Dark-lumen magnetic resonance colonography in patients with suspected sigmoid diverticulitis: a feasibility study

Ajaj, Waleed; Ruehm, Stefan G.; Lauenstein, Thomas C.; Goehde, Susanne C.; Kuehle, Christiane A.; Herborn, Christoph U.; Langhorst, Jost; Zoepf, Thomas; Gerken, Guido; Goyen, Mathias

doi:10.1007/s00330-005-2862-2

Cited by 39 publications

(38 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The use of magnetic resonance colonography for the diagnosis of ACD was investigated by Ajaj et al [43]. This feasibility study reported a promising sensitivity of 86% and specificity of 92%.…”

Section: Discussionmentioning

confidence: 98%

Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: Meta-analysis of test accuracy

et al. 2008

View full text Add to dashboard Cite

The purpose was to investigate the diagnostic accuracy of graded compression ultrasonography (US) and computed tomography (CT) in diagnosing acute colonic diverticulitis (ACD) in suspected patients. We performed a systematic review and meta-analysis of the accuracy of CT and US in diagnosing ACD. Study quality was assessed with the QUADAS tool. Summary estimates of sensitivity and specificity were calculated using a bivariate random effects model. Six US studies evaluated 630 patients, and eight CT studies evaluated 684 patients. Overall, their quality was moderate. We did not identify meaningful sources of heterogeneity in the study results. Summary sensitivity estimates were 92% (95% CI: 80%-97%) for US versus 94% (95%CI: 87%-97%) for CT (p = 0.65). Summary specificity estimates were 90% (95%CI: 82%-95%) for US versus 99% (95%CI: 90%-100%) for CT (p = 0.07). For the identification of alternative diseases sensitivity ranged between 33% and 78% for US and between 50% and 100% for CT. The currently best available evidence shows no statistically significant difference in accuracy of US and CT in diagnosing ACD. Therefore, both US and CT can be used as initial diagnostic tool until new evidence is brought forward. However, CT is more likely to identify alternative diseases.

show abstract

Section: Discussionmentioning

confidence: 98%

Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: Meta-analysis of test accuracy

et al. 2008

View full text Add to dashboard Cite

show abstract

“…MRI has the advantage that no ionizing radiation and intravenous contrast medium are needed to reach a higher soft tissue contrast than CT. MRI is increasingly used in the acute setting for patients with acute abdominal pain, but accuracy data are still limited. Based on studies with small numbers of patients, sensitivity and specificity of MRI for diagnosing ACD vary between 86 and 100% and 88 and 100% (level B [67,68] and level C [69,70]).…”

Section: Clinical Diagnosis and Radiological Imagingmentioning

confidence: 99%

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

Andeweg¹,

Mulder²,

et al. 2013

View full text Add to dashboard Cite

Background: The incidence of acute left-sided colonic diverticulitis (ACD) is increasing in the Western world. To improve the quality of patient care, a guideline for diagnosis and treatment of diverticulitis is needed. Methods: A multidisciplinary working group, representing experts of relevant specialties, was involved in the guideline development. A systematic literature search was conducted to collect scientific evidence on epidemiology, classification, diagnostics and treatment of diverticulitis. Literature was assessed using the classification system according to an evidence-based guideline development method, and levels of evidence of the conclusions were assigned to each topic. Final recommendations were given, taking into account the level of evidence of the conclusions and other relevant considerations such as patient preferences, costs and availability of facilities. Results: The natural history of diverticulitis is usually mild and treatment is mostly conservative. Although younger patients have a higher risk of recurrent disease, a higher risk of complications compared to older patients was not found. In general, the clinical diagnosis of ACD is not accurate enough and therefore imaging is indicated. The triad of pain in the lower left abdomen on physical examination, the absence of vomiting and a C-reactive protein >50 mg/l has a high predictive value to diagnose ACD. If this triad is present and there are no signs of complicated disease, patients may be withheld from further imaging. If imaging is indicated, conditional computed tomography, only after a negative or inconclusive ultrasound, gives the best results. There is no indication for routine endoscopic examination after an episode of diverticulitis. There is no evidence for the routine administration of antibiotics in patients with clinically mild uncomplicated diverticulitis. Treatment of pericolic or pelvic abscesses can initially be treated with antibiotic therapy or combined with percutaneous drainage. If this treatment fails, surgical drainage is required. Patients with a perforated ACD resulting in peritonitis should undergo an emergency operation. There is an ongoing debate about the optimal surgical strategy. Conclusion: Scientific evidence is scarce for some aspects of ACD treatment (e.g. natural history of ACD, ACD in special patient groups, prevention of ACD, treatment of uncomplicated ACD and medical treatment of recurrent ACD), leading to treatment being guided by the surgeon's personal preference. Other aspects of the management of patients with ACD have been more thoroughly researched (e.g. imaging techniques, treatment of complicated ACD and elective surgery of ACD). This guideline of the diagnostics and treatment of ACD can be used as a reference for clinicians who treat patients with ACD.

show abstract

“…Initial results suggest MRC to be sensitive and specific for the detection of clinically relevant colorectal polyps and carcinomas (12)(13)(14). Furthermore, moderate and severe bowel wall inflammation can be accurately depicted (15)(16)(17). Regarding side-effects of MRC, no complications have been reported so far.…”

Section: Discussionmentioning

confidence: 99%

MR colonography with fecal tagging: Do individual patient characteristics influence image quality?

Kinner¹,

Kuehle²,

Langhorst³

et al. 2007

Magnetic Resonance Imaging

Self Cite

View full text Add to dashboard Cite

Purpose:To evaluate if different patient characteristics influence performance of fecal tagging (a new MR colonography (MRC) technique to label stool to avoid bowel cleansing) and, consecutively, MR image quality. Materials and Methods:A total of 333 patients (mean age ϭ 61 years) underwent MRC with fecal tagging. Four segments of the large bowel (ascending, transverse, descending, and sigmoid colon) were assessed as for the presence of nontagged stool particles, which can impede an assessment of the colonic wall. Ratings were correlated with patients' characteristics including patient age (Ͻ55 vs. Ն55 years), body mass index (BMI) (Ͻ25 vs. Ն25), gender, and acceptance levels for fecal tagging. Statistical analysis was performed using a Mann-Whitney U-test.Results: A total of 1332 colonic segments were evaluated. Among them, 327 segments (25%) did not contain any visible stool particles. Considerably reduced image quality was found in 61 segments (5%). Best image quality was found in the sigmoid colon (mean value ϭ 1.9), while image quality of the ascending colon turned out to be worst (mean value ϭ 2.6). Fecal tagging effectiveness showed a reverse correlation with patient age. However, all other characteristics did not have a statistically significant influence on fecal tagging outcome.Conclusion: MRC in conjunction with barium-based fecal tagging led to diagnostic image quality in 95% of all colonic segments. Since tagging results were significantly decreased in patients Ն55 years, tagging protocols should to be modified in this group, i.e., by increasing the time interval of tagging administration.

show abstract

Dark-lumen magnetic resonance colonography in patients with suspected sigmoid diverticulitis: a feasibility study

Cited by 39 publications

References 39 publications

Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: Meta-analysis of test accuracy

Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: Meta-analysis of test accuracy

Guidelines of Diagnostics and Treatment of Acute Left-Sided Colonic Diverticulitis

MR colonography with fecal tagging: Do individual patient characteristics influence image quality?

Contact Info

Product

Resources

About