Diverticular disease severity score based on CT colonography

We propose a diverticular disease severity score (DDSS) based on CT colonography (CTC) findings. Seventy-nine patients (62 +/- 14.5 years) underwent CTC after recovering from an episode of acute diverticulitis. Two independent readers classified each case using a four-point scale (DDSS), based on maximum sigmoid colon wall thickness (MSCWT) and minimum lumen diameter at CTC: 1 = MSCWT < 3 mm, lumen diameter a parts per thousand yen15 mm; 2 = MSCWT 3-8 mm, lumen diameter a parts per thousand yen5 mm; 3 = MSCWT a parts per thousand yen8 mm, lumen diameter a parts per thousand yen5 mm; 4 = MSCWT a parts per thousand yen8 mm, lumen diameter < 5 mm. Intra- and interobserver reproducibility was evaluated. Of 79 patients, 32 (40 %) underwent surgery after CTC; MSCWT was directly measured on the pathological specimen. Intra- and interobserver reproducibility of DDSS were almost perfect (k = 0.90-0.84). DDSS significantly correlated with the probability of surgery (P = 0.001). After surgery, histopathology revealed acute/chronic diverticular inflammation only in 29 cases, and superimposed sigmoid cancer (n = 2) or Crohn's disease (n = 1) in 3 patients with a DDSS of 4. MSCWT at histopathology correlated with DDSS (P = 0.008). DDSS is highly reproducible and correlates with pathological MSCWT. Nearly 1 in 3 patients with a DDSS of 4 had significant superimposed histopathology. CTC with DDSS can provide colorectal surgeons with valuable information. aEuro cent A diverticular disease severity score (DDSS) based on CT colonography is proposed. aEuro cent This DDSS is based on sigmoid colon wall thickness and lumen diameter. aEuro cent High scores may be associated with relevant coexisting lesions. aEuro cent A CTC-based DDSS may influence therapeutic decision-making.