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Abstract：
OBJECTIVE: The aim of the study is to identify CT findings that are predictive of recurrence of acute uncomplicated colonic diverticulitis, to better risk-stratify these patients for whom guidelines recommend a conservative outpatient treatment and to determine the appropriate management with an improvement of health costs.
METHODS: Over the past year, 33 patients enrolled in an outpatient integrated care pathway (PDTA) for uncomplicated acute diverticulitis with 1-year follow-up period, without recurrence, and 33 patients referred to Emergency Department for a recurrent acute diverticulitis were included. Images of admission CT were reviewed by two radiologists and the imaging features were analyzed and compared with Chi-square and Student t tests. Univariate and multivariate Cox regression models were employed to identify parameters that significantly predicted recurrence in 1-year follow-up period and establish cutoff and recurrence-free rates. The maximally selected rank statistics (MSRS) were used to identify the optimal wall thickening cutoff for the prediction of recurrence.
RESULTS: Patients with recurrence showed a greater mean parietal thickness compared to the group without recurrence (16 mm vs. 11.5 mm; HR 1.25, p < 0.001) and more evidence of grade 4 of peridiverticular inflammation (40% vs. 12%, p = 0.009, HR 3.44). 12-month recurrence-free rates progressively decrease with increasing thickness and inflammation. In multivariate analysis, only parietal thickness maintained its predictive power with an optimal cutpoint > 15 mm that causes a sixfold increased risk of recurrence (HR 6.22; 95% CI, 3.05-12.67; p < 0.001). Beyond thickness and peridiverticular inflammation, predictive value of early recurrence within 90 days from the 1st episode resulted also an Hinchey Ib on admission CT.
CONCLUSIONS: The maximum wall thickening and the grade of peridiverticular inflammation can be considered as predictive factors of recurrence and may be helpful in selecting patients for a tailored treatment to prevent the risk of recurrence.
METHODS: Over the past year, 33 patients enrolled in an outpatient integrated care pathway (PDTA) for uncomplicated acute diverticulitis with 1-year follow-up period, without recurrence, and 33 patients referred to Emergency Department for a recurrent acute diverticulitis were included. Images of admission CT were reviewed by two radiologists and the imaging features were analyzed and compared with Chi-square and Student t tests. Univariate and multivariate Cox regression models were employed to identify parameters that significantly predicted recurrence in 1-year follow-up period and establish cutoff and recurrence-free rates. The maximally selected rank statistics (MSRS) were used to identify the optimal wall thickening cutoff for the prediction of recurrence.
RESULTS: Patients with recurrence showed a greater mean parietal thickness compared to the group without recurrence (16 mm vs. 11.5 mm; HR 1.25, p < 0.001) and more evidence of grade 4 of peridiverticular inflammation (40% vs. 12%, p = 0.009, HR 3.44). 12-month recurrence-free rates progressively decrease with increasing thickness and inflammation. In multivariate analysis, only parietal thickness maintained its predictive power with an optimal cutpoint > 15 mm that causes a sixfold increased risk of recurrence (HR 6.22; 95% CI, 3.05-12.67; p < 0.001). Beyond thickness and peridiverticular inflammation, predictive value of early recurrence within 90 days from the 1st episode resulted also an Hinchey Ib on admission CT.
CONCLUSIONS: The maximum wall thickening and the grade of peridiverticular inflammation can be considered as predictive factors of recurrence and may be helpful in selecting patients for a tailored treatment to prevent the risk of recurrence.
摘要：
目的：本研究的目的是确定预测急性单纯性结肠憩室炎复发的CT表现，为了更好地对指南推荐保守门诊治疗的患者进行风险分层，并确定适当的治疗方法，同时改善医疗费用。
方法：在过去的一年中，33例患者纳入门诊综合护理路径（PDTA）治疗无并发症急性憩室炎，随访1年，没有复发，纳入33例因复发性急性憩室炎转诊至急诊科的患者。由两名放射科医生回顾入院时的CT图像，并通过卡方和Studentt检验分析并比较其影像学特征。采用单变量和多变量Cox回归模型来确定在1年随访期间显着预测复发的参数，并建立截止率和无复发率。最大选择的等级统计（MSRS）用于确定预测复发的最佳壁增厚截止值。
结果：与未复发组相比，复发患者的平均顶骨厚度更大（16mmvs.11.5mm；HR1.25，p<0.001），更多证据表明憩室周围炎症的4级（40％vs.12%,p=0.009，HR3.44）。12个月无复发率随着厚度和炎症的增加而逐渐降低。在多变量分析中，只有顶骨厚度保持其预测能力,最佳切割点>15mm,导致复发风险增加6倍(HR6.22;95%CI,3.05-12.67;p<0.001).超过厚度和憩室周围炎症，首次发作后90天内早期复发的预测价值也导致入院CT时的HincheyIb。
结论：最大壁增厚和憩室周围炎症程度可被认为是复发的预测因素，并可能有助于选择患者进行量身定制的治疗以防止复发风险。
方法：在过去的一年中，33例患者纳入门诊综合护理路径（PDTA）治疗无并发症急性憩室炎，随访1年，没有复发，纳入33例因复发性急性憩室炎转诊至急诊科的患者。由两名放射科医生回顾入院时的CT图像，并通过卡方和Studentt检验分析并比较其影像学特征。采用单变量和多变量Cox回归模型来确定在1年随访期间显着预测复发的参数，并建立截止率和无复发率。最大选择的等级统计（MSRS）用于确定预测复发的最佳壁增厚截止值。
结果：与未复发组相比，复发患者的平均顶骨厚度更大（16mmvs.11.5mm；HR1.25，p<0.001），更多证据表明憩室周围炎症的4级（40％vs.12%,p=0.009，HR3.44）。12个月无复发率随着厚度和炎症的增加而逐渐降低。在多变量分析中，只有顶骨厚度保持其预测能力,最佳切割点>15mm,导致复发风险增加6倍(HR6.22;95%CI,3.05-12.67;p<0.001).超过厚度和憩室周围炎症，首次发作后90天内早期复发的预测价值也导致入院CT时的HincheyIb。
结论：最大壁增厚和憩室周围炎症程度可被认为是复发的预测因素，并可能有助于选择患者进行量身定制的治疗以防止复发风险。
