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. According to various studies, the following points can be considered:

• Computed Tomography (CT) is widely regarded as the most accurate imaging modality for diagnosing diverticulitis and its complications 2, 3, 4, 5, 6.
• CT scans can identify extracolonic extent of disease, making them a valuable tool in the acute, symptomatic stage of diverticulitis 5.
• Ultrasound (US) can be useful in early, uncomplicated diverticulitis, especially in non-obese patients, but it may not be as effective in detecting complications such as free air, fecal peritonitis, and deeply located abscesses 2.
• Magnetic Resonance Imaging (MRI) is also mentioned as a potential imaging modality for diverticulitis, but its use is not as widespread as CT scans 5.

Advantages of CT Scans

CT scans have several advantages in diagnosing diverticulitis, including:

• High sensitivity (79-99%) for detecting diverticular inflammation 6.
• Ability to evaluate disease severity and degree 6.
• Useful in differentiating diverticulitis from other diseases that may cause abdominal pain, such as neoplasm, inflammatory bowel disease, and colon ischemia 6.
• Can guide therapy planning in the presence of complications such as abscess or intestinal perforation 6.

Classification of Diverticulitis

A radiological classification system has been created to guide the management of acute colonic diverticulitis (ACD) in patients treated conservatively or with interventional procedures 6. This system divides ACD into two groups: uncomplicated and complicated, with further subdivision of complicated ACD into four stages based on the presence of microperforation, abscess, and peritoneum involvement.