Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients

We prospectively evaluated a helical CT technique in which contrast material is administered only through the colon for the imaging of suspected diverticulitis.

One hundred fifty consecutive patients who presented to our emergency department with clinically suspected diverticulitis underwent helical abdominal CT after contrast material was administered only through the colon. CT findings of diverticulitis included diverticula, muscular wall hypertrophy, focal colonic wall thickening, and pericolonic fat stranding. CT results were correlated with clinical follow-up (all patients) and with pathologic findings (41 patients).

A final clinical diagnosis of diverticulitis was made in 64 patients (43%), of whom 62 (97%) had CT results positive for diverticulitis. Of the 86 patients for whom diverticulitis was clinically excluded, all (100%) had CT results that were negative for diverticulitis. CT interpretations had a sensitivity of 97%, a specificity of 100%, a positive predictive value of 100%, a negative predictive value of 98%, and an overall accuracy of 99%. Alternative diagnoses were noted on CT in 50 (58%) of 86 patients who did not have diverticulitis and included 50 (78%) of the 64 patients in whom an alternative condition other than nonspecific abdominal pain was established.

Helical CT obtained after contrast material administered only through the colon is accurate (99%) for confirming or excluding clinically suspected diverticulitis and for suggesting alternative conditions (78%) when they are present. This CT technique avoids the risks, discomforts, and costs of oral and i.v. contrast material administration and allows immediate scanning.