MRI was found to be more accurate than CT for the differentiation of cancer from diverticulitis (sensitivity: 100% versus 67%, specificity: 100% versus 93%) [12]. There are no large studies confirming the diagnostic accuracy of MRI for the general evaluation of patients with left lower quadrant pain. Radiography Abdomen and Pelvis Radiography is not useful as the initial imaging test for the general population of patients with left lower quadrant pain because CT is more accurate. Radiography can identify large volume extraluminal air, can diagnose ileus or bowel obstruction, or may diagnose urolithiasis. CT is more sensitive and specific for each of those entities. Radiography may play a role in the triage of severely ill patients with a surgical abdomen, but CT is used in most cases. Variant 2: Left lower quadrant pain. Suspected diverticulitis. Initial imaging. Diverticulitis is suspected in patients with left lower quadrant pain, fever, and leukocytosis. However, this triad is present in only approximately 25% of patients with diverticulitis [6,26]. Misdiagnosis based on clinical assessment alone has been reported to be between 34% and 68% [6,27,28]. CT Abdomen and Pelvis CT is the most useful examination for patients with suspected colonic diverticulitis because of its reproducibility, superior diagnostic accuracy (98%) [16,19], accuracy for alternative diagnoses with a similar presentation [9,16], risk-stratification of patients for operative versus nonoperative treatment [8,30-32], and inpatient versus outpatient triage [33,34]. CT diagnosis of uncomplicated acute diverticulitis in the emergency department can prevent unneeded hospital admission [3,5]. This is because most colonic diverticulitis is uncomplicated and can be managed with outpatient antibiotics [11]. Juszczyk et al [5] showed that early CT for acute diverticulitis can reduce hospital admission by more than 50% and shorten hospital length of stay.
Left Lower Quadrant Pain. MRI was found to be more accurate than CT for the differentiation of cancer from diverticulitis (sensitivity: 100% versus 67%, specificity: 100% versus 93%) [12]. There are no large studies confirming the diagnostic accuracy of MRI for the general evaluation of patients with left lower quadrant pain. Radiography Abdomen and Pelvis Radiography is not useful as the initial imaging test for the general population of patients with left lower quadrant pain because CT is more accurate. Radiography can identify large volume extraluminal air, can diagnose ileus or bowel obstruction, or may diagnose urolithiasis. CT is more sensitive and specific for each of those entities. Radiography may play a role in the triage of severely ill patients with a surgical abdomen, but CT is used in most cases. Variant 2: Left lower quadrant pain. Suspected diverticulitis. Initial imaging. Diverticulitis is suspected in patients with left lower quadrant pain, fever, and leukocytosis. However, this triad is present in only approximately 25% of patients with diverticulitis [6,26]. Misdiagnosis based on clinical assessment alone has been reported to be between 34% and 68% [6,27,28]. CT Abdomen and Pelvis CT is the most useful examination for patients with suspected colonic diverticulitis because of its reproducibility, superior diagnostic accuracy (98%) [16,19], accuracy for alternative diagnoses with a similar presentation [9,16], risk-stratification of patients for operative versus nonoperative treatment [8,30-32], and inpatient versus outpatient triage [33,34]. CT diagnosis of uncomplicated acute diverticulitis in the emergency department can prevent unneeded hospital admission [3,5]. This is because most colonic diverticulitis is uncomplicated and can be managed with outpatient antibiotics [11]. Juszczyk et al [5] showed that early CT for acute diverticulitis can reduce hospital admission by more than 50% and shorten hospital length of stay.