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Differentiation between Diverticulitis and Colorectal Cancer: Quantitative CT Perfusion Measurements versus Morphologic Criteria—Initial Experience¹

¹ From the Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, England (V.G.); Department of Academic Radiology, University College London, Level 2 Podium, University College Hospital, 235 Euston Rd, London NW1 2BU, England (S.H., S.A.T.); and Intestinal Imaging Centre, St Mark's Hospital, Harrow, England (D.B., P.B., C.I.B.). From the 2005 RSNA Annual Meeting. Received October 11, 2005; revision requested November 30; revision received January 26, 2006; accepted February 9; final version accepted May 5. Supported in part by a grant from the Royal College of Radiologists, London, England. Address correspondence to S.H. (e-mail: s.halligan{at}ucl.ac.uk).

Purpose: To determine whether computed tomographic (CT) perfusion measurements in prospectively recruited patients can be used to differentiate between diverticulitis and colorectal cancer and to compare this discrimination with that of standard morphologic criteria.

Materials and Methods: After institutional review board approval and written informed consent were obtained, 60 patients (24 men, 36 women; mean age, 69 years; range, 33.5–90.4 years; 20 patients with cancer, 20 with diverticulitis, and 20 with inactive diverticular disease) underwent CT perfusion imaging at the level of the colonic abnormality, and perfusion parameters were calculated. Analysis of variance was used to investigate any differences in perfusion between the patient groups. Two independent observers also analyzed an abdominopelvic CT study obtained immediately after the CT perfusion study and noted standard morphologic criteria for differential diagnosis. The sensitivity and specificity of CT perfusion measurements for determining the diagnostic category were compared with morphologic criteria by means of multivariate analysis to identify the most discriminatory criteria.

Results: Mean blood volume, blood flow, transit time, and permeability were significantly different between patients with cancer and those with diverticulitis (P < .0001); patients with cancer had the highest blood volume, blood flow, and permeability and the shortest transit time. The most discriminatory criteria for determining diagnostic category were blood volume, transit time, permeability, and presence of pericolonic nodes (P = .05, .02, .04, and .02, respectively). Blood volume and blood flow each had a sensitivity of 80% and had specificity of 70% and 75%, respectively, for cancer in comparison with standard morphologic criteria: less than 5 cm of bowel involvement (45% sensitivity, 95% specificity), presence of a mass (85% sensitivity, 90% specificity), pericolonic inflammation (75% sensitivity, 5% specificity), and pericolonic nodes (90% sensitivity, 45% specificity).

Conclusion: CT perfusion measurements enable differentiation and better discrimination, in comparison with morphologic criteria, between cancer and diverticulitis.

© RSNA, 2007

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