gnckКолопроктологияKoloproktologia2073-75562686-7303Russian Association of Coloproctology10.33878/2073-7556-2023-22-4-33-44gnck-1863Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESВозможности компьютерной томографии и ультразвукового исследования в диагностике хронических воспалительных осложнений дивертикулярной болезниValue of computed tomography and abdominal ultrasound for chronic inflammatory complications of diverticular diseasehttps://orcid.org/0000-0002-9442-7480БеловД. М.BelovD. M.

Белов Денис Мануэлевич — врач-рентгенолог, младший научный сотрудник,

ул. Саляма Адиля, д. 2, г. Москва, 123423

Denis M. Belov,

Salyama Adilya st., 2, Moscow, 123423

https://orcid.org/0000-0003-2545-7966ЗароднюкИ. В.ZarodnyukI. V.

Зароднюк Ирина Владимировна — доктор медицинских наук, руководитель отделения рентгенодиагностики, компьютерной томографии и магниторезонансной томографии,

ул. Саляма Адиля, д. 2, г. Москва, 123423

Irina V. Zarodnyuk,

Salyama Adilya st., 2, Moscow, 123423

zarodnyuk_iv@gnck.ruhttps://orcid.org/0000-0002-8403-195XТрубачеваЮ. Л.TrubachevaYu. L.

Трубачева Юлия Леонидовна — доктор медицинских наук, руководитель отделения ультразвуковой диагностики,

ул. Саляма Адиля, д. 2, г. Москва, 123423

Yuliya L. Trubacheva,

Salyama Adilya st., 2, Moscow, 123423

https://orcid.org/0000-0002-3038-1524МоскалевА. И.MoskalevA. I.

Москалев Алексей Игоревич— кандидат медицинских наук, руководитель научно-образовательного отдела,

ул. Саляма Адиля, д. 2, г. Москва, 123423

Alexey I. Moskalev,

Salyama Adilya st., 2, Moscow, 123423

https://orcid.org/0000-0001-8189-3071МайновскаяО. А.MaynovskayaO. A.

Майновская Ольга Александровна — кандидат медицинских наук, руководитель отделения патоморфологии,

ул. Саляма Адиля, д. 2, г. Москва, 123423

Olga A. Maynovskaya,

Salyama Adilya st., 2, Moscow, 123423

ФГБУ «НМИЦ колопроктологии имени А.Н. Рыжих» Минздрава РоссииРоссияRyzhih National Medical Research Center of ColoproctologyRussian Federation2023211220232243344Copyright © Белов Д.М., Зароднюк И.В., Трубачева Ю.Л., Москалев А.И., Майновская О.А., 20232023Белов Д.М., Зароднюк И.В., Трубачева Ю.Л., Москалев А.И., Майновская О.А.Belov D.M., Zarodnyuk I.V., Trubacheva Y.L., Moskalev A.I., Maynovskaya O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.ruproctology.com/jour/article/view/1863Цель исследования

Цель исследования: оценить диагностическую эффективность компьютерной томографии (КТ) и ультразвукового исследования (УЗИ) в выявлении хронических воспалительных осложнений у пациентов с дивертикулярной болезнью ободочной кишки (ДБ).

Пациенты и методы

Пациенты и методы: в проспективное когортное исследование включено 50 пациентов с осложненным течением ДБ ободочной кишки. Всем пациентам выполнена КТ брюшной полости с внутривенным контрастированием и ультразвуковое исследование кишечника для определения вида воспалительных осложнений ДБ. Всем пациентам выполнены оперативные вмешательства в объеме резекции измененных отделов ободочной кишки. Результаты КТ и УЗИ сопоставлены с данными морфологического исследования препаратов удаленных сегментов кишки.

Результаты

Результаты: чувствительность и специфичность двух методов составили в выявлении: дивертикулита 66,7% и 95,7% — для КТ, 100%, и 95,7% — для УЗИ, соответственно; паракишечных инфильтратов 94,8% и 90,9% — для КТ, 94,8% и 100% — для УЗИ; абсцессов/полостей 87,5% и 96,2% — для КТ, 91,6% и 100% — для УЗИ; кишечных свищей 87,5% и 100% — для КТ, 87,5% и 100% — для УЗИ, соответственно. Статистически значимых различий в диагностической эффективности методов не выявлено ни по одному из показателей. Определен высокий уровень согласованности (Kappa Coefficient 0,71) результатов КТ и УЗИ в диагностике воспалительных осложнений ДБ.

Заключение

Заключение: проведенное исследование выявило сходную высокую диагностическую эффективность КТ и УЗИ при хронических воспалительных осложнениях ДБ. Учитывая преимущества и недостатки рассматриваемых методов, каждый из них может применяться как в качестве единственного способа диагностики, так и комплексно в зависимости от клинической ситуации и решаемых клинических задач.

Aim

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

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

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.

воспалительные осложнения дивертикулярной болезникомпьютерная томографияультразвуковое исследованиеinflammatory complications of diverticular diseasecomputed tomographyultrasoundReferencesKlarenbeek BR, de Korte N, van der Peet DL, et al. Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis. 2012;27:207–14. doi: 10.1007/s00384-011-1314-5Klarenbeek BR, de Korte N, van der Peet DL, et al. Review of current classifications for diverticular disease and a translation into clinical practice. Int J Colorectal Dis. 2012;27:207–14. doi: 10.1007/s00384-011-1314-5Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85–109.Hinchey EJ, Schaal PG, Richards GK. Treatment of perforated diverticular disease of the colon. Adv Surg. 1978;12:85–109.Sher ME, Agachan F, Bortul M, et al. Laparoscopic surgery for diverticulitis. Surg Endosc. 1997;11:264–7. doi: 10.1007/s004649900340Sher ME, Agachan F, Bortul M, et al. Laparoscopic surgery for diverticulitis. Surg Endosc. 1997;11:264–7. doi: 10.1007/s004649900340Wasvary H, Turfah F, Kadro O, et al. Same hospitalization resection for acute diverticulitis. Am Surg. 1999;65:632–6.Wasvary H, Turfah F, Kadro O, et al. Same hospitalization resection for acute diverticulitis. Am Surg. 1999;65:632–6.Hansen O, Graupe F, Stock W. Prognosefaktoren der perforierten Dickdarm diverticulitis[Prognostic factors in perforating diverticulitis of the large intestine]. Chirurg. 1998;69:443–9. doi: 10.1007/s001040050436Hansen O, Graupe F, Stock W. Prognosefaktoren der perfori erten Dickdarm diverticulitis [Prognostic factors in perforating diverticulitis of the large intestine]. Chirurg. 1998;69:443–9. doi: 10.1007/s001040050436Neff CC, van Sonnenberg E. CT of diverticulitis. Diagnosis and treatment. Radiol Clin North Am. 1989;27:743–52.Neff CC, van Sonnenberg E. CT of diverticulitis. Diagnosis and treatment. Radiol Clin North Am. 1989;27:743–52.Ambrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management a prospective study of 542 patients. Eur Radiol. 2002;12:1145–9. doi: 10.1007/s00330-001-1143-yAmbrosetti P, Becker C, Terrier F. Colonic diverticulitis: impact of imaging on surgical management a prospective study of 542 patients. Eur Radiol. 2002;12:1145–9. doi: 10.1007/s00330-001-1143-yTursi A, Brandimarte G, Giorgetti G, et al. The clinical picture of uncomplicated versus complicated diverticulitis of the colon. Dig Dis Sci. 2008;53:2474–9. doi: 10.1007/s10620-007-0161-2Tursi A, Brandimarte G, Giorgetti G, et al. The clinical picture of uncomplicated versus complicated diverticulitis of the colon. Dig Dis Sci. 2008;53:2474–9. doi: 10.1007/s10620-007-0161-2Kaiser AM, Jiang JK, Lake JP, et al. The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol. 2005;100:910–7. doi: 10.1111/j.1572-0241.2005.41154.xKaiser AM, Jiang JK, Lake JP, et al. The management of complicated diverticulitis and the role of computed tomography. Am J Gastroenterol. 2005;100:910–7. doi: 10.1111/j.1572-0241.2005.41154.xRoson Gradaille N, Narbona Díez A, Garriga Farriol MV, et al. Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: Value of current severity classification schemes. Radiologia (Engl Ed). 2023;65(1):32–42. doi: 10.1016/j.rxeng.2020.12.007Roson Gradaille N, Narbona Díez A, Garriga Farriol MV, et al. Classification of acute diverticulitis in the left colon with ultrasonography and computed tomography: Value of current severity classification schemes. Radiologia (Engl Ed). 2023;65(1):32–42. doi: 10.1016/j.rxeng.2020.12.007Ардатская М.Д., Ачкасов С.И., Веселов В.В. и соавт. Дивертикулярная болезнь. Клинические рекомендации. Колопроктология. 2021;20(3):10–27. doi: 10.33878/2073-7556-2021-20-3-10-27Ardatskaya M.D., Achkasov S.I., Veselov V.V., et al. Diverticular disease. Clinical guidelines. Koloproktologia. 2021;20(3):10–27. (In Russ.). doi: 10.33878/2073-7556-2021-20-3-10-27Шелыгин Ю.А., Ачкасов С.И., Москалёв А.И. Классификация дивертикулярной болезни. Колопроктология. 2014;4(50):5–13.Shelygin Yu.A., Achkasov S.I., Moskalev A.I. Classification of diverticular disease. Koloproktologia. 2014;4(50):5–13 (In Russ.)Ripollés T, Sebastián-Tomás JC, Martínez-Pérez MJ, et al. Ultrasound can differentiate complicated and noncomplicated acute colonic diverticulitis: a prospective comparative study with computed tomography. Abdom Radiol (NY). 2021;46(8):3826–3834. doi: 10.1007/s00261-021-03060-5Ripollés T, Sebastián-Tomás JC, Martínez-Pérez MJ, et al. Ultrasound can differentiate complicated and noncomplicated acute colonic diverticulitis: a prospective comparative study with computed tomography. Abdom Radiol (NY). 2021;46(8):3826–3834. doi: 10.1007/s00261-021-03060-5Toorenvliet BR, Bakker RFR, Breslau PJ, et al. Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision-making. Colorectal Dis. 2010;12:179–187.Toorenvliet BR, Bakker RFR, Breslau PJ, et al. Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision-making. Colorectal Dis. 2010;12:179–187.Kandagatla PG, Stefanou AJ. Current Status of the Radiologic Assessment of Diverticular Disease. Clin Colon Rectal Surg. 2018;31(4):217–220. doi: 10.1055/s-0037-1607466Kandagatla PG, Stefanou AJ. Current Status of the Radiologic Assessment of Diverticular Disease. Clin Colon Rectal Surg. 2018;31(4):217–220. doi: 10.1055/s-0037-1607466Laméris W, van Randen A, van Gulik TM, et al. A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum. 2010;53:896–904.Laméris W, van Randen A, van Gulik TM, et al. A clinical decision rule to establish the diagnosis of acute diverticulitis at the emergency department. Dis Colon Rectum. 2010;53:896–904.You H, Sweeny A, Cooper ML, et al. The management of diverticulitis: a review of the guidelines. Med J Aust. 2019;211(9):421–427. doi: 10.5694/mja2.50276You H, Sweeny A, Cooper ML, et al. The management of diverticulitis: a review of the guidelines. Med J Aust. 2019;211(9):421–427. doi: 10.5694/mja2.50276Tursi A, Scarpignato C, Strate LL, et al. Colonic diverticular disease [published correction appears in Nat Rev Dis Primers. 2020 Apr 29;6(1):35] [published correction appears in Nat Rev Dis Primers. 2020 Jun 17;6(1):50]. Nat Rev Dis Primers. 2020;6(1):20. Published 2020 Mar 26. doi: 10.1038/s41572-020-0153-5Tursi A, Scarpignato C, Strate LL, et al. Colonic diverticular disease [published correction appears in Nat Rev Dis Primers. 2020 Apr 29;6(1):35] [published correction appears in Nat Rev Dis Primers. 2020 Jun 17;6(1):50]. Nat Rev Dis Primers. 2020;6(1):20. Published 2020 Mar 26. doi: 10.1038/s41572-020-0153-5Kishnani S, Ottaviano K, Rosenberg L, et al. Diverticular Disease — An Updated Management Review. Gastroenterology Insights. 2022;13(4):326–339. doi: 10.3390/gastroent13040033Kishnani S, Ottaviano K, Rosenberg L, et al. Diverticular Disease — An Updated Management Review. Gastroenterology Insights. 2022;13(4):326–339. doi: 10.3390/gastroent13040033Huang CH, Liu KL, Lim ZJ, et al. Colonic Diverticulitis Location Affects the Diagnostic Accuracy of Point-of-Care Ultrasound: A Multicenter, 10-Year Study. Ultrasound Med Biol. 2023;49(7):1611– 1615. doi: 10.1016/j.ultrasmedbio.2023.03.010Huang CH, Liu KL, Lim ZJ, et al. Colonic Diverticulitis Location Affects the Diagnostic Accuracy of Point-of-Care Ultrasound: A Multicenter, 10-Year Study. Ultrasound Med Biol. 2023;49(7):1611– 1615. doi: 10.1016/j.ultrasmedbio.2023.03.010Thorisson A, Nikberg M, Torkzad MR, et al. Diagnostic accuracy of acute diverticulitis with unenhanced low-dose CT. BJS Open. 2020;4(4):659–665. doi: 10.1002/bjs5.50290Thorisson A, Nikberg M, Torkzad MR, et al. Diagnostic accuracy of acute diverticulitis with unenhanced low-dose CT. BJS Open. 2020;4(4):659–665. doi: 10.1002/bjs5.50290Белов Д.М., Зароднюк И.В., Москалев А.И., и соавт. КТ признаки деструкции дивертикула при воспалительных осложнениях дивертикулярной болезни ободочной кишки. Колопроктология. 2022;21(1):71–82. doi: 10.33878/2073-7556-2022-21-1-71-82Belov D.M., Zarodnyuk I.V., Maynovskaya O.A., et al. CT signs of diverticulum destruction in inflammatory complications of diverticular disease. Koloproktologia. 2022;21(1):71–82. (in Russ.). doi: 10.33878/2073-7556-2022-21-1-71-82Трубачева Ю.Л., Орлова Л.П., Москалев А.И., и соавт. Ультразвуковая диагностика хронического параколического инфильтрата при дивертикулярной болезни ободочной кишки. Хирургия. Журнал им. Н.И. Пирогова. 2020;(9):14-19.Trubacheva Yu.L., Orlova L.P., Moskalev A.I., et al. Ultrasound diagnosis of chronic paracolic inflammatory mass in diverticular disease. Pirogov Russian Journal of Surgery = Khirurgiya. Zurnal im. N.I. Pirogova. 2020;(9):14–19. (In Russ.). doi: 10.17116/hirurgia202009114Dickerson EC, Chong ST, Ellis JH, et al. Recurrence of Colonic Diverticulitis: Identifying Predictive CT Findings-Retrospective Cohort Study. Radiology. 2017;285(3):850–858. doi: 10.1148/radiol.2017161374Dickerson EC, Chong ST, Ellis JH, et al. Recurrence of Colonic Diverticulitis: Identifying Predictive CT Findings-Retrospective Cohort Study. Radiology. 2017;285(3):850–858. doi: 10.1148/radiol.2017161374Hall JF, Roberts PL, Ricciardi R, et al. Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence? Dis Colon Rectum. 2011;54(3):283–288. doi: 10.1007/DCR.0b013e3182028576Hall JF, Roberts PL, Ricciardi R, et al. Long-term follow-up after an initial episode of diverticulitis: what are the predictors of recurrence? Dis Colon Rectum. 2011;54(3):283–288. doi: 10.1007/DCR.0b013e3182028576Eglinton T, Nguyen T, Raniga S, et al. Patterns of recurrence in patients with acute diverticulitis. Br J Surg. 2010;97(6):952–957. doi: 10.1002/bjs.7035Eglinton T, Nguyen T, Raniga S, et al. Patterns of recurrence in patients with acute diverticulitis. Br J Surg. 2010;97(6):952–957. doi: 10.1002/bjs.7035Buchs NC, Konrad-Mugnier B, Jannot AS, et al. Assessment of recurrence and complications following uncomplicated diverticulitis. Br J Surg. 2013;100(7):976–979. doi: 10.1002/bjs.9119Buchs NC, Konrad-Mugnier B, Jannot AS, et al. Assessment of recurrence and complications following uncomplicated diverticulitis. Br J Surg. 2013;100(7):976–979. doi: 10.1002/bjs.9119El-Sayed C, Radley S, Mytton J, et al. Risk of Recurrent Disease and Surgery Following an Admission for Acute Diverticulitis. Dis Colon Rectum. 2018;61(3):382–389. doi: 10.1097/DCR.0000000000000939El-Sayed C, Radley S, Mytton J, et al. Risk of Recurrent Disease and Surgery Following an Admission for Acute Diverticulitis. Dis Colon Rectum. 2018;61(3):382–389. doi: 10.1097/DCR.0000000000000939Sallinen V, Mali J, Leppäniemi A, et al. Assessment of risk for recurrent diverticulitis: a proposal of risk score for complicated recurrence. Medicine (Baltimore). 2015;94(8):e557. doi: 10.1097/MD.0000000000000557Sallinen V, Mali J, Leppäniemi A, et al. Assessment of risk for recurrent diverticulitis: a proposal of risk score for complicated recurrence. Medicine (Baltimore). 2015;94(8):e557. doi: 10.1097/MD.0000000000000557Ritz JP, Lehmann KS, Frericks B, et al. Outcome of patients with acute sigmoid diverticulitis: multivariate analysis of risk factors for free perforation. Surgery. 2011;149(5):606–613. doi: 10.1016/j.surg.2010.10.005Ritz JP, Lehmann KS, Frericks B, et al. Outcome of patients with acute sigmoid diverticulitis: multivariate analysis of risk factors for free perforation. Surgery. 2011;149(5):606–613. doi: 10.1016/j.surg.2010.10.005Chapman JR, Dozois EJ, Wolff BG, et al. Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes? Ann Surg. 2006;243(6):876–883. doi: 10.1097/01.sla.0000219682.98158.11Chapman JR, Dozois EJ, Wolff BG, et al. Diverticulitis: a progressive disease? Do multiple recurrences predict less favorable outcomes? Ann Surg. 2006;243(6):876–883. doi: 10.1097/01.sla.0000219682.98158.11Unlü C, Beenen LF, Fauquenot JM, et al. Inter-observer reliability of computed tomographic classifications of diverticulitis. Colorectal Dis. 2014;16(6):O212-O219. doi: 10.1111/codi.12533Unlü C, Beenen LF, Fauquenot JM, et al. Inter-observer reliability of computed tomographic classifications of diverticulitis. Colorectal Dis. 2014;16(6):O212-O219. doi: 10.1111/codi.12533

The authors declare that there are no conflicts of interest present.