The use of CT colonography (CTC) as both a diagnostic and screening examination for colon cancer is steadily increasing. It also is valuable as a prognostic tool for patients recovering from acute diverticulitis, according to radiologists at the Università degli Studi di Milano in Italy.
At the Azienda Ospedaliera San Paolo University hospital in Milan, a CTC is ordered for recovering patients about two months following an episode of acute diverticulitis. CTC provides a detailed map of the extent of diverticular disease and the number of diverticula. It provides detailed information on post-acute involvement of colonic segments and allows for the diagnosis of complications such as diverticular stricture or fistula that may require surgical treatment. Because active inflammation during acute diverticulitis can obscure important coexisting disease such as colorectal cancer, it is important to subsequently verify if other conditions exist.
In 2013, radiologist Nicola Flor, M.D., with a multi-disciplinary team of physicians in Milan and the collaboration of Perry Pickhardt, M.D., professor of radiology at the University of Wisconsin, developed a four-point diverticular disease severity score (DDSC) based on CT colonography findings. It is based on different degrees of wall thickening and stenosis of the sigmoid colon lumen.1
Flor and colleagues subsequently conducted a study published online October 5, 2015 in Academic Radiology to assess the prognostic value of CTC in patients recovering after acute diverticulitis and to evaluate the clinical relevance of any additional information gained from CTC. Forty-six patients admitted to the emergency department of the Azienda Ospedaliera San Paolo between March 2010 and December 2013 were included in the study cohort. A follow-up CTC had been performed between four and 36 weeks following initial treatment for acute diverticulitis of the left colon. The scan was performed in supine and prone positions, and 59% of the patients had an additional lateral decubitus scan to ameliorate sigmoid colon distension.
For the study, a radiologist retrospectively analyzed the abdominal CT and the CTC examinations for each patient, calculating the severity of disease with a modified Hinchey classification and DDSS. The authors reported that all the DDSS measurements were taken on two-dimensional multiplanar reformatted images from the best distended series using standard soft-tissue windowing.
Nine percent of the patients had a DDSS 4 score, 15% with DDSS 3, 37% with DDSS2, and 39% with DDSS 1. Twenty-four percent were classified as having severe disease and 76% as having mild-moderate disease. By comparison, the Hinchley classification indicated that 33% had severe disease and 67% had mild-moderate disease.
Forty percent of the patients underwent elective surgery after CTC for complications or recurrence of acute diverticulitis or sigmoid colon severe stenosis. The authors reported that a significant correlation was found between the probability of undergoing elective surgery and the CTC-based DDSS, whereas no correlation was found between this probability and the CT-based modified Hinchey classification.
Moreover, CTC identified additional findings in five (11%) of the patients. These included an enterocolic fistula, an enterotubal fistula, and two cases of colon cancer. Notably, the abdominal CT scans of the two patients with colon cancer were negative.
In conclusion, the authors recommend CTC as the test of choice in patients recovering from an episode of acute diverticulitis.
REFERENCES
- Flor N, Rigamonti P, Ceretti AP, et al. Diverticular disease severity score based on CT colongraphy. 2013 Eur Radiol 23:2723-2729.
- Flor N, Maconi G, Sardanelli F, et al. Prognostic Value of the Diverticular Disease Severity Score Based on CT Colonography: Follow-up in Patients Recovering from Acute Diverticulitis. Acad Radiol. Published online October 5, 2015.
FAQs
Hence, colonoscopy is typically recommended after an episode of acute diverticulitis to rule out underlying malignancy. Currently, 64-slice multidetector CT scanners are capable of providing higher-resolution images and may be able to distinguish malignancy from diverticular inflammation.
What is the follow up after acute diverticulitis? ›
Follow-up care
Your healthcare professional may recommend a colonoscopy six weeks or longer after you no longer have symptoms of diverticulitis.
Is a colonoscopy necessary after CT diagnosed acute diverticulitis? ›
A diagnostic colonoscopy should be undertaken for a person with CT-diagnosed diverticulitis if new symptoms arise within two years of a normal colonoscopy. Colorectal cancer, particularly at an early stage, cannot be excluded through a CT scan.
What is the CT protocol for diverticulitis? ›
Doctors often diagnose diverticulitis using a computed tomography (CT) scan of your abdomen and pelvis. It is best to perform the scan with intravenous (IV) contrast when possible. Many centers will also ask that you drink a form of oral contrast. Both contrast materials make the intestinal tract easier to see.
How long after diverticulitis should colonoscopy be done? ›
According to the American Gastrointestinal Association, a colonoscopy should be performed six to eight weeks after resolution of acute diverticulitis. The purpose of this study is to determine if there is malignancy after an acute diverticulitis event in adults less than 50 years old.
Why would I need a CT colonography? ›
CT colonography is a computed tomography ( CT ) examination to look at the large bowel (colon). It is a method of diagnosing bowel cancer when it is still at an early stage. A CT machine uses x-rays and advanced computers to create detailed images. We then examine these images to check the health of your bowel.
How bad is acute diverticulitis? ›
Diverticulitis is uncomplicated 80% of the time. But severe or persistent diverticulitis can lead to complications such as: Gastrointestinal bleeding: Bleeding from diverticula can be severe and lead to anemia. Intestinal obstruction: Severe swelling might cause your colon to temporarily narrow.
How long does it take to fully recover from acute diverticulitis? ›
In about 95 out of 100 people, uncomplicated diverticulitis goes away on its own within a week. In about 5 out of 100 people, the symptoms stay and treatment is needed. Surgery is only rarely necessary.
What is an acute episode of diverticulitis? ›
Acute diverticulitis can present in various ways, from mild intermittent pain to chronic severe unrelenting abdominal pains. Fever and a change in bowel movements are common, along with constipation and diarrhea. The symptoms of diverticulitis can also look like other problems.
Can CT colonography replace colonoscopy? ›
CT colonography is an excellent alternative for patients who have clinical factors that increase the risk of complications from colonoscopy, such as treatment with a blood thinner or a severe breathing problem.
Computed tomography (CT) of the abdomen and pelvis with IV contrast is considered to be the best imaging method because it can confirm the presence of acute colonic diverticulitis, evaluate disease severity and degree, and often differentiate colonic diverticulitis from other diseases.
What are the symptoms of severe diverticulitis? ›
Symptoms
- Tenderness, usually in the left lower part of the abdomen.
- Bloating or gas.
- Fever and chills.
- Nausea and vomiting.
- Not feeling hungry and not eating.
CTC provides a detailed map of the extent of diverticular disease and the number of diverticula. It provides detailed information on post-acute involvement of colonic segments and allows for the diagnosis of complications such as diverticular stricture or fistula that may require surgical treatment.
What is the rule of 2 diverticulitis? ›
It is often referred to by the rule of 2's; 2% of the population, within 2 feet of the ileocecal valve, 2 inches in length, tow types of heterotopic Mucosa, and presentation before the age of two.
What foods to avoid diverticulitis? ›
But high-fiber foods are harder to digest, and avoiding these foods during a flare-up can help get your symptoms under control. Some high-fiber foods to stay away from during this time include: Fresh fruit, especially apples, pears, and raspberries. Vegetables (other than canned), especially green peas and broccoli.
Is CT colonography as good as colonoscopy? ›
Traditional colonoscopy remains the more comprehensive approach; CT colonography can't remove polyps and may miss those smaller than 10 millimeters.
Why was my CT colonography so painful? ›
You may have some bloating or pain in your abdomen after the test. This is due to the carbon dioxide or air put into the bowel. This should go away shortly afterwards. There is a small risk of a tear (perforation) in your bowel.
What is a virtual colonoscopy for diverticulitis? ›
A virtual colonoscopy allows your doctor to look at your colon and rectum to find abnormal areas. Abnormalities that may be detected and diagnosed include: diverticulosis, which causes small pouches in your digestive tract.
At the Azienda Ospedaliera San Paolo University hospital in Milan, a CTC is ordered for recovering patients about two months following an episode of acute diverticulitis. CTC provides a detailed map of the extent of diverticular disease and the number of diverticula. It provides detailed information on post-acute involvement of colonic segments and allows for the diagnosis of complications such as diverticular stricture or fistula that may require surgical treatment. Because active inflammation during acute diverticulitis can obscure important coexisting disease such as colorectal cancer, it is important to subsequently verify if other conditions exist. 
In 2013, radiologist Nicola Flor, M.D., with a multi-disciplinary team of physicians in Milan and the collaboration of Perry Pickhardt, M.D., professor of radiology at the University of Wisconsin, developed a four-point diverticular disease severity score (DDSC) based on CT colonography findings. It is based on different degrees of wall thickening and stenosis of the sigmoid colon lumen.1
For the study, a radiologist retrospectively analyzed the abdominal CT and the CTC examinations for each patient, calculating the severity of disease with a modified Hinchey classification and DDSS. The authors reported that all the DDSS measurements were taken on two-dimensional multiplanar reformatted images from the best distended series using standard soft-tissue windowing. 