Toward an evidence-based step-up approach in diagnosing diverticulitis

Area of Science:

• Gastroenterology
• Diagnostic Imaging
• Colorectal Surgery

Background:

• Acute colonic diverticulitis (ACD) diagnosis often requires additional imaging due to non-specific findings and complication risks.
• The diagnostic value of supplementary imaging in suspected ACD remains unclear.

Purpose of the Study:

• To systematically review literature on the accuracy of clinical evaluation and diagnostic modalities for suspected ACD.
• To establish an evidence-based diagnostic approach for ACD.

Main Methods:

• Systematic review and meta-analysis of studies reporting diagnostic accuracy for suspected diverticulitis.
• Assessment of study quality using the STARD checklist.
• Extraction and pooling of sensitivity and specificity estimates for diagnostic tests.

Main Results:

• Clinical diagnosis accuracy varied (sensitivity 64-68%).
• Ultrasound (US) and Computed Tomography (CT) showed comparable diagnostic accuracy (US sensitivity 90%, specificity 90%; CT sensitivity 95%, specificity 96%).
• Magnetic Resonance Imaging (MRI) demonstrated high sensitivity (98%) but variable specificity (70-78%); contrast enema showed lower accuracy than US and CT.

Conclusions:

• Clinical evaluation is sufficient for two-thirds of ACD cases.
• US and CT are the preferred imaging modalities for ACD diagnosis, with CT offering higher specificity and better identification of alternative diagnoses.
• A stepwise approach using US followed by CT for inconclusive cases is recommended for suspected ACD.