MRI Abdomen and Pelvis 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 the routine use of MRI for the diagnosis of suspected diverticulitis. Findings of diverticulitis at MRI are like those at CT: colonic diverticula, thickened diverticulum(la), and inflammation in the pericolic fat, with or without complication (eg, abscess, fistula, perforation). MRI is less sensitive than CT for small-volume extraluminal gas and is more affected by patient motion than CT. Abbreviated MR protocols are being explored to reduce acquisition time and enable emergency department evaluation for suspected diverticulitis, but this remains a research application. Radiography Abdomen and Pelvis Radiography is not useful as the initial imaging test for the general population of patients with suspected diverticulitis because CT is more accurate. Radiography can identify large volume extraluminal air or bowel obstruction. CT is more sensitive and specific for both. Radiography may play a role in the triage of severely ill patients with a surgical abdomen, but CT is used in most cases. US Abdomen Transabdominal Although US is the initial imaging test for suspected diverticulitis in some European countries and the developing world, it still is not widely used in the United States, possibly in part due to a larger obese population. Acute diverticulitis is diagnoseable by US using the following criteria [25]: 1. Short-segment colonic wall thickening (>5 mm) 2. Inflamed diverticulum in the thickened area (hypoechoic and surrounded by hyperechoic fat) 3. Noncompressible hyperechoic pericolic tissue
Left Lower Quadrant Pain. MRI Abdomen and Pelvis 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 the routine use of MRI for the diagnosis of suspected diverticulitis. Findings of diverticulitis at MRI are like those at CT: colonic diverticula, thickened diverticulum(la), and inflammation in the pericolic fat, with or without complication (eg, abscess, fistula, perforation). MRI is less sensitive than CT for small-volume extraluminal gas and is more affected by patient motion than CT. Abbreviated MR protocols are being explored to reduce acquisition time and enable emergency department evaluation for suspected diverticulitis, but this remains a research application. Radiography Abdomen and Pelvis Radiography is not useful as the initial imaging test for the general population of patients with suspected diverticulitis because CT is more accurate. Radiography can identify large volume extraluminal air or bowel obstruction. CT is more sensitive and specific for both. Radiography may play a role in the triage of severely ill patients with a surgical abdomen, but CT is used in most cases. US Abdomen Transabdominal Although US is the initial imaging test for suspected diverticulitis in some European countries and the developing world, it still is not widely used in the United States, possibly in part due to a larger obese population. Acute diverticulitis is diagnoseable by US using the following criteria [25]: 1. Short-segment colonic wall thickening (>5 mm) 2. Inflamed diverticulum in the thickened area (hypoechoic and surrounded by hyperechoic fat) 3. Noncompressible hyperechoic pericolic tissue