Abstract
BackgroundThe aim of this study was to evaluate the diagnostic accuracy of unenhanced low‐dose CT (LDCT) in acute colonic diverticulitis in comparison with contrast‐enhanced standard‐dose CT (SDCT).MethodsAll patients with clinically suspected diverticulitis who underwent LDCT followed by SDCT between January and October 2017 were evaluated prospectively. CT examinations were assessed for signs of diverticulitis, complications and other differential diagnoses by three independent radiologists (two consultants and one fourth‐year resident) using SDCT as the reference method. Sensitivity and specificity were calculated and Cohen's κ coefficient was used for agreement analyses.ResultsOf the 149 patients included (mean age 66·7 years, M : F ratio 0·4), 107 (71·8 per cent) had imaging consistent with diverticulitis on standard CT. Sensitivity and specificity values for a diverticulitis diagnosis using LDCT were 95–99 and 86–100 per cent respectively, and respective values for identification of complications were 58–73 and 78–100 per cent. The corresponding κ values among the three readers for diagnosis were 0·984, 0·934 and 0·816, whereas κ values for complications were 0·680, 0·703 and 0·354. Of the 26 patients who presented with other causes of abdominal symptoms identified on standard CT, 23 were diagnosed correctly on LDCT. Missed cases included splenic infarction (1) and segmental colitis (2).ConclusionThe diagnostic accuracy of LDCT was high for the presence of acute diverticulitis. However, as signs of complicated disease can be missed using the low‐dose protocol, use of LDCT as a primary examination method should not preclude SDCT when complications may be suspected.
Highlights
The incidence of diverticulitis has increased during recent decades, and is reported to be up to 188 per 100 000 population per annum[1,2]
The aim of the present study was to evaluate whether unenhanced low-dose CT (LDCT) is as accurate as standard-dose CT (SDCT) in detecting suspected acute colonic diverticulitis
Some 107 (71⋅8 per cent) of the 149 included patients met the criteria for diverticulitis according to the reference method (SDCT) and consensus between consultants was reached; these patients were considered to have true cases of acute colonic diverticulitis (Fig. 1)
Summary
The incidence of diverticulitis has increased during recent decades, and is reported to be up to 188 per 100 000 population per annum[1,2]. The aim of this study was to evaluate the diagnostic accuracy of unenhanced low-dose CT (LDCT) in acute colonic diverticulitis in comparison with contrast-enhanced standard-dose CT (SDCT). Methods: All patients with clinically suspected diverticulitis who underwent LDCT followed by SDCT between January and October 2017 were evaluated prospectively. CT examinations were assessed for signs of diverticulitis, complications and other differential diagnoses by three independent radiologists (two consultants and one fourth-year resident) using SDCT as the reference method. Sensitivity and specificity values for a diverticulitis diagnosis using LDCT were 95–99 and 86–100 per cent respectively, and respective values for identification of complications were 58–73 and 78–100 per cent. As signs of complicated disease can be missed using the low-dose protocol, use of LDCT as a primary examination method should not preclude SDCT when complications may be suspected
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