What is the best imaging modality for diverticulitis (inflammation of the diverticula)?

From the Guidelines

Computed Tomography (CT) is the best imaging modality for diverticulitis.

Key Points

• CT has high sensitivity (92-99%) and specificity (97-100%) for diagnosing diverticulitis 1.
• CT is preferred over other imaging modalities, such as ultrasound (US) and magnetic resonance imaging (MRI), due to its high diagnostic accuracy and ability to detect alternative diagnoses 1.
• CT can help identify complications of diverticulitis, such as abscesses, perforation, and fistulas, and guide percutaneous drainage or surgical management 1.
• The American College of Radiology (ACR) and other professional societies recommend CT as the initial imaging modality for suspected diverticulitis 1.

Diagnostic Accuracy

• CT has been shown to have high sensitivity and specificity for diagnosing diverticulitis, with values ranging from 92-99% and 97-100%, respectively 1.
• MRI has also been studied as a potential imaging modality for diverticulitis, but its sensitivity and specificity are lower than those of CT, with values of 94% and 88%, respectively 1.
• US has been reported to have variable sensitivity and specificity for diagnosing diverticulitis, with values ranging from 77-98% and 80-99%, respectively 1.

Clinical Considerations

• CT imaging should be used judiciously in female patients of childbearing age, and alternative imaging modalities, such as US, should be considered when possible 1.
• The use of CT imaging should be balanced against the potential risks of radiation exposure and the detection of incidental findings 1.
• Clinicians should err on the side of imaging in patients with predictors of progression to complicated diverticulitis, such as symptoms lasting longer than 5 days or signs of perforation, bleeding, or obstruction 1.

From the Research

Imaging Modalities for Diverticulitis

The best imaging modality for diverticulitis is a topic of discussion among medical professionals.

• Computed Tomography (CT) is considered the most reliable modality for diagnosing diverticulitis and its complications, especially in complicated cases or obese patients 2, 3, 4, 5.
• Ultrasound (US) can be useful in early, uncomplicated diverticulitis, particularly in non-obese patients, and can provide valuable information on the progression of the disease 2.
• CT signs of diverticulitis include focal inflammatory wall thickening and paracolic inflammation superimposed on diverticular disease 3, 4.
• Other imaging modalities such as barium enema and magnetic resonance imaging (MRI) can also be used, but CT remains the procedure of choice in the acute, symptomatic stage 6, 5.

Advantages and Disadvantages of Each Modality

• CT:
  • Advantages: highly accurate, can detect extracolonic extent of disease, and useful in complicated cases or obese patients 3, 4, 5.
  • Disadvantages: may not be suitable for all patients, particularly those with renal impairment or allergy to contrast material.
• US:
  • Advantages: non-invasive, relatively low-cost, and can be used as a first-line modality in acute abdomen 2.
  • Disadvantages: may not be as accurate as CT, particularly in complicated cases or obese patients.
• Other modalities:
  • Barium enema: can be used to diagnose diverticulitis, but has largely been replaced by CT due to its limited ability to detect extracolonic extent of disease 6, 5.
  • MRI: has been studied in patients with complicated diverticulitis, but its role is still evolving 6.