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Springer Science+Business Media, LLC 2012 Published online: 25 February 2012
Abdom Imaging (2012) 37:11011109 DOI: 10.1007/s00261-012-9858-6
Abdominal
Imaging
Chronic diverticulitis vs. colorectal cancer: ndings on CT colonography
Stefaan Gryspeerdt, Philippe Lefere
Virtual Colonoscopy Teaching Centre, Akkerstraat 32 c, 8830 Hooglede, Belgium
Abstract
Purpose: The purpose of this update article is to evaluate findings on CT colonography in patients with chronic diverticulitis and to compare the findings in patients with colorectal carcinoma.
Materials and methods: Different morphological criteria retrieved from a literature review were retrospectively analyzed in a series of 13 patients with proven chronic diverticulitis. The findings were compared with a series of 10 patients with colorectal carcinoma.
Results: Overall, the findings in chronic diverticulitis resemble the findings in acute diverticulitis. The advantage of virtual CT colonography in differentiating both entities relies in the combination of morphological features previously described on axial computed tomography and double contrast barium enema. The single strongest morphological feature pointing towards the diagnosis of chronic diverticulitis is the presence of diverticula in the affected segment. In the presence of diverticula in the affected segment, a long segment (10 cm), thick fascia sign without adenopathies, mild bowel wall thickening, tapered margins, and distorted but preserved mucosal folds are likely to further improve accuracy of diagnosing chronic diverticulitis. Conclusion: The single strongest morphological sign to differentiate chronic diverticulitis from colorectal cancer is the presence of diverticula in the affected segment.
Key words: DiverticulitisChronicTumorColon Virtual CT colonoscopy
In Western countries the presence of diverticular disease has increased over the past century. The prevalence of diverticulosis is similar in man and woman, increasing with age ranging from approximately 10% in adults
younger than 40 years of age to 5070% among those 80 years of age or older [17].
The terms diverticulosis and diverticular disease are used to describe the presence of an uninamed diverticulum.
Diverticulitis indicates inammation of the diverticulum, accompanied by gross and microscopic perforation. It is a common condition with an estimated incidence of 25%. Of those patients who experience an attack of diverticulitis one-third will have recurrent symptoms and another third will have a subsequent episode [810].
The inammatory changes and associated brosis cause distortion of the bowel wall. Abdominal CT has beenshown to reveal wall thickening and pericolic inammatory stranding...