Ultrasound criteria for differential diagnosis between colonic diverticulosis and sigmoid colon cancer

28 patients with unclear diagnosis (complicated colonic diverticulosis or sigmoid colon cancer) were included in this study. Ultrasound examination was performed in all patients, colonoscopy - in 23 (82.1%), contrast enema - in 10 (35.7%), computed tomography - in 14 (50.0%). 25 (89.3%) patients underwent surgery. The 1^st group included 13 (46.4%) patients with complicated colonic diverticulosis, the 2^nd group - 15 (53.6%) patients with a sigmoid colon cancer (8 of them in combination with diverticular disease). There were no significant differences of clinical findings between groups of patients. The most sensitive ultrasound signs for sigmoid colon cancer diagnosis were: colonic wall structure disorganization, irregular colonic wall thickening, pathological area length <10 cm, and disappearance of haustra. The most sensitive ultrasound signs for inflammatory complications of diverticular disease were: regular colonic wall thickening, wall thickness <15 mm, pathological area length ≥10 cm, pathological area indistinct boundaries, hyperhaustration, and colonic wall normal structure. In order to increase the efficacy of ultrasound in the diagnosis of sigmoid colon cancer, a scoring system has been proposed. In cases, when ultrasound sign for sigmoid colon cancer was obtained, 1 or 2 points were added according to its sensitivity (2 points for signs with sensitivity ≥80%, 1 point for signs with less sensitivity). The diagnostic test “5points or more - sigmoid colon cancer’ had sensitivity of 86.7%, specificity of 100.0%, and area under the curve of 0.959. Ultrasound can be used for differential diagnosis between complicated colonic diverticulosis and sigmoid colon cancer, especially in cases of CT unclear findings or CT contraindications presence.

ультразвуковое исследование, дивертикулярная болезнь, колоректальный рак, ultrasound, diverticular disease, colorectal cancer, ultrasound

1. Granlund J., Svensson T., Granath F., Hjern F., Ekbom A., Blomqvist P., Schmidt P.T. Diverticular disease and the risk of colon cancer - a populationbased case-control study // Aliment. Pharmacol. Ther. 2011. V. 34. No. 6. P. 675-681. Doi: 10.1111/j.1365-2036.2011.04782.x.

2. Krones C.J., Klinge U., Butz N., Junge K., Stumpf M., Rosch R., Hermanns B., Heussen N., Schumpelick V. The rare epidemiologic coincidence of diverticular disease and advanced colonic neoplasia // Int. J. Colorectal. Dis. 2006. V. 21. No. 1. P. 18-24. Doi: 10.1007/s00384-005-0742-5.

3. Goh V., Halligan S., Taylor S.A., Burling D., Bassett P., Bartram C.I. Differentiation between diverticulitis and colorectal cancer: quantitative CT perfusion measurements versus morphologic criteria - initial experience // Radiology. 2007. V. 242. No. 2. P. 456-462. Doi: 10.1148/radiol.2422051670.

4. Shen S.H., Chen J.D., Tiu C.M., Chou Y.H., Chiang J.H., Chang C.Y., Lee C.H. Differentiating colonic diverticulitis from colon cancer: the value of computed tomography in the emergency setting // J. Chin. Med. Assoc. 2005. V. 68. No. 9. P. 411-418. Doi: 10.1016/S1726-4901(09)70156-X.

5. Sheiman L., Levine M.S., Levin A.A., Hogan J., Rubesin S.E., Furth E.E., Laufer I. Chronic diverticulitis: clinical, radiographic, and pathologic findings // Am. J. Roentgenol. 2008. V. 191. No. 2. P. 522-528. Doi: 10.2214/AJR.07.3597.

6. Morini S., Zullo A., Hassan C., Tomao S., Campo S.M. Diverticulosis and colorectal cancer: between lights and shadows // J. Clin. Gastroenterol. 2008. V. 42. No. 7. P. 763-770. Doi: 10.1097/MCG.0b013e31816200fb.

7. Meurs-Szojda M.M., Terhaar sive Droste J.S., Kuik D.J., Mulder C.J., Felt-Bersma R.J. Diverticulosis and diverticulitis form no risk for polyps and colorectal neoplasia in 4 241 colonoscopies // Int. J. Colorectal Dis. 2008. V. 23. No. 10. P. 979-984. Doi: 10.1007/s00384-008-0510-4.

8. Schout P.J., Spillenaar Bilgen E.J., Groenen M.J. Routine screening for colon cancer after conservative treatment of diverticulitis // Dig. Surg. 2012. V. 29. No. 5. P. 408-411. Doi: 10.1159/000345332.

9. Sallinen V., Mentula P., Leppaniemi A. Risk of colon cancer after computed tomography-diagnosed acute diverticulitis: is routine colonoscopy necessary? // Surg. Endosc. 2014. V. 28. No. 3. P. 961-966. Doi: 10.1007/s00464-013-3257-0.

10. Lau K.C., Spilsbury K., Farooque Y., Kariyawasam S.B., Owen R.G., Wallace M.H., Makin G.B. Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? // Dis. Colon Rectum. 2011. V. 54. No. 10. P. 1265-1270. Doi: 10.1097/DCR.0b013e31822899a2.

11. Sai V.F., Velayos F., Neuhaus J., Westphalen A.C. Colonoscopy after CT diagnosis of diverticulitis to exclude colon cancer: a systematic literature review // Radiology. 2012. V. 263. No. 2. P. 383- 390. Doi: 10.1148/radiol.12111869.

12. Choi Y.H., Koh S.J., Kim J.W., Kim B.G., Lee K.L., Im J.P., Kim J.S., Jung H.C. Do we need colonoscopy following acute diverticulitis detected on computed tomography to exclude colorectal malignancy? // Dig. Dis. Sci. 2014. V. 59. No. 9. P. 2236-2242. Doi: 10.1007/s10620-014-3151-1.

13. Sharma P.V., Eglinton T., Hider P., Frizelle F. Systematic review and meta-analysis of the role of routine colonic evaluation after radiologically confirmed acute diverticulitis // Ann. Surg. 2014. V. 259. No. 2. P. 263-272. Doi: 10.1097/SLA.0000000000000294.

14. Ripolles T., Martinez-Perez M.J., Gomez Valencia D.P., Vizuete J., Martin G. Sigmoid stenosis caused by diverticulitis vs. carcinoma: usefulness of sonographic features for their differentiation in the emergency setting // Abdom. Imaging. 2015. V. 40. No. 7. P. 2219-2231. Doi: 10.1007/s00261-015-0448-2.

15. Ripolles T., Agramunt M., Martinez M.J., Costa S., Gomez-Abril S.A., Richart J. The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients // Eur. Radiol. 2003. V. 13. No. 12. P. 2587-2595. Doi: 10.1007/s00330-003-1861-4.

16. Lameris W., van Randen A., Bipat S., Bossuyt P.M., Boermeester M.A., Stoker J. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy // Eur. Radiol. 2008. V. 18. No. 11. P. 2498-2511. Doi: 10.1007/s00330-008-1018-6.

17. Орлова Л.П. Клиническое значение ультрасонографии в диагностике рака толстой кишки // Русский медицинский журнал. 1998. Т. 6. № 19. С. 1258.

18. Орлова Л.П., Трубачева Ю.Л., Маркова Е.В. Ультразвуковая семиотика дивертикулярной болезни ободочной кишки и ее хронических воспалительных осложнений // Ультразвуковая и функциональная диагностика. 2008. № 3. С. 18-25.

19. Трубачева Ю.Л., Орлова Л.П., Калинина И.В. Роль ультразвуковых методов исследования в диагностике дивертикулярной болезни ободочной кишки и ее хронических воспалительных осложнений // Колопроктология. 2014. № 1 (47) (приложение). С. 86-92.

20. Gryspeerdt S., Lefere P. Chronic diverticulitis vs. colorectal cancer: findings on CT colonography // Abdom. Imaging. 2012. V. 37. No. 6. P. 1101-1109. Doi: 10.1007/s00261-012-9858-6.

21. Elmi A., Hedgire S., Pargaonkar V., Cao K., McDermott S., Harisinghani M. Is early colonoscopy beneficial in patients with CT-diagnosed diverticulitis? // Am. J. Roentgenol. 2013. V. 200. No. 6. P. 1269-1274. Doi: 10.2214/AJR.12.9539.