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

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.

1. Drapkina O.M., Lazebnik L.B., Bakulin I.G., Skazyvaeva E.V., Bakulina N.V., Sitkin S.I., et al. Colonic diverticular disease: clinical presentation, diagnosis, treatment, and prevention Clinical guidelines of the Russian Scientifi c Medical Society of Internal Medicine, the Gastroenterological Scientifi c Society of Russia, and the North- West Society of Gastroenterologists and Hepatologists. Experimental and Clinical Gastroenterology. 2023;2:33–69 (In Russ.). DOI: 10.31146/1682-8658-ecg-210-2-33-69

2. Minushkin O.N., Kruchinina M.A., Altukhova E.I., Tugova Yu.E. Diverticular disease of the colon: diagnosis, treatment, and prevention of complications. Meditsinskiy sovet = Medical Council. 2022;6:109–15 (In Russ.). DOI: 10.21518/2079-701X-2022-16-6-109-115

3. Shahedi K., Fuller G., Bolus R., Cohen E., Vu M., Shah R., et al. Long-term risk of acute diverticulitis among patients with incidental diverticulosis found during colonoscopy. Clin Gastroenterol Hepatol. 2013;11(12):1609–13. DOI: 10.1016/j.cgh.2013.06.020

4. Altomare A., Gori M., Cocca S., Carotti S., Francesconi M., Ribolsi M., et al. Impaired colonic contractility and intestinal permeability in symptomatic uncomplicated diverticular disease. J Neurogastroenterol Motil. 2021;27(2):292–301. DOI: 10.5056/jnm20110

5. Belov D.M., Zarodnyuk I.V., Moskalev A.I., Maynovskaya O.A. CT signs of diverticulum destruction in infl ammatory complications of diverticular disease. Koloproktologia. 2022;21(1):71–82 (In Russ.). DOI: 10.33878/2073-7556-2022-21-1-71-82

6. Karpukhin O.Yu., Yusupova A.F., Pankratova Yu.S., Cherkashina M.I., Akhmadullina A.A. Computer tomography in diagnostics and treatment of infl ammatory complications of diverticular disease of the colon. Koloproktologia. 2021;20(4):34–41 (In Russ.). DOI: 10.33878/2073-7556-2021-20-4-34-41

7. Kruis W., Germer C.T., Böhm S., Dumoulin F.L., Frieling T., Hampe J., et al. German guideline diverticular disease/diverticulitis: Part I: Methods, pathogenesis, epidemiology, clinical characteristics (defi nitions), natural course, diagnosis and classifi cation. United Eur Gastroenterol J. 2022;10(9):923–39. DOI: 10.1002/ueg2.12309

8. Tandilava I., Urushadze O., Tsetskhladze D., Kashibadze K., Phutkaradze S., Meskhi N., et al. Retrospective analysis of CT colonoscopy of 7 years experience in a clinical practice. Radiobiology and Radiation Safety. 2023;3(4):67–78.

9. Andeweg C.S., Wegdam J.A., Groenewoud J., van der Wilt G.J., van Goor H., Bleichrodt R.P. Toward an evidence-based step-up approach in diagnosing diverticulitis. Scand J Gastroenterol. 2014;49(7):775–84. DOI: 10.3109/00365521.2014.908475

10. Ripollés T., Sebastián-Tomás J.C., Martínez-Pérez M.J., Manrique A., Gómez-Abril S.A., Torres-Sanchez T. Ultrasound can diff erentiate complicated and noncomplicated acute colonic diverticulitis: a prospective comparative study with computed tomography. Abdom Radiol (NY). 2021;46(8):3826–34. DOI: 10.1007/s00261-021-03060-5

11. Jerjen F., Zaidi T., Chan S., Sharma A., Mudliar R., Soomro K., et al. Magnetic Resonance Imaging for the diagnosis and management of acute colonic diverticulitis: a review of current and future use. J Med Radiat Sci. 2021;68(3):310–9. DOI: 10.1002/jmrs.458

12. Ajaj W., Debatin J.F., Lauenstein T. Colonography by magnetic resonance imaging. Eur J Gastroenterol Hepatol. 2005;17(8):815–20. DOI: 10.1097/00042737-200508000-00006

13. Storz C., Rothenbacher T., Rospleszcz S., Linseisen J., Messmann H., De Cecco C.N., et al. Characteristics and associated risk factors of diverticular disease assessed by magnetic resonance imaging in subjects from a Western general population. Eur Radiol. 2019;29(3):1094–103. DOI: 10.1007/s00330-018-5687-5

14. Ardatskaya M.D., Achkasov S.I., Veselov V.V., Zarodnuk I.V., Ivashkin V.T., Karpukhin O.Yu., et al. Clinical guidelines. Diverticular disease. Koloproktologia. 2021;20(3):10–27 (In Russ.). DOI: 10.33878/2073-7556-2021-20-3-10-27

15. Hadji Ismail I.A., Varabei A.V., Lahodzich N.A., Dybau A.H., Starastsin A.M., Baturin I.K. Diverticular disease of the colon: pathogenesis, classifi cation and complications. Meditsinskie novosti. 2020;6:25–9 (In Russ.).