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 the studies, the following points can be considered:

• Computed Tomography (CT) is considered the diagnostic gold standard for the imaging evaluation of diverticulitis 2, 3, 4, 5.
• CT is superior to ultrasound (US) in detecting free air, fecal peritonitis, and deeply located abscesses, especially in obese patients 2.
• US may be superior to CT in not too obese patients, and is most useful in early, uncomplicated diverticulitis 2.
• Magnetic Resonance Imaging (MRI) may have a role in the evaluation of diverticulitis, but more research is needed to determine its effectiveness 3.
• Point-of-care ultrasound may become more important for initial diagnosis and follow-up assessment, similar to its use in trauma patients 3.

Specific Findings

The studies also highlight the following specific findings:

• CT signs of diverticulitis include focal inflammatory wall thickening and paracolic inflammation superimposed on diverticular disease 4, 5.
• Common alternative conditions that can clinically mimic diverticulitis include small bowel obstruction, primary epiploic appendagitis, acute cholecystitis, appendicitis, ileitis, ovarian cystic disease, and ureteral stone disease 4.
• CT findings can be used to classify diverticulitis as mild or severe, and to guide treatment planning 5.

Comparison of Imaging Modalities

The studies compare the different imaging modalities as follows:

• CT is more accurate than US in diagnosing diverticulitis, but US may be useful in certain cases, such as in not too obese patients or in early, uncomplicated diverticulitis 2.
• MRI may have a role in the evaluation of diverticulitis, but its effectiveness is still being researched 3.
• Contrast enema, computed tomography, and ultrasound have all been used extensively to diagnose the complications of diverticular disease, but CT is currently considered the gold standard 6.