Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 26, 2022; 10(12): 3686-3697
Published online Apr 26, 2022. doi: 10.12998/wjcc.v10.i12.3686
Role of multidetector computed tomography in patients with acute infectious colitis
Seung Jung Yu, Jae Hyuk Heo, Eun Jeong Choi, Jong Hyuk Kim, Hong Sub Lee, Sun Young Kim, Jae Hoon Lim
Seung Jung Yu, Jae Hyuk Heo, Eun Jeong Choi, Hong Sub Lee, Department of Internal Medicine, Inje University Busan Paik Hospital, Busan 47392, South Korea
Jong Hyuk Kim, Jae Hoon Lim, Department of Radiology, Myongji Hospital, Hanyang University College of Medicine, Goyang 10475, South Korea
Sun Young Kim, Department of Cancer Control and Population Health, National Cancer Center, Goyang 10408, South Korea
Author contributions: Lee HS and Lim JH designed the research study; Lee HS, Yu SJ, Heo JH and Choi EJ performed the research; Kim SY contributed analytic tools; Yu SJ and Heo JH analyzed the data and wrote the manuscript; and All authors have read and approve the final manuscript.
Supported by the 2019 Inje University research grant.
Institutional review board statement: Ethics committee approval was received for this study from Institutional Review Board of the Myongji hospital (Decision No. MJH 2018-08-020).
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at hslee@paik.ac.kr
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong Sub Lee, MD, PhD, Professor, Department of Internal Medicine, Inje University Busan Paik Hospital, 75 Bokji-ro, Busanjin-gu, Busan 47392, South Korea. hslee@paik.ac.kr
Received: May 31, 2021
Peer-review started: May 31, 2021
First decision: July 1, 2021
Revised: September 14, 2021
Accepted: March 4, 2022
Article in press: March 4, 2022
Published online: April 26, 2022
Processing time: 324 Days and 12.1 Hours
Abstract
BACKGROUND

The role of multidetector computed tomography (MDCT) in patients with acute infectious colitis is still unclear.

AIM

To examine the usefulness of MDCT in distinguishing the etiology of acute infectious colitis.

METHODS

Overall, 244 patients who met the criteria for acute infectious colitis and visited the Hospital from February 2015 to 2018 were retrospectively enrolled and divided into two groups (bacterial: 204, viral: 40) according to causes of acute colitis, based on stool PCR. Eleven MDCT parameters, including wall thickening, submucosal edema, mucosal enhancement, serosa involvement, empty colon sign, small bowel involvement, comb sign, continuous distribution, accordion sign, mucosal thickening, and lymph node enlargement, were constructed in a blinded fashion.

RESULTS

MDCT parameters of wall thickening (OR: 13.60; 95%CI: 5.80–31.88; P < 0.001), submucosal edema (OR: 36.08; 95%CI: 13.54–96.13; P < 0.001), mucosal enhancement (OR: 22.55; 95%CI: 9.28–54.81; P < 0.001), serosal involvement (OR: 14.50; 95%CI: 3.33–63.23; P < 0.001), empty colon sign (OR: 6.68; 95%CI: 2.44–18.32; P < 0.001), continuous distribution (OR: 24.09; 95%CI: 9.38–61.90; P < 0.001), accordion sign (OR: 9.02; 95%CI: 1.12–72.35; P = 0.038), mucosal thickening (OR: 46.41; 95%CI: 10.38–207.51; P < 0.001), and lymph node enlargement (OR: 4.39; 95%CI: 1.22–15.72; P = 0.023) were significantly associated with bacterial colitis. At least one positive finding in four CT outcomes (submucosal edema, mucosal enhancement, continuous distribution, mucosal thickening) in summer showed a high probability of bacterial colitis (sensitivity, 41.67; specificity, 92.50; OR: 24.95).

CONCLUSION

MDCT provides many clues that can be useful in suggesting a specific etiology of acute infectious colitis.

Keywords: Colitis; Multidetector computed tomography; Differential diagnosis; Bacterial infections; Viral infections

Core Tip: The main purpose of this study was to investigate if computed tomography (CT) is valuable in discriminating bacterial colitis from viral colitis. Multidetector CT (MDCT) parameters of wall thickening, submucosal edema, mucosal enhancement, serosal involvement, empty colon sign, continuous distribution, accordion sign, mucosal thickening, and lymph node enlargement may be suggestive of bacterial colitis. At least one positive finding in four MDCT parameters (submucosal edema, mucosal enhancement, continuous distribution, mucosal thickening) in the summer season is suggestive of a bacterial infection.