The researchers investigated the impact of imaging on the surgical management of colonic diverticulitis.
The findings of the study were published in the May issue of European Radiology.
From 1986 to 1997, all patients admitted in the authors' emergency center with clinically suspected left-colonic diverticulitis had a water-soluble contrast enema (CE) and a computed tomography (CT) scan.
These were done within 72 hours of their admission, unless clinical findings required immediate laparotomy.
The patients were prospectively included in the study if one or both radiological exams showed signs of acute diverticulitis and/or diverticulitis was surgically removed and histologically proven.
Some 542 patients entered the study. Of these, 86% had a CT exam, 81% had a CE, and 77% had both exams.
|Sensitivity of imaging exam:|
Computed tomography: 98%
Contrast enema: 92%
| European Radiology |
The performance of CT was found to be significantly superior to CE in terms of sensitivity (98 vs 92%), and in the evaluation of the severity of the inflammation (26 vs 9%).
Moreover, of 69 patients who had an associated abscess seen on CT, only 29% of these individuals had indirect signs of this complication on CE.
During the acute phase, the chances of medical treatment failure were statistically greater when diverticulitis was considered severe on CT, than when it is considered moderate (26% for severe diverticulitis vs 4% for moderate).
After successful medical treatment of the acute episode, patients with severe diverticulitis on the CT had statistically greater incidence of secondary bad outcome, than patients with moderate diverticulitis did (36% vs 17%).
Author P. Ambrosetti, of the Clinic of Digestive Surgery at the University Hospital of Geneva, said on behalf of the group, "Computed tomography should be preferred to CE as the initial radiological exam of diverticulitis.
"This is because of its statistically significant superiority in sensitivity and for its statistically much higher performance in the detection of severe infection, especially when an abscess is associated with the disease."
"The severity of diverticulitis on CT is statistically predictive of the risk of medical treatment failure during the acute phase. It is also predictive of the chances of bad secondary outcome after a successful medical treatment of the first episode," it was concluded.