 10% of patients. CTC could be the preferred test in patients recovering after AD.
Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, Milan 20142, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, Milan 20142, Italy. Electronic address: nicola.flor@unimi.it.
Nicola
N
Flor
Gastroenterology Unit, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Milan, Italy.
Giovanni
G
Maconi
Unità di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Dipartimento di Scienze Biomediche della Salute, Università degli Studi di Milano, San Donato Milanese 20097, Italy.
Francesco
F
Sardanelli
Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan 20122, Italy.
Maria Antonietta
MA
Lombardi
Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan 20122, Italy.
Bernardo
B
Colombo
Unità di Radiologia, IRCCS Policlinico San Donato, San Donato Milanese, Italy; Dipartimento di Scienze Biomediche della Salute, Università degli Studi di Milano, San Donato Milanese 20097, Italy.
Giovanni
G
Di Leo
Unità Operativa di Anatomia Patologica, Azienda Ospedaliera San Paolo, Milan 20142, Italy.
Monica
M
Falleni
Unità Operativa di Radiologia Diagnostica e Interventistica, Azienda Ospedaliera San Paolo, Via di Rudinì 8, Milan 20142, Italy; Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, Milan 20142, Italy.
Gianpaolo
G
Cornalba
Dipartimento di Scienze della Salute, Università degli Studi di Milano, Via di Rudinì 8, Milan 20142, Italy; Scuola di Specializzazione in Radiodiagnostica, Facoltà di Medicina e Chirurgia, Università degli Studi di Milano, Milan 20122, Italy; Department of Radiology, University of Wisconsin School of Medicine & Public Health, Madison, WI 53792-3252, USA.
Perry J
PJ
Pickhardt
D000208:Acute Disease; D015331:Cohort Studies; D023881:Colonography, Computed Tomographic; D004239:Diverticulitis, Colonic / Q000000981:diagnostic imaging* / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012720:Severity of Illness Index
Abdominal CT; Acute diverticulitis; CT colonography; Colon; Diverticular disease