Role of multidetector computed tomography in patients with acute infectious colitis

lNTRODUCTlON

Acute infectious colitis is a common health problem globally. Although many cases of colitis are selflimiting and can be managed by adequate conservative treatment, such as hydration or electrolyte correction, antibiotics may be applied in certain situations (

, sepsis with enteric fever, immunocompromised patient, internationally-travelled patient)[1]. Additionally, it is difficult to diagnose and manage some cases complicated with inflammatory bowel disease, ischemic colitis, or medicationrelated colitis. Therapy customized to the etiology of colitis should be applied as soon as possible. The earlier customized therapy starts, the better the expected prognosis[1,2].

Stool culture is generally the definitive diagnostic tool for bacterial colitis. Because most viruses that cause infectious colitis cannot be cultured, electron microscopy (EM) examination and immunoassay have been used for viruses, such as norovirus, rotavirus, and adenovirus. Microscopic examination is still routinely used for parasite identification. However, these examination methods require considerable expertise, are labor intensive, and are very time-consuming[3,4]. Multiplex molecular PCR panels have recently been developed for the detection of gastrointestinal pathogens directly from clinical stool samples. They have a high diagnostic performance (sensitivity = 94.5%, specificity = 99%) and take only several days[5-8].

Acute infectious colitis usually shows non-specific clinical manifestations and physical signs.Definitive pathogens of infectious colitis can be proven by culture, EM, immunoassay, and microscopy.

However, clinicians need blood and imaging tests to investigate the severity and extent, as well as to exclude other causes of abdominal pain. For blood tests, C-reactive protein and WBC, which can detect infection or inflammation, are mainly used. In particular, C-reactive protein may help differentiate pathogens[9]. Multidetector CT (MDCT) is now being universally used as the first imaging modality for the evaluation of patients with non-specific abdominal pain, including colitis. As a result, many cases of colitis have been diagnosed using MDCT. CT has the merits of broad availability and ease of performance[10].

All patients were examined in the supine position, from the dome of the liver to the level of the perineum, to cover the entire course of the gastrointestinal tract. We routinely administered 1.5 mL of contrast matter (Optiray, Ultravist) per kg of body weight in patients without renal disorder. Non-ionic iodinated contrast matter at a concentration of 30 g of iodine per 100 mL was administered at a rate of 3 mL/s through an 18-gauge (G) venous catheter. Scanning was started 70 s after the beginning of contrast matter injection. This interval was consistent with the mesenteric phase of abdominal imaging and allowed us to evaluate the status of the colon wall in the best condition. This phase also offered comprehensive information about the abdomen and pelvis, including abdominal vessels.

A radiologist can help to confirm the diagnosis and evaluate the severity, as well as to assess distributing pattern, morphology of the wall, pericolonic soft tissues and adjacent structures, often the key for differentiating specific causes[11]. The purpose of this study is to discuss and illustrate MDCT features that offer important diagnostic clues for suggesting a specific etiology of acute colitis. In particular, we focus on infectious colitis, with the aim to differentiate the diagnosis of bacterial colitis from viral colitis. We examined the correlation between MDCT findings and PCR results.

MATERlALS AND METHODS

MDCT technique

MDCT examinations were conducted on the following two multidetector devices: MDCT 64 sections(Brilliance64, Philips) and MDCT 64 sections (LightSpeed volume CT, General Electric Medical Systems).

6月29日，市人大常委會(huì)召開(kāi)了一次預(yù)算績(jī)效管理工作督導(dǎo)會(huì)，會(huì)上聽(tīng)取了市財(cái)政局、市教育局、市城管局、市衛(wèi)生局等四個(gè)單位的工作匯報(bào)，深入天門市小板鎮(zhèn)兩個(gè)村實(shí)地參觀了市城管局“農(nóng)村垃圾集中處理”項(xiàng)目現(xiàn)場(chǎng)。市人大領(lǐng)導(dǎo)對(duì)存在的問(wèn)題和薄弱環(huán)節(jié)提出了整改意見(jiàn)，提出市政府每年至少要召開(kāi)一次預(yù)算績(jī)效管理工作專題會(huì)議，將預(yù)算績(jī)效管理工作納入政府考核內(nèi)容范圍；各單位要提高認(rèn)識(shí)，組建專班負(fù)責(zé)這項(xiàng)工作；市財(cái)政局要完善各項(xiàng)制度、建立平臺(tái)操作機(jī)制、建立自評(píng)報(bào)告考評(píng)機(jī)制、建立動(dòng)態(tài)管理項(xiàng)目機(jī)制。

[2] James E. Dougherty, Robert L. Pfaltzgraff, Contending Theories of International Relations: a Comprehensive Survey(5th Edition), 北京：北京大學(xué)出版社, 2004年, pp. 165-166.

Bowel wall thickening was classified into normal (＜ 5 mm) and abnormal (≥ 5 mm)[12,13].Submucosal edema and mucosal hyperenhancement indicate inflammatory changes. The target sign means stratification of the three layers: mucosa, submucosa, and serosa. The mucosa and serosa were enhanced, whereas the submucosa remained hypoattenuated because of edema[14]. Serosal involvement (fat stranding) (Figure 1) indicates an acute inflammatory process and serous fluid leakage.Small bowel involvement was defined as positive when any segment of the small bowel wall was thickened. The comb sign (Figure 2) refers to the hypervascular appearance of the mesentery because of fibro-fatty proliferation and perivascular inflammatory infiltration in the distended intestinal arcades[15]. Continuous distribution indicates that bowel wall and pericolonic change invade continuously without skipping areas. The accordion sign (Figure 3) comprises of markedly thickened haustral folds,low attenuation from mucosal and submucosal edema, and irregular mucosal contour with polypoid protrusions[16]. The appearance of the colon may resemble that of an accordion. Mucosal thickening and lymph node enlargement (short diameter ＞ 10 mm) (Figure 4) were also evaluated as present or absent. The empty colon sign (Figure 5) which represents the complete emptiness of the colonic lumen,such as absence of gas, fluid or feces, was graded as either absent or present[17]. Small bowel involvement was checked when small bowel wall thickening, dilatation, or both were seen[18].

The reviewers were blinded to the patients’ clinical histories and final diagnoses. For further analysis,disagreements were resolved through discussions until a consensus was achieved.

MDCT image analysis

The Comb sign, which refers to a hypervascular appearance of the mesentery with vascular dilatation and engorgement of the vasa recta, can be frequently seen in inflammatory bowel disease. It is not pathognomonic of Crohn’s disease; however, it can be seen in other causes of acute colitis[20,21] or vasculitis[22].

2)求出初始點(diǎn)集中所有點(diǎn)到擬合的空間平面的距離，以及點(diǎn)到圓心(x0,y0,z0)的距離與半徑的差值，分別記為Fi、Di(i=0,1,2,…n)：

國(guó)立北平圖書(shū)館對(duì)青年職員的選聘采取專家推薦的形式，一般經(jīng)由館內(nèi)外專家學(xué)者介紹或館長(zhǎng)直接推薦，再經(jīng)過(guò)國(guó)立北平圖書(shū)館委員會(huì)審議。例如1931年6月6日國(guó)立北平圖書(shū)館委員會(huì)會(huì)議，議程第四項(xiàng)即審查了館長(zhǎng)推薦的五位職員，分別是編纂委員劉節(jié)、王庸，館員陳貫吾、張秀民、徐俊［2］（334）。

MDCT results were retrospectively analyzed and evaluated independently by two residents in training in the radiology department. One board-certified radiologist with specialty in abdominal imaging reviewed and confirmed the CT images. All contrast-enhanced CT (CECT) images were evaluated in the context of the hospital’s picture archiving and communication system (PACS).Measurements were conducted using an electronic ruler. The colon was divided into four anatomic segments: Rectosigmoid colon, descending colon, transverse colon, and ascending colon including cecum.

C-reactive protein and WBC analysis

The mean values of C-reactive protein and WBC were calculated to compare the numerical differences between bacterial and viral colitis. In addition, by classifying the patient groups based on the number of presumed infection or inflammation, the difference between bacterial and viral colitis was analyzed. Creactive protein was determined to be 0.3 mg/dL or higher and WBC was 10000 x 10

/L or higher to determine the presence of infection or inflammation. In addition, in order to find out whether there are differences in the clinical symptoms of colitis according to the etiology, the patient groups were classified and compared according to the three symptoms: fever, diarrhea, and abdominal pain.

Statistical analysis

To evaluate the utility of MDCT in infectious colitis, patients were categorized into groups based on stool PCR (bacterial colitis and viral colitis). Fisher’s exact test was used for examining the relationship of MDCT parameters and baseline demographics with the two groups of bacterial and viral colitis. We then computed sensitivity, specificity, positive predictive value (PPV), and negative predictive value(NPV) of each MDCT parameter by bacterial and viral colitis. We also evaluated diagnostic performance for each group of colitis by estimating odds ratios of colitis for each MDCT parameter using logistic regression models after adjusting for age, season, diabetes, cardiovascular diseases, and cancer history.A

value of ＜ 0.05 was considered statistically significant. All statistical analyses were conducted in R version 3.6.2 (The R Foundation for Statistical Computing; https://www.r-project.org/). The statistical methods of this study were reviewed by Kim SY from Department of Cancer Control and Population Health, National Cancer Center, Goyang.

圖4是用戶操作軟件結(jié)構(gòu)圖。用戶操作軟件包括底層控制、科學(xué)計(jì)算、人機(jī)交互、單機(jī)交互、本體控制、視頻監(jiān)控等6部分。

RESULTS

Subjects

Figure 6 showes study design and patient selection. From February 2015 to December 2018, 348 patients were clinically diagnosed with acute colitis. However 87 patients were excluded due to PCR-negative,and 17 patients were excluded by the bacterial and viral combined infection, So Finally 244 patients was enrolled to study. Table 1 presents the baseline characteristics of the study population. The patients were 134 women and 110 men, with an average age of 45.1 years. The cause of colitis was bacterial for 84% patients (

= 204) and viral for 16% (

= 40). Bacterial colitis was more common in summer than in other three seasons (

= 0.001). The other baseline characteristics did not differ between the two groups of colitis.

MDCT analysis results

Table 2 shows the prevalence of acute colitis for 11 MDCT parameters. Acute colitis was more prevalent in the bacterial colitis group than in the viral group for all MDCT parameters; the relationship with the cause of colitis was significant for all MDCT parameters except for small bowel involvement.

Wall thickening was present in 90% of bacterial colitis cases

40% of viral colitis cases (

＜ 0.001).Submucosal edema was encountered in 93% of bacterial colitis cases

30% of viral colitis cases (

＜0.001). Mucosal enhancement was found in 89% of bacterial colitis cases

28% of viral colitis cases (

＜0.001). Serosal involvement was detected in 46% of bacterial colitis cases

5% of viral colitis cases (

＜0.001). Empty colon sign was found in 49% of bacterial colitis cases

13% of viral colitis cases (

＜0.001). Continuous distribution was detected in 85% of bacterial colitis cases

25% of viral colitis cases (

＜ 0.001). Accordion sign was found in 17% of bacterial colitis cases

3% of viral colitis cases (

=0.038). Mucosal thickening was found in 67% of bacterial colitis cases

5% of viral colitis cases (

＜0.001). Lymph node enlargement was found in 21% of bacterial colitis cases

8% of viral colitis cases (

= 0.023).

Table 3 summarizes the diagnostic performances of MDCT by bacterial and viral colitis. Bacterial colitis showed better diagnostic performance than viral colitis for all MDCT parameters. Sensitivity,specificity, PPV, and NPV of wall thickening were 89.7%, 60.0%, 92.0%, 89.5%, and 53.3%, respectively.Submucosal edema, mucosal enhancement, and continuous distribution had higher sensitivity(84.8%–92.6%), whereas serosal involvement, empty colon sign, comb sign, accordion sign, mucosal thickening, and lymph node enlargement had higher specificity (87.5%–97.5%). Viral colitis showed particularly low sensitivity and specificity. Sensitivity of each MDCT findings for viral colitis ranged from 2.5% to 40%.

Table 4 shows odds ratios (ORs) of relevant MDCT parameters by the two groups of acute colitis. For bacterial colitis, OR of wall thickening was 13.60 (95% confidence interval: 5.80–31.88). In 11 MDCT parameters, submucosal edema, mucosal enhancement, continuous distribution, and mucosal thickening had especially high ORs [36.08 (13.54–96.13), 22.55 (19.28–54.81), 24.09 (9.38–61.90), and 46.41(10.38–207.51), respectively]. For viral colitis, all ORs were below 1.

Tables 5 and 6 show diagnostic statistics of four CT results (submucosal edema, mucosal enhancement, continuous distribution, and mucosal thickening) with seasonal consideration. The incidence of colitis was the highest in the summer season (39%). While relying upon at least one of four MDCT parameters in summer, sensitivity and specificity for bacterial colitis was found to be particularly high (41.67 and 92.50, respectively). OR of four combined MDCT parameters was higher for bacterial colitis than for viral colitis.

C-reactive protein and WBC analysis

Comparing the mean values of C-reactive protein, Bacterial colitis was higher than viral colitis, which was statistically significant. However, there was no difference in the prevalence of bacterial and viral colitis classified according to the reference values of WBC and C-reactive protein and there was no statistical significance in differentiating the etiology by clinical symptoms.

DlSCUSSlON

The main purpose of this study was to investigate if CT is valuable in discriminating bacterial colitis from viral colitis. There were a few previous studies on underlying etiology in a large patient cohort[17,19]. However, no studies reported on subdividing the etiology of infectious colitis into bacterial or viral causes. Plastaras

[17] investigated the usefulness of MDCT in examining the underlying cause of acute colitis. They classified bowel wall thickening on the basis of 3 mm. This thickening was found in most cases (97%) of colitis; however, it was not useful in distinguishing the causes. However, this study classified bowel wall thickening on the basis of 5 mm. Increasing thickness was suggestive of bacterial colitis. Additionally, submucosal edema was associated with bacterial colitis, suggesting that edematous changes in the submucosal layer had a significant effect on bowel wall thickness.

測(cè)量位置應(yīng)做統(tǒng)一規(guī)定，確保上次檢修與本次檢修在同一位置上測(cè)量，以減少誤差。齒高的降低值與上次修后汽封間隙之和，即為本次修前汽封間隙。

Plastaras

[17] first suggested the empty colon sign, which was defined as a complete emptiness of the colonic lumen. They reported that the empty colon sign was a finding suggestive of infectious colitis.In our study, the empty colon sign was particularly related to bacterial colitis.

The following 11 MDCT parameters were evaluated and described: bowel wall thickening, submucosal edema, mucosal hyperenhancement, serosal involvement (fat stranding), small bowel involvement,comb sign, continuous distribution (≥ 6 cm), accordion sign, mucosal thickening, lymph node enlargement (short diameter ＞ 10 mm), and empty colon sign. We recoded all CT findings to binary values.

一是大力推動(dòng)金融扶貧工作。充分發(fā)揮各金融機(jī)構(gòu)在政策、資金、資源上的優(yōu)勢(shì)，進(jìn)一步改善貧困地區(qū)金融服務(wù)水平，不斷增加貧困地區(qū)資金供給，加大貧困地區(qū)基礎(chǔ)設(shè)施建設(shè)、產(chǎn)業(yè)扶貧、易地扶貧搬遷等方面的投入。重點(diǎn)抓好扶貧小額信貸工作，及時(shí)籌集落實(shí)財(cái)政貼息資金和風(fēng)險(xiǎn)補(bǔ)償資金，加強(qiáng)小額信貸審核、發(fā)放及監(jiān)管，特別是強(qiáng)化對(duì)戶貸企用資金的跟蹤監(jiān)管。妥善處理好對(duì)脫貧戶、錯(cuò)評(píng)戶和死亡貧困戶的財(cái)政貼息及貸款收回工作，按要求及時(shí)啟動(dòng)風(fēng)險(xiǎn)補(bǔ)償機(jī)制，切實(shí)保證扶貧小額信貸風(fēng)險(xiǎn)始終處于可控范圍。

通過(guò)以上圖例分析，我們獲得了如下啟示:當(dāng)心電圖上出現(xiàn)“高度或三度房室阻滯”伴逸搏心律時(shí)，在逸搏R-R間期中有2個(gè)P波，如果第二個(gè)P波總是圍繞在QRS波的前、中、后，逸搏R-R間期小于2倍P-P間期，且出現(xiàn)典型的提前心室?jiàn)Z獲，則通常可診斷為二度房室阻滯伴房室干擾形成的假性高度或三度房室阻滯，可通過(guò)加長(zhǎng)記錄心電圖或改變心房率來(lái)觀察其變化規(guī)律加以鑒別。

In the past, the accordion sign was thought to be specific for pseudomembranous colitis. Now, it is indicative of severe colonic edema or inflammation, and not specific for

colitis[28].This study has demonstrated a statistically significant difference between the accordion sign and bacterial colitis.

Lymph node enlargement was a discriminating factor in the diagnosis of bacterial causes. There were many endoscopy-proven infectious cases which showed bowel wall thickening with fat stranding and lymph node enlargement on CT[29]. In the case of a wall thickening associated with lymph node enlargement, it was necessary to rule out a malignancy. Heterogeneous and asymmetric focal thickening suggested malignancy, while symmetric regular and homogeneous thickening were associated with benign conditions[18,30].

Plastaras

[17] suggest that the presence of the empty colon sign, continuous distribution of colonic abnormality, and the absence of enlarged lymph nodes are discriminating CT signs for infectious colitis[1]. However, in this study, lymph node enlargement was found in 18% of total colitis and the empty colon sign was present in 43%, while continuous distribution was detected in 75% of total colitis. Thus,continuous distribution is considered appropriate for distinguishing infectious colitis, but there are considerable exceptions in which the absence of lymph node enlargement is highly likely to discriminate infectious enteritis.

It was statistically significant that C-reactive protein was higher in bacterial colitis than in viral colitis,but it was not clear how high the threshold should be for suspicion. We took non-normal values as a reference point, but no statistical significance was found. However, in the case of bacterial colitis, since the sensitivity of C-reactive protein was 93%, if it is elevated, it is necessary to consider Bacterial colitis as an exclusion diagnosis.

If it is summertime and there is at least one positive finding in four CT parameters (submucosal edema, mucosal enhancement, continuous distribution, mucosal thickening), a bacterial infection may be suspected with a sensitivity of 41.67 and a specificity of 92.50. Although the sensitivity is a little low and the specificity is high, this may be helpful in clinical use, such as antibiotics administration, when bacterial infection is suspected.

Formulation design key points for baby sunscreen cosmetics 6 67

Limits of the study

The present study has several limitations. First, this study was performed in a retrospective, observational, and single center manner. Second, there was no control group of patients without colitis. Also,there were more patients in the bacterial colitis group (84%) compared to too few patients in the viral colitis group (16%). This may be considered a selection bias. Thus, a large prospective and welldesigned study, including protocols—such as MDCT, serology/bacteriology, and endoscopy result—is necessary. Third, this present study only dealt with infectious colitis. Other causes of colitis (

, inflammatory or ischemic colitis) and colitis with unexplained causes were excluded. Finally, three radiologists participated in the MDCT readout. Therefore, there could be inter-observer differences. However, we did our best to minimize the discrepancy with enthusiastic results for equivocal MDCT findings.

CONCLUSlON

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

ARTlCLE HlGHLlGHTS

FOOTNOTES

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.

PLC控制技術(shù)相較于其他傳統(tǒng)控制技術(shù)，具有以下幾種特點(diǎn)。首先PLC控制技術(shù)能夠?qū)ΦV山生產(chǎn)和開(kāi)采之中的全過(guò)程中進(jìn)行管理與控制，從而避免發(fā)生不同階段管理方式不同的情況，更好地實(shí)現(xiàn)礦山生產(chǎn)各階段的銜接。當(dāng)前很多礦山開(kāi)采之中的材料和組件價(jià)格比較低廉，利用PLC控制技術(shù)，不僅僅能夠高效地完成礦山的管理工作，同時(shí)還能夠做好成本控制，幫助礦山生產(chǎn)企業(yè)實(shí)現(xiàn)經(jīng)濟(jì)效益。

Distribution of colonic abnormality was more associated with inflammatory bowel disease and ischemic colitis than with infectious colitis[23-25]. The probability of the specific location according to the organisms was mentioned (

, right colon for Yersinia and Salmonella, diffuse involvement for cytomegalovirus and Escherichia coli

left colon for Shigella), but there could be considerable overlap. In addition, there was no significant segmental predominance[26,27]. Therefore, in this study, the distribution was simply divided into continuous or skipped involvement, and continuous involvement of colonic abnormality had significant difference in bacterial colitis.

the 2019 Inje University research grant.

Ethics committee approval was received for this study from Institutional Review Board of the Myongji hospital (Decision No. MJH 2018-08-020).

The authors have no conflicts of interest to declare.

本周，記者對(duì)西北地區(qū)尿素、復(fù)合肥市場(chǎng)進(jìn)行調(diào)查采訪。記者了解到，西北地區(qū)目前用肥基本結(jié)束，只有少量作物有零星用肥需求。當(dāng)前正值冬儲(chǔ)季節(jié)，但是今年冬儲(chǔ)價(jià)格太高，經(jīng)銷商雖庫(kù)存低位，但下游觀望氣氛濃郁，拿貨積極性并不高，多數(shù)經(jīng)銷商表示不計(jì)劃冬儲(chǔ)。

Technical appendix, statistical code, and dataset available from the corresponding author at hslee@paik.ac.kr

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 BYNC 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 noncommercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

South Korea

Seung Jung Yu 0000-0003-3725-3901; Jae Hyuk Heo 0000-0002-4426-920Χ; Eun Jeong Choi 0000-0003-0897-8815; Jong Hyuk Kim 0000-0002-9417-4989; Hong Sub Lee 0000-0002-2962-0209; Sun Young Kim 0000-0002-7110-3395; Jae Hoon Lim 0000-0001-7594-2455.

The Korean Association of Internal Medicine, No. 12991;The Korean Society of Gastroenterology, No. 1-13-2095.

Ma YJ

進(jìn)入新時(shí)期，江澤民和胡錦濤同志也高度重視黨的紀(jì)律建設(shè)。江澤民同志在十五屆中央紀(jì)委三次全會(huì)上首次提出了“紀(jì)律建設(shè)”概念，其后多次講話中也對(duì)紀(jì)律建設(shè)的重要性進(jìn)行了闡述，并且提出了一系列加強(qiáng)紀(jì)律建設(shè)的舉措。胡錦濤同志在黨的十八大報(bào)告中繼續(xù)沿用了“紀(jì)律建設(shè)”概念，可以說(shuō)十八大迎來(lái)了紀(jì)律建設(shè)的“春天”。

A

下面例子左邊是某賣家客戶信息(姓名、年齡)，要求運(yùn)行后輸出用戶顯示信息的C#代碼段。右邊圖引入面向?qū)ο蠓诸惥幊谈鞣N模塊類組成字段及方法函數(shù)的圖解描述(代碼模塊化)。見(jiàn)圖4。

Ma YJ

1 Shane AL, Mody RK, Crump JA, Tarr PI, Steiner TS, Kotloff K, Langley JM, Wanke C, Warren CA, Cheng AC, Cantey J,Pickering LK. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea.

2017 ; 65 : 1963 -1973 [PMID: 29194529 DOI: 10 .1093 /cid/cix959 ]

2 Clinical Guideline for the Diagnosis and Treatment of Gastrointestinal Infections. Infect Chemother 2010 ; 42 : 323 -361 [DOI: 10 .3947 /ic.2010 .42 .6 .323 ]

3 Lee JM, Lee KM. Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease. Clin Endosc 2016 ; 49 : 370 -375 [PMID: 27484813 DOI: 10 .5946 /ce.2016 .090 ]

4 Mantzaris GJ. Endoscopic diagnosis of infectious colitis. Ann Gastroenterol 2007 ; 20 [DOI:10 .1016 /s0016 -5085 (99 )70591 -3 ]

5 Zhang H, Morrison S, Tang YW. Multiplex polymerase chain reaction tests for detection of pathogens associated with gastroenteritis.

2015 ; 35 : 461 -486 [PMID: 26004652 DOI: 10 .1016 /j.cll.2015 .02 .006 ]

6 Binnicker MJ. Multiplex Molecular Panels for Diagnosis of Gastrointestinal Infection: Performance, Result Interpretation,and Cost-Effectiveness.

2015 ; 53 : 3723 -3728 [PMID: 26311866 DOI: 10 .1128 /JCM.02103 -15 ]

7 Halligan E, Edgeworth J, Bisnauthsing K, Bible J, Cliff P, Aarons E, Klein J, Patel A, Goldenberg S. Multiplex molecular testing for management of infectious gastroenteritis in a hospital setting: a comparative diagnostic and clinical utility study.

2014 ; 20 : O460 -O467 [PMID: 24274687 DOI: 10 .1111 /1469 -0691 .12476 ]

8 Goldenberg SD, Bacelar M, Brazier P, Bisnauthsing K, Edgeworth JD. A cost benefit analysis of the Luminex xTAG Gastrointestinal Pathogen Panel for detection of infectious gastroenteritis in hospitalised patients.

2015 ; 70 : 504 -511 [PMID: 25449904 DOI: 10 .1016 /j.jinf.2014 .11 .009 ]

9 Sasaki K, Fujita I, Hamasaki Y, Miyazaki S. Differentiating between bacterial and viral infection by measuring both Creactive protein and 2 '-5 '-oligoadenylate synthetase as inflammatory markers. J Infect Chemother 2002 ; 8 : 76 -80 [PMID:11957124 DOI: 10 .1007 /s101560200010 ]

10 Thoeni RF, Cello JP. CT imaging of colitis. Radiology 2006 ; 240 : 623 -638 [PMID: 16926320 DOI:10 .1148 /radiol.2403050818 ]

11 Delabrousse E, Ferreira F, Badet N, Martin M, Zins M. Coping with the problems of diagnosis of acute colitis.

2013 ; 94 : 793 -804 [PMID: 23751227 DOI: 10 .1016 /j.diii.2013 .03 .012 ]

12 Fisher JK. Abnormal colonic wall thickening on computed tomography. J Comput Assist Tomogr 1983 ; 7 : 90 -97 [PMID:6826855 DOI: 10 .1097 /00004728 -198302000 -00016 ]

13 Al-Khowaiter SS, Brahmania M, Kim E, Madden M, Harris A, Yoshida EM, Gray JR. Clinical and endoscopic significance of bowel-wall thickening reported on abdominal computed tomographies in symptomatic patients with no history of gastrointestinal disease.

2014 ; 65 : 67 -70 [PMID: 23142403 DOI: 10 .1016 /j.carj.2012 .01 .002 ]

14 Barral M, Boudiaf M, Dohan A, Hoeffel C, Camus M, Pautrat K, Fishman EK, Cohen S, Soyer P. MDCT of acute colitis in adults: an update in current imaging features.

2015 ; 96 : 133 -149 [PMID: 24835625 DOI:10 .1016 /j.diii.2014 .04 .008 ]

15 Meyers MA, McGuire PV. Spiral CT demonstration of hypervascularity in Crohn disease: "vascular jejunization of the ileum" or the "comb sign".

1995 ; 20 : 327 -332 [PMID: 7549737 DOI: 10 .1007 /BF00203365 ]

16 Macari M, Balthazar EJ, Megibow AJ. The accordion sign at CT: a nonspecific finding in patients with colonic edema.

1999 ; 211 : 743 -746 [PMID: 10352600 DOI: 10 .1148 /radiology.211 .3 .r99 jn32743 ]

17 Plastaras L, Vuitton L, Badet N, Koch S, Di Martino V, Delabrousse E. Acute colitis: differential diagnosis using multidetector CT.

2015 ; 70 : 262 -269 [PMID: 25522900 DOI: 10 .1016 /j.crad.2014 .11 .008 ]

18 Fernandes T, Oliveira MI, Castro R, Araújo B, Viamonte B, Cunha R. Bowel wall thickening at CT: simplifying the diagnosis.

2014 ; 5 : 195 -208 [PMID: 24407923 DOI: 10 .1007 /s13244 -013 -0308 -y]

19 Philpotts LE, Heiken JP, Westcott MA, Gore RM. Colitis: use of CT findings in differential diagnosis. Radiology 1994 ;190 : 445 -449 [PMID: 8284397 DOI: 10 .1148 /radiology.190 .2 .8284397 ]

20 Madureira AJ. The comb sign. Radiology 2004 ; 230 : 783 -784 [PMID: 14990842 DOI: 10 .1148 /radiol.2303020645 ]

21 Panizza PS, Viana PC, Horvat N, Dos Santos VR Júnior, de Araújo DA, Yamanari TR, Leite CD, Cerri GG. Inflammatory Bowel Disease: Current Role of Imaging in Diagnosis and Detection of Complications: Gastrointestinal Imaging.

2017 ; 37 : 701 -702 [PMID: 28287943 DOI: 10 .1148 /rg.2017160050 ]

22 Ju JH, Min JK, Jung CK, Oh SN, Kwok SK, Kang KY, Park KS, Ko HJ, Yoon CH, Park SH, Cho CS, Kim HY. Lupus mesenteric vasculitis can cause acute abdominal pain in patients with SLE.

2009 ; 5 : 273 -281 [PMID:19412194 DOI: 10 .1038 /nrrheum.2009 .53 ]

23 Iacobellis F, Berritto D, Fleischmann D, Gagliardi G, Brillantino A, Mazzei MA, Grassi R. CT findings in acute, subacute,and chronic ischemic colitis: suggestions for diagnosis.

2014 ; 2014 : 895248 [PMID: 25247191 DOI:10 .1155 /2014 /895248 ]

24 Kilcoyne A, Kaplan JL, Gee MS. Inflammatory bowel disease imaging: Current practice and future directions.

2016 ; 22 : 917 -932 [PMID: 26811637 DOI: 10 .3748 /wjg.v22 .i3 .917 ]

25 Berritto D, Iacobellis F, Mazzei MA, Volterrani L, Guglielmi G, Brunese L, Grassi R. MDCT in ischaemic colitis: how to define the aetiology and acute, subacute and chronic phase of damage in the emergency setting.

2016 ; 89 :20150821 [PMID: 27007462 DOI: 10 .1259 /bjr.20150821 ]

26 Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. Radiographics 2000 ; 20 : 399 -418 [PMID: 10715339 DOI: 10 .1148 /radiographics.20 .2 .g00 mc15399 ]

27 Jung JY, Park YS, Baek DH, Choi JH, Jo YJ, Kim SH, Son BK, Chae JD, Kim DH, Jung YY. [The prevalence of Yersinia infection in adult patients with acute right lower quadrant pain].

2011 ; 57 : 14 -18 [PMID: 21258196 DOI: 10 .4166 /kjg.2011 .57 .1 .14 ]

28 Ash L, Baker ME, O'Malley CM Jr, Gordon SM, Delaney CP, Obuchowski NA. Colonic abnormalities on CT in adult hospitalized patients with Clostridium difficile colitis: prevalence and significance of findings.

2006 ;186 : 1393 -1400 [PMID: 16632736 DOI: 10 .2214 /AJR.04 .1697 ]

29 Lee JS, Cho JH, Kim KO, Lee SH, Jang BI. [Clinical significance of the large intestinal wall thickening detected by abdominal computed tomography].

2012 ; 60 : 300 -305 [PMID: 23172278 DOI:10 .4166 /kjg.2012 .60 .5 .300 ]

30 Tapasvi C, Prajapati N, Madhok R, Gupta AK, Taneja V, Aggarwal A. Evaluation of bowel wall thickening by computed tomography to differentiate benign from malignant lesions.

2014 ; 8 : RC09 -RC12 [PMID: 25584284 DOI:10 .7860 /JCDR/2014 /10601 .5149 ]