Ultrasound accuracy in acute diverticulitis: A systematic review and Meta-analysis

Area of Science:

• Medical Imaging
• Gastroenterology
• Diagnostic Accuracy

Background:

• The diagnostic utility of ultrasound for acute diverticulitis, particularly complicated cases, is debated.
• Computed tomography (CT) is often the gold standard, but ultrasound offers a non-invasive alternative.

Purpose of the Study:

• To synthesize contemporary quantitative data on the diagnostic accuracy of ultrasound for suspected acute diverticulitis.
• To compare the accuracy of point-of-care ultrasound (POCUS) versus radiology-performed ultrasound (RADUS).
• To evaluate diagnostic performance in simple versus complicated diverticulitis.

Main Methods:

• A systematic literature search of Scopus, PubMed, Google Scholar, and CENTRAL (1990-2023).
• Inclusion of 12 diagnostic accuracy studies with CT as the reference standard.
• Calculation of sensitivity, specificity, likelihood ratios, and AUC, with subgroup analyses for POCUS/RADUS and simple/complicated diverticulitis.

Main Results:

• Overall ultrasound sensitivity was 92.5% and specificity was 87.7% for acute diverticulitis.
• Point-of-care ultrasound (POCUS) demonstrated higher sensitivity (94.1%) than radiology-performed ultrasound (RADUS) (83.2%).
• For complicated diverticulitis, ultrasound sensitivity was lower (58.3%) but specificity was high (98.2%).

Conclusions:

• Ultrasound is a highly accurate imaging modality for diagnosing acute diverticulitis.
• Bedside ultrasound performed by emergency physicians and surgeons shows enhanced sensitivity.
• While less sensitive for complicated diverticulitis, ultrasound remains highly specific in these cases.