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Published on: October 16, 2013
Sigmoid cancer versus chronic diverticular disease: differentiating features at CT colonography
Leonie M J Lips1, Pierre T J Cremers, Perry J Pickhardt
1From the Departments of Radiology (L.M.J.L., M.T.d.W., P.C.G.S.) and Clinical Epidemiology (M.L.G.J.), VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, the Netherlands; Department of Radiology, Maxima Medical Centre, Veldhoven, the Netherlands (P.T.J.C.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.); and Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (S.E.H.C.).
Purpose:
To retrospectively identify morphologic findings at computed tomographic (CT) colonography that are the most reliable in the differentiation of masslike chronic diverticular disease from sigmoid carcinoma in a large patient cohort.
Materials And Methods:
This study was approved by the institutional review boards. The need for signed consent was waived for this retrospective study. The cohort consisted of 212 patients (mean age, 68 years; 113 women, 99 men) with focal masslike findings in the sigmoid colon at CT colonography, representing chronic diverticular disease (n = 97) or sigmoid carcinoma (n = 115). CT colonography studies were scored according to presence or absence of potential discriminators by a panel of four readers in consensus. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, and multivariate analysis was performed.
Results:
Absence of diverticula in the affected segment showed high NPV and PPV (0.95 and 0.93, respectively). Also, shoulder phenomenon showed a high NPV (0.92) and PPV (0.75). Segment length of 10 cm or less (NPV, 0.85; PPV, 0.61) and destroyed mucosal folds (NPV, 1.00; PPV, 0.62) had a high NPV but a low PPV. Although segments affected by carcinoma often showed straightened and eccentric growth patterns, no thick fascia sign, and more and larger local-regional lymph nodes (all P < .05), NPV was insufficient for discrimination (NPV ≤ 0.66). Combination of absence of diverticula and presence of shouldering showed a high diagnostic certainty (93%).
Conclusion:
Carcinoma is best differentiated from masslike diverticular disease by the absence of diverticula in the affected segment and the presence of shoulder phenomenon.
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