CT signs of diverticulum destruction in inflammatory complications of diverticular disease

Belov, D. M.; Zarodnyuk, I. V.; Maynovskaya, O. A.; Майновская, О. А.

doi:10.33878/2073-7556-2022-21-1-71-82

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…(2013) показали, что в среднем период формирования острого дивертикулита от момента начала заболевания составляет чуть более семи лет, а риск воспалительных осложнений со стороны измененной стенки кишки повышается пропорционально снижению возраста конкретного пациента на момент установления диагноза [3,4]. Возвращаясь к проблеме постановки диагноза и определении стадии ДБОК, следует указать на тот факт, что постановка диагноза на основании лабораторных показателей и клинических проявлений весьма затруднительна, а выбор тактики проводимых лечебных процедур напрямую зависит от результатов инструментальной диагностики [5,6]. С этой целью в клинической практике используется целый ряд визуализационных диагностических методов, таких как рентгеновская ирригография, колоноскопия, ультразвуковое исследование, компьютерная и магнитно-резонансная томография [7].…”

Section: оригинальные исследования введениеunclassified

Perfusion Computed Tomography in the Diagnosis of Colonic Diverticular Disease and its Complications

Timerbulatov,

Itkulov,

Baikov

et al. 2023

Kreativnaâ hirurgiâ i onkologiâ

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Introduction. Colonic diverticular disease (colonic diverticulitis) is considered to be a serious medical and social problem of modern society, marked by a persistent decrease in the quality of life of patients and a steady growth in morbidity with a tendency to increase complications of the underlying disease in the form of inflammatory destructive changes in the intestinal wall.Materials and methods. The study involved 63 patients with colonic diverticulitis, males and females, aged 34 through 79 years. All participants were divided into 3 groups, depending on the damage to the intestinal wall. The first group included 11 patients with intact intestinal wall, the second group included 43 patients with diverticulitis, and the third group — 9 patients with adenocarcinoma of the large intestine.Results and discussion. When performing perfusion computed tomography (PCT) of the intestinal wall, it was found that BF values in acute diverticulitis, compared to the intact intestinal wall, increased on average by 1.7 times, while in malignancies — by 5.3 times. BV values in acute diverticulitis, as compared to the intact intestinal wall, increased by 9.2, and in malignancies — 13.6 times. MRI values in acute diverticulitis, as compared to the intact intestinal wall, increased by 2.5 times, and in malignancies — 3.9 times. PS values in acute diverticulitis, as compared to the intact intestinal wall, increased by 1.7 times, and in malignancies — 3.8 times.Conclusion. Since PCT is able to detect the difference of microcirculation parameters in inflammatory and malignant processes, it can be used in the diagnostic algorithm to determine further treatment strategy.

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Section: оригинальные исследования введениеunclassified

Perfusion Computed Tomography in the Diagnosis of Colonic Diverticular Disease and its Complications

Timerbulatov,

Itkulov,

Baikov

et al. 2023

Kreativnaâ hirurgiâ i onkologiâ

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Prognostic possibilities of CT in the diagnosis of chronic inflammatory complications of diverticular disease

Belov,

Zarodnyuk,

Moskalev

et al. 2023

Medicinskaâ vizualizaciâ

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Objective: to determine the diagnostic effectiveness of computed tomography (CT) in predicting the course of the disease in patients with chronic inflammatory complications of diverticular disease (DD).Material and methods. The study included 70 patients with a complicated course of colon diverticular disease in the phase of exacerbation of the chronic inflammatory process. All patients underwent CT of the abdominal cavity with intravenous contrast to assess the type and severity of inflammatory changes in the colon and surrounding tissues in the area of localization of diverticula. All patients received conservative treatment and were monitored as part of the ongoing study for 12 months from the moment of initial treatment at the Center. Surgical intervention due to the ineffectiveness of conservative therapy or the recurrence of the inflammatory process during the established follow-up period was considered as an unfavorable outcome of the disease (42/60%). The positive effect of drug therapy without signs of a return of the clinical picture of inflammation within 12 months was considered as a favorable outcome (28/40%). A statistical analysis of CT signs of inflammatory changes in various DD outcomes was performed to identify prognostic CT parameters.Results. Statistically significant differences were revealed between the severity of inflammatory changes according to CT data for different outcomes of the disease. In the favorable outcome group, the main part (23/28.82%) were patients with diverticulitis, in the unfavorable outcome group, 2/3 of patients (29/42.64%) were diagnosed with pericolic infiltrates, including abscesses/cavities, and colon fistulas. It was found that the thickness of the intestinal wall, the extent of inflammatory changes in the intestinal wall, the extent of inflammatory infiltration of pericolic fiber, the symptom of “centipede”, the accumulation of fluid in the pericolic region statistically significantly differed with different outcomes of chronic inflammatory complications of diverticular disease. Мultivariate Cox proportional hazard model revealed two main predictors of the onset of an unfavorable outcome – thickening of the intestinal wall and the presence of fluid in the pericolic region. Thickening of the intestinal wall at values equal to or greater than 0,6 cm increased the risk of an unfavorable outcome by 4.69 times, and the presence of fluid by 4.52 times.Conclusion. The use in clinical practice of the revealed CT predictors of the onset of an unfavorable outcome in chronic inflammatory complications of DB can serve as one of the factors for deciding on elective surgery in this category of patients.

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Value of computed tomography and abdominal ultrasound for chronic inflammatory complications of diverticular disease

Belov,

Zarodnyuk,

Trubacheva

et al. 2023

Koloproktologiâ

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Aim: to evaluate the diagnostic value of computed tomography (CT) and abdominal ultrasound (US) for chronic inflammatory complications in patients with diverticular disease (DD).Patients and Methods: the prospective cohort study included 50 patients with complicated DD. All patients underwent preoperative abdominal CT with intravenous contrast and abdominal US, with further elective bowel resection. The results of CT and ultrasound were compared with morphology of the removed specimens.Results: the sensitivity and specificity for chronic diverticulitis was 66.7% and 95.7% for CT and 100.0% and 95.7% for US. For chronic pericolic abdominal mass it was 94.8% and 90.9% for CT, 94.8% and 100.0% for US; for abdominal abscesses/cavities it was 87.5% and 96.2% for CT and 91.6% and 100.0% for US; for diverticular fistulas it was 87.5% and 100.0% for CT and 87.5% and 100.0% for US. No significant differences were obtained between two diagnostic modalities. A high level of consistency (κ-coefficient 0.71) of CT and US for the diagnosis of inflammatory complications of DD was found. Conclusion: CT and US have a similar high diagnostic value for chronic inflammatory complications of DD. Each of them can be used as a single diagnostic modality or both depending on the clinical case.

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CT signs of diverticulum destruction in inflammatory complications of diverticular disease

Cited by 3 publications

References 15 publications

Perfusion Computed Tomography in the Diagnosis of Colonic Diverticular Disease and its Complications

Perfusion Computed Tomography in the Diagnosis of Colonic Diverticular Disease and its Complications

Prognostic possibilities of CT in the diagnosis of chronic inflammatory complications of diverticular disease

Value of computed tomography and abdominal ultrasound for chronic inflammatory complications of diverticular disease

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