Contrast-enhanced enema can be used to assess for complications of diverticulitis (eg, fistula) and for presurgical planning before colonic resection (ie, assess length of stricture and colonic motility) [16,32]. Intracavitary contrast Left Lower Quadrant Pain material commonly does not fill colovesical fistula tracts due to their small caliber and insufficient intraluminal pressure. Fluoroscopy Cystography A fluoroscopic cystogram is uncommonly used as an initial imaging test for evaluation of suspected complications of diverticulitis. However, in the setting of potential colovesical fistula following diverticulitis, it may be considered useful in some circumstances as an additional imaging modality, for example, in the setting of preoperative planning, or if the CT findings are ambiguous, and/or based on surgeon preference [47,48]. MRI Abdomen and Pelvis MRI is a second-line imaging examination for suspected complications of diverticulitis. When performed, contrast- enhanced MRI is likely more accurate than unenhanced MRI. Small studies with risk of bias have assessed the diagnostic accuracy of MRI compared to CT. In 2021, Jerjen et al [43] published a systematic review of the use of MRI for the diagnosis of acute colonic diverticulitis. The authors found that the diagnostic accuracy of MRI for diverticulitis is likely less than that of CT but insufficiently studied. Published estimates of diagnostic accuracy have been limited by study-related biases and small sample sizes. At present, there are insufficient published data to support routine use of MRI for the diagnosis of complications of diverticulitis. MRI is less sensitive for extraluminal gas than CT and is more affected by motion artifacts. Motion artifacts are common in severely ill patients. Radiography Abdomen and Pelvis Radiography is not useful as the initial imaging test for the general population of patients with suspected complications from diverticulitis because CT is more accurate.
Left Lower Quadrant Pain. Contrast-enhanced enema can be used to assess for complications of diverticulitis (eg, fistula) and for presurgical planning before colonic resection (ie, assess length of stricture and colonic motility) [16,32]. Intracavitary contrast Left Lower Quadrant Pain material commonly does not fill colovesical fistula tracts due to their small caliber and insufficient intraluminal pressure. Fluoroscopy Cystography A fluoroscopic cystogram is uncommonly used as an initial imaging test for evaluation of suspected complications of diverticulitis. However, in the setting of potential colovesical fistula following diverticulitis, it may be considered useful in some circumstances as an additional imaging modality, for example, in the setting of preoperative planning, or if the CT findings are ambiguous, and/or based on surgeon preference [47,48]. MRI Abdomen and Pelvis MRI is a second-line imaging examination for suspected complications of diverticulitis. When performed, contrast- enhanced MRI is likely more accurate than unenhanced MRI. Small studies with risk of bias have assessed the diagnostic accuracy of MRI compared to CT. In 2021, Jerjen et al [43] published a systematic review of the use of MRI for the diagnosis of acute colonic diverticulitis. The authors found that the diagnostic accuracy of MRI for diverticulitis is likely less than that of CT but insufficiently studied. Published estimates of diagnostic accuracy have been limited by study-related biases and small sample sizes. At present, there are insufficient published data to support routine use of MRI for the diagnosis of complications of diverticulitis. MRI is less sensitive for extraluminal gas than CT and is more affected by motion artifacts. Motion artifacts are common in severely ill patients. Radiography Abdomen and Pelvis Radiography is not useful as the initial imaging test for the general population of patients with suspected complications from diverticulitis because CT is more accurate.