Reference
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1. Parks TG. Natural history of diverticular disease of the colon. Clin Gastroenterol. 1975;4(1):53-69. Review/Other-Dx N/A To examine the course and prognosis particularly of symptomatic diverticular disease. No results stated in abstract. 4
2. Rafferty J, Shellito P, Hyman NH, Buie WD. Practice parameters for sigmoid diverticulitis. Dis Colon Rectum. 2006;49(7):939-944. Review/Other-Dx N/A To address the evaluation and management of sigmoid diverticulitis. No results stated in abstract. 4
3. Caputo P, Rovagnati M, Carzaniga PL. Is it possible to limit the use of CT scanning in acute diverticular disease without compromising outcomes? A preliminary experience. Ann Ital Chir. 86(1):51-5, 2015 Jan-Feb. Observational-Dx 93 patients To determine whether the use of CT scanning in the assessment of acute diverticulitis can be reduced without a negative effect on outcome. In patients with a HS </= 1b surgical intervention was never required and therefore we believe that US imaging is sufficient and they can be spared the exposure to ionizing radiation associated with CT scans. 4
4. Bodmer NA, Thakrar KH. Evaluating the Patient with Left Lower Quadrant Abdominal Pain. [Review]. Radiol Clin North Am. 53(6):1171-88, 2015 Nov. Review/Other-Dx N/A To review the evaluation of a patient with left lower quadrant abdominal pain. No results stated in abstract. 4
5. Fung AK, Ahmeidat H, McAteer D, Aly EH. Validation of a grading system for complicated diverticulitis in the prediction of need for operative or percutaneous intervention. Ann R Coll Surg Engl. 97(3):208-14, 2015 Apr. Observational-Dx 367 patients To retrospectively validate a CT grading system for acute complicated diverticulitis in the prediction of the need for operative or percutaneous intervention. Three hundred and sixty-seven patients (34.6%) had CT performed for acute diverticulitis during the study period. Forty-four patients (12.0%) had acute complicated diverticulitis (abscess and/or free intraperitoneal air) confirmed on CT. There were 22 women (50%) and the overall median age was 59 years (range: 19-92 years). According to the CT findings, there was one case with grade 1, eighteen patients with grade 2, four with grade 3 and twenty-one with grade 4 diverticulitis. Three patients with grade 2, three patients with grade 3 and ten patients with grade 4 disease underwent acute radiological or surgical intervention. 3
6. Millet I, Sebbane M, Molinari N, et al. Systematic unenhanced CT for acute abdominal symptoms in the elderly patients improves both emergency department diagnosis and prompt clinical management. Eur Radiol. 27(2):868-877, 2017 Feb. Observational-Dx 401 patients To assess the added-value of systematic unenhanced abdominal computed tomography (CT) on emergency department (ED) diagnosis and management accuracy compared to current practice, in elderly patients with non-traumatic acute abdominal symptoms. Systematic unenhanced CT significantly improved the accurate diagnosis (76.8% to 85%, p=1.1x10-6) and management (88.5% to 95.8%, p=2.6x10-6) rates compared to current practice. It allowed diagnosing 30.3% of acute unsuspected pathologies, 3.4% of which were unexpected surgical procedure requirement. 3
7. Abbas MA, Cannom RR, Chiu VY, et al. Triage of patients with acute diverticulitis: are some inpatients candidates for outpatient treatment?. Colorectal Dis. 15(4):451-7, 2013 Apr. Review/Other-Dx 639 patients To determine whether some inpatients with acute diverticulitis are candidates for outpatient treatment. Of 639 patients, 368 (57.6%) had a minimal hospitalization. Female gender and CT scan findings of free air/fluid were negatively associated with the likelihood of minimal hospitalization. The presence of an abscess < 3 cm and stranding on CT did not predict the need for a higher level of care. Despite the statistical significance of several patient-level predictors, the model did not identify patients likely to need only minimal hospitalization. 4
8. Thorisson A, Smedh K, Torkzad MR, Pahlman L, Chabok A. CT imaging for prediction of complications and recurrence in acute uncomplicated diverticulitis. Int J Colorectal Dis. 31(2):451-7, 2016 Feb. Observational-Dx 623 patients To re-evaluate the computed tomography (CT) scans of the patients in the AVOD study to find out whether there were CT findings that were missed and to study whether CT signs in uncomplicated diverticulitis could predict complications or recurrence. Of the 623 patients included in the study, 602 CT scans were obtained and re-evaluated. Forty-four (7 %) patients were found to have complications on the admitting CT scan that had been overlooked. Twenty-seven had extraluminal gas and 17 had an abscess. Four of these patients deteriorated and required surgery, but the remaining patients improved without complications. Of the 18 patients in the no-antibiotic group, in whom signs of complications on CT were overlooked, 15 recovered without antibiotics. No CT findings in patients with uncomplicated diverticulitis could predict complications or recurrence. 3
9. Al-Sahaf O, Al-Azawi D, Fauzi MZ, El-Masry S, Gillen P. Early discharge policy of patients with acute colonic diverticulitis following initial CT scan. Int J Colorectal Dis. 2008;23(8):817-820. Review/Other-Dx 42 patients Retrospective study to determine if patients with mild ACD on early CT scan can be treated and discharged at an early time. CT severity classification: 61.9% mild, 7.1% moderate, and 31.0% severe diverticulitis. Patients with mild ACD were discharged safely, had no recurrence of their symptoms, and needed no readmission within 6 months of follow-up. Patients with mild ACD on CT scan performed within 24 hours could be safely discharged and treated according to protocols of outpatient management of diverticulitis. 4
10. Ajaj W, Ruehm SG, Lauenstein T, et al. Dark-lumen magnetic resonance colonography in patients with suspected sigmoid diverticulitis: a feasibility study. Eur Radiol. 2005;15(11):2316-2322. Observational-Dx 40 patients A prospective study to assess dark-lumen MRC for the evaluation of patients with suspected sigmoid diverticulitis, by comparing the results to conventional colonoscopy. Conventional colonoscopy confirmed the presence of light inflammatory signs in 4 patients which were missed in MRC. MRC correctly identified wall thickness and contrast uptake of the sigmoid colon in the patients with diverticulitis. In 3 of these patients false-positive findings were observed, and MRC classified the inflammation of the sigmoid colon as diverticulitis whereas conventional colonoscopy and histopathology confirmed invasive carcinoma. MRC detected additionally relevant pathologies of the entire colon and could be performed in cases where conventional colonoscopy was incomplete. MRC may be considered a promising alternative to conventional colonoscopy for the detection of sigmoid diverticulitis. 2
11. Buckley O, Geoghegan T, McAuley G, Persaud T, Khosa F, Torreggiani WC. Pictorial review: magnetic resonance imaging of colonic diverticulitis. Eur Radiol. 2007;17(1):221-227. Review/Other-Dx N/A To illustrate the emerging role of MRI in the diagnosis and evaluation of colonic diverticulitis. MRI has a major advantage over CT in that there is no ionizing radiation. In one institution, MRI has increasingly been used as a complimentary imaging modality to CT in the diagnosis and evaluation of diverticulitis and its complications. 4
12. Heverhagen JT, Sitter H, Zielke A, Klose KJ. Prospective evaluation of the value of magnetic resonance imaging in suspected acute sigmoid diverticulitis. Dis Colon Rectum. 2008;51(12):1810-1815. Observational-Dx 55 patients, 2 blinded assessors To prospectively examine patients with suspected ACD and to provide sensitivity, specificity, and interobserver agreement in a blinded trial. The two assessors exhibited sensitivities of more than 94%, specificities of 88%, positive likelihood ratios of >7.5, and negative likelihood ratios of <0.07. The kappa coefficient showed a significant, strong correlation between both assessors (kappa = 0.68). MRI is investigator independent and provides high sensitivity and specificity for the diagnosis of ACD. 1
13. Kircher MF, Rhea JT, Kihiczak D, Novelline RA. Frequency, sensitivity, and specificity of individual signs of diverticulitis on thin-section helical CT with colonic contrast material: experience with 312 cases. AJR Am J Roentgenol. 2002;178(6):1313-1318. Observational-Dx 312 patients To determine sensitivity and specificity of helical CT for diverticulitis. CT had a sensitivity of 99%, a specificity of 99%, and an overall accuracy of 99% for detection of diverticulitis. The two most frequent signs of diverticulitis were bowel wall thickening (96%) and fat stranding (95%). Less frequent but highly specific signs were fascial thickening (50%), free fluid (45%), and inflamed diverticula (43%). 3
14. Oistamo E, Hjern F, Blomqvist L, Von Heijne A, Abraham-Nordling M. Cancer and diverticulitis of the sigmoid colon. Differentiation with computed tomography versus magnetic resonance imaging: preliminary experiences. Acta Radiol. 2013;54(3):237-241. Observational-Dx 30 patients To determine whether MRI could be helpful to differentiate between diverticulitis and cancer of the sigmoid colon compared to the differentiation offered by evaluation of MDCT in a clinical situation. With contrast-enhanced CT, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 66.7% (10/15) and 93.3% (14/15), respectively. Using T2-weighted and diffusion-weighted MRIs, the sensitivity and specificity for diagnosis of cancer and diverticulitis were 100% (14/14) and 100% (14/14), respectively. 4
15. Schreyer AG, Furst A, Agha A, et al. Magnetic resonance imaging based colonography for diagnosis and assessment of diverticulosis and diverticulitis. Int J Colorectal Dis. 2004;19(5):474-480. Review/Other-Dx 14 patients 56 segments A prospective study to assess the feasibility of MRC to assess diverticulosis or diverticulitis by comparing results with that of abdominal CT. MRC revealed the same diagnosis as CT in all patients without ionizing radiation. Additionally, 3D-rendered models and virtual colonoscopy can be performed. This comprehensive 3D model could replace pre-surgical planning BE with concurrent assessment of the residual colon. 4
16. Lau KC, Spilsbury K, Farooque Y, et al. Is colonoscopy still mandatory after a CT diagnosis of left-sided diverticulitis: can colorectal cancer be confidently excluded? Dis Colon Rectum. 2011;54(10):1265-1270. Observational-Dx 1,407 patients To determine whether colonoscopy is necessary and what additional information is gained from this procedure. Left-sided diverticulitis was diagnosed in 1,088 patients on CT scan, whereas follow-up colonoscopy reports were available for 319 patients. 82 (26%) patients had incidental findings of polyps (9 polyps >1 cm), and 9 patients (2.8%) received diagnoses of colorectal cancers on colonoscopy. After cross-referencing with the cancer registry, the overall prevalence of colorectal cancer among the cohort within 1 year of CT scan was 2.1% (23 cases). The odds of a diagnosis of colorectal cancer were 6.7 times (95% CI, 2.4–18.7) in patients with an abscess reported on CT, 4 times (95% CI, 1.1–14.9) in patients with local perforation, and 18 times (95% CI, 5.1–63.7) in patients with fistula compared with patients with uncomplicated diverticulitis. 4
17. Flor N, Maconi G, Cornalba G, Pickhardt PJ. The Current Role of Radiologic and Endoscopic Imaging in the Diagnosis and Follow-Up of Colonic Diverticular Disease. [Review]. AJR Am J Roentgenol. 207(1):15-24, 2016 Jul. Review/Other-Dx N/A To focus more more on the workup and management of post acute, chronic, and other related conditions of diverticular disease. No results stated in abstract. 4
18. Sai VF, Velayos F, Neuhaus J, Westphalen AC. Colonoscopy after CT diagnosis of diverticulitis to exclude colon cancer: a systematic literature review. Radiology. 2012;263(2):383-390. Review/Other-Dx 10 articles To estimate the prevalence of underlying adenocarcinoma of the colon in patients in whom acute diverticulitis was diagnosed at CT and to compare that to the prevalence of colon cancer in the general population. 10 articles met the inclusion criteria. Data from these articles included only 771 patients who underwent surgery, colonoscopy, or BE study within 24 weeks of diagnosis. 14 patients were found to have colon cancer, for a prevalence of 2.1% (95% CI: 1.2%, 3.2%). This compares to a calculated estimated prevalence of 0.68% among U.S. adults >55 years. 4
19. Ou G, Rosenfeld G, Brown J, et al. Colonoscopy after CT-diagnosed acute diverticulitis: Is it really necessary?. Can J Surg. 58(4):226-31, 2015 Aug. Observational-Dx 293 patients To determine the prevalence of CRC among patients with CT-diagnosed acute diverticulitis. A total of 293 patients had acute diverticulitis diagnosed on CT scan, but 8 were nonresidents and were excluded. Of the 285 included in the analysis, the mean age was 59.4 +/- 15.1 years, and 167 (58.6%) were men. Among the 114 patients who underwent follow-up evaluation, malignancy was diagnosed in 4 (3.5%). The overall prevalence of malignancy among patients with CT-diagnosed diverticulitis was 1.4%. 3
20. Elmi A, Hedgire SS, Pargaonkar V, Cao K, McDermott S, Harisinghani M. Is early colonoscopy beneficial in patients with CT-diagnosed diverticulitis?. AJR Am J Roentgenol. 200(6):1269-74, 2013 Jun. Observational-Dx 1034 patients To establish CT criteria as an indication for colonoscopy in patients with acute diverticulitis. Of 1034 patients with a CT diagnosis of diverticulitis, 402 (235 women and 167 men; mean age, 63.3 years) had available endoscopic colonic evaluation after CECT. The mean follow-up was 5.3 years. Seventy-eight patients had polyps (71% adenomatous) and nine patients (2.2%) were diagnosed with colon cancer (seven women, two men). The odds ratio for diagnosis of colon cancer was 23.35 in patients with mesenteric or retroperitoneal lymphnodes, 4.67 for abscess, and 24.43 in patients with obstruction and localized mass reported on CT. A significant correlation was found between the location of diverticulitis and cancer (p < 0.001). The diagnosis of cancer was made within 6 months from the date of CECT in eight patients. The odds of cancer were 2.5 times higher in women. 3
21. Stabile Ianora AA, Moschetta M, Pedote P, Scardapane A, Angelelli G. Preoperative local staging of colosigmoideal cancer: air versus water multidetector-row CT colonography. Radiol Med. 2012;117(2):254-267. Experimental-Dx 70 patients To evaluate the diagnostic accuracy of multidetector-row computed tomography (MDCT) performed with two different hypodense endoluminal contrast agents for the preoperative staging of colosigmoideal cancer. The overall diagnostic accuracy of MDCT was 68.6% for water and 62.8% for air colonography. In the evaluation of the T parameter, the accuracy values were 88.6% for water and 80% for air colonography. In staging of the N parameter, the accuracy values were 77.1% and 74.3% for water and air MDCT colonography, respectively. 3
22. Pickhardt PJ, Hassan C, Halligan S, Marmo R. Colorectal cancer: CT colonography and colonoscopy for detection--systematic review and meta-analysis. [Review]. Radiology. 259(2):393-405, 2011 May.Radiology. 259(2):393-405, 2011 May. Meta-analysis 49 studies To perform a systematic review and meta-analysis of published studies assessing the sensitivity of both computed tomographic (CT) colonography and optical colonoscopy (OC) for colorectal cancer detection. Forty-nine studies provided data on 11,151 patients with a cumulative colorectal cancer prevalence of 3.6% (414 cancers). The sensitivity of CT colonography for colorectal cancer was 96.1% (398 of 414; 95% confidence interval [CI]: 93.8%, 97.7%). No heterogeneity (I(2) = 0%) was detected. No cancers were missed at CT colonography when both cathartic and tagging agents were combined in the bowel preparation. The sensitivity of OC for colorectal cancer, derived from a subset of 25 studies including 9223 patients, was 94.7% (178 of 188; 95% CI: 90.4%, 97.2%). A moderate degree of heterogeneity (I(2) = 50%) was present. Good
23. Flor N, Mezzanzanica M, Rigamonti P, et al. Contrast-enhanced computed tomography colonography in preoperative distinction between T1-T2 and T3-T4 staging of colon cancer. Acad Radiol. 2013;20(5):590-595. Observational-Dx 61 patients To predict the T stage of nonrectal colon cancer using contrast-enhanced computed tomography colonography. At pathologic examination, we found the following stages: T1 (n = 5), T2 (n = 10), T3 (n = 41), T4a (n = 6), and T4b (n = 5). Intraobserver and interobserver reproducibilities were almost perfect for wall deformity (kappa = 1.00 and kappa = 0.88, respectively), substantial for perilesional fat abnormality (kappa = 0.79 and kappa = 0.74, respectively). Using the results of the more experienced reader, accuracy of wall deformity >/=50% (apple-core) alone for T >/= 3 was 62 of 67 (0.93, 95% confidence interval [CI] 0.83-0.97) and that of perilesional fat abnormality alone was 37 of 67 (0.55, 95% CI 0.43-0.67) (P < .001). Predictive value for >/= T3 of the association wall deformity >/=50% with perilesional fat abnormality was 22 of 22 (1.00, 95% CI 0.85-1.00), higher, but not significantly, than that of wall deformity >/=50% with normal perilesional fat 29 of 33 (0.88, 95% CI 0.72-0.97) (P = .148, Fisher exact test). 2
24. Nerad E, Lahaye MJ, Maas M, et al. Diagnostic Accuracy of CT for Local Staging of Colon Cancer: A Systematic Review and Meta-Analysis. [Review]. AJR. American Journal of Roentgenology. 207(5):984-995, 2016 Nov.AJR Am J Roentgenol. 207(5):984-995, 2016 Nov. Meta-analysis 13 studies To determine the accuracy of CT in the detection of tumor invasion beyond the bowel wall and nodal involvement of colon carcinomas. On the basis of a total of 13 studies, pooled sensitivity, specificity, and diagnostic ORs for detection of tumor invasion beyond the bowel wall (T3-T4) were 90% (95% CI, 83-95%), 69% (95% CI, 62-75%), and 20.6 (95% CI, 10.2-41.5), respectively. For detection of tumor invasion depth of 5 mm or greater (T3cd-T4), estimates from four studies were 77% (95% CI, 66-85%), 70% (95% CI, 53-83%), and 7.8 (95% CI, 4.2-14.2), respectively. For nodal involvement (N+), 16 studies were included with values of 71% (95% CI, 59-81%), 67% (95% CI, 46-83%), and 4.8 (95% CI, 2.5-9.4), respectively. Two studies using CT colonography were included with sensitivity and specificity of 97% (95% CI, 90-99%) and 81% (95% CI, 65-91%), respectively, for detecting T3-T4 tumors. Good
25. Goh V, Halligan S, Taylor SA, Burling D, Bassett P, Bartram CI. Differentiation between diverticulitis and colorectal cancer: quantitative CT perfusion measurements versus morphologic criteria--initial experience. Radiology. 2007;242(2):456-462. Observational-Dx 60 patients To determine whether CT perfusion measurements in prospectively recruited patients can be used to differentiate between diverticulitis and colorectal cancer and to compare this discrimination with that of standard morphologic criteria. CT perfusion measurements enable differentiation and better discrimination, in comparison with morphologic criteria, between cancer and diverticulitis. 2
26. Achiam MP, Andersen LP, Klein M, et al. Differentiation between benign and malignant colon tumors using fast dynamic gadolinium-enhanced MR colonography; a feasibility study. Eur J Radiol. 2010;74(3):e45-50. Observational-Dx 14 patients To determine whether fast dynamic gadolinium-enhanced MRI combined with MRC could be used to differentiate a benign from a malignant obstructing colon tumor. The wash-in and wash-out rates were significantly different between the benign and malignant tumors, and a clear distinction between benign and malignant disease was therefore possible by looking only at the MR data. Furthermore, MRC evaluating the rest of the colon past the stenosis was possible with all patients. 2
27. Hill BC, Johnson SC, Owens EK, Gerber JL, Senagore AJ. CT scan for suspected acute abdominal process: impact of combinations of IV, oral, and rectal contrast. World J Surg. 2010;34(4):699-703. Observational-Dx 661 patients To evaluate the diagnostic accuracy of abdominal/pelvic CT with varying use of contrast agents in hospitalized patients. A total of 661 patients were identified. Use of IV contrast alone was found in 54.2% of CT scans and was correct in 92.5% of cases. IV and oral contrast was used in 22.2% of CT scans and was 94.6% correct. Unenhanced imaging was performed in 16.2% and was correct in 92.5%. Oral contrast alone was used in 7.0% and was 93.5% correct. There was no significant difference in the ability to correctly diagnose a suspected acute abdominal process when enhanced CT imaging was compared to unenhanced (P>0.05). 3
28. Kessner R, Barnes S, Halpern P, Makrin V, Blachar A. CT for Acute Nontraumatic Abdominal Pain-Is Oral Contrast Really Required?. Academic Radiology. 24(7):840-845, 2017 Jul.Acad Radiol. 24(7):840-845, 2017 Jul. Observational-Dx 348 patients To compare the diagnostic performance of abdominal computed tomography (CT) performed with and without oral contrast in patients presenting to the emergency department (ED) with acute nontraumatic abdominal pain. Each group consisted of 82 men and 92 women. The average age of the two groups was 48 years. The main clinical diagnoses of the pathological examinations were appendicitis (17.5%), diverticulitis (10.9%), and colitis (5.2%). A normal CT examination was found in 34.8% of the patients. There was no significant difference between the groups regarding most of the clinical parameters that were examined. None of the examinations of all of the 174 study group patients was found to be technically inadequate, and therefore no patient had to undergo additional scanning to establish a diagnosis. The consensus reading of the senior radiologists determined that the lack of oral contrast was insignificant in 96.6% of the cases and that contrast material might have been useful in only 6 of 174 study group patients (3.4%). The radiologists found oral contrast to be helpful only in 8 of 174 control group patients (4.6%). There was no significant difference between the clinical and radiological diagnoses in both groups (study group, P = 0.261; control group, P = 0.075). 3
29. Broder JS, Hamedani AG, Liu SW, Emerman CL. Emergency department contrast practices for abdominal/pelvic computed tomography-a national survey and comparison with the american college of radiology appropriateness criteria(). J Emerg Med. 44(2):423-33, 2013 Feb. Review/Other-Dx 106 patients To survey United States academic emergency departments to document national practice. 106/152 (70%) surveys were completed. IV contrast was the most frequently cited contrast. At least 90% of respondents reported using IV contrast in 12/18 indications. Oral contrast use was more variable. In no indication did =90% of respondents indicate use of oral contrast, and in only 2 indications did =90% avoid its use. Rectal contrast was rarely used. The most common indications for which no contrast agent was used were suspected renal colic (79%), viscus perforation (19%), penetrating abdominal trauma (18%), and blunt abdominal trauma (15%). 4
30. Kaur P, Karandikar SS, Roy-Choudhury S. Accuracy of multidetector CT in detecting anastomotic leaks following stapled left-sided colonic anastomosis. Clin Radiol. 2014;69(1):59-62. Observational-Dx 170 patients To assess accuracy of MDCT and individual radiological signs in the diagnosis of anastomotic leaks. 17% (30/170) of the anterior resections were suspected to have an anastomotic leak. 93% (28/30) of patients underwent MDCT. 7.6%t (11+2/170) had a confirmed leak. Two patients underwent surgery without MDCT. A leak was confirmed by MDCT in 91% (10/11) of patients. The sensitivity, specificity, and PPV and NPV of MDCT in diagnosing a leak was 0.91, 1, 1, and 0.95, respectively. The sensitivity of peri-anastomotic air, peri-anastomotic collection, extravasation of rectal contrast medium, and staple line integrity was 0.81, 0.63, 0.54, and 0.72, respectively. Use of rectal contrast medium (8/11 cases) increased the subjective ease of diagnosis and was the only sign in 1 patient. 3
31. Werner A, Diehl SJ, Farag-Soliman M, Duber C. Multi-slice spiral CT in routine diagnosis of suspected acute left-sided colonic diverticulitis: a prospective study of 120 patients. Eur Radiol. 2003;13(12):2596-2603. Observational-Dx 120 patients To evaluate the use of multi-slice CT for detection of clinically suspected left-sided colonic diverticulitis with regard to diagnosis, complications and alternative diagnoses. The multi-slice CT results were compared with histopathological and intraoperative findings or other radiological or endoscopic methods and clinical outcome. Acute diverticulitis was proven in 67 of the 120 (55.8%) patients, which was detected by multi-slice CT with an accuracy of 98% (sensitivity 97%, specificity 98%). Contained perforation or abscess formation were detected with an accuracy of 96% (sensitivity 100%, specificity 91%) and 98% (sensitivity 100%, specificity 97%), respectively. In 31 of 120 (25.8%) patients’ diagnoses other than diverticulitis caused abdominal pain, which was correctly diagnosed by multi-slice CT in 71%. The multi-slice CT as well as other concurrently performed diagnostic methods showed normal findings and no causes for the patient’s symptoms in 22 of the 120 (18.4%) patients. 3
32. Bates DDB, Fernandez MB, Ponchiardi C, et al. Surgical management in acute diverticulitis and its association with multi-detector CT, modified Hinchey classification, and clinical parameters. Abdom Radiol (NY) 2018;43:2060-65. Observational-Dx 301 patients To assess whether CT findings, clinical parameters, and modified Hinchey classification are predictive of management outcomes of patients with acute diverticulitis. CT findings associated with surgical management include the presence of a pericolonic fluid collection (36.8% vs. 8.2%, P = 0.0001), colonic fistula (13.2% vs. 0.4%, P = 0.0002), extraluminal air (26.4% vs. 9.3%, P = 0.0052), bowel obstruction (5.2% vs. 0.0%, P = 0.0162), and a modified Hinchey score of Ib or higher (55.3% vs. 11.7%, P = 0.0001). Slightly lower systolic blood pressure was also associated with operative management (137.2 mmHg vs. 128.2 mmHg, P = 0.0220). 3
33. Sartelli M, Moore FA, Ansaloni L, et al. A proposal for a CT driven classification of left colon acute diverticulitis. World J Emerg Surg 2015;10:3. Review/Other-Dx N/A To present a new simple classification system based on both CT scan results driving decisions making management of acute diverticulitis that may be universally accepted for day to day practice. No results stated in abstract. 4
34. Hwang JA, Kim SM, Song HJ, et al. Differential diagnosis of left-sided abdominal pain: primary epiploic appendagitis vs colonic diverticulitis. World J Gastroenterol. 19(40):6842-8, 2013 Oct 28. Observational-Dx 53 patients To investigate the clinical characteristics of left primary epiploic appendagitis and to compare them with those of left colonic diverticulitis. Twenty-eight patients and twenty-five patients were diagnosed with symptomatic left PEA and ACD, respectively. The patients with left PEA had focal abdominal tenderness on the left lower quadrant (82.1%). On CT examination, most (89.3%) of the patients with left PEA were found to have an oval fatty mass with a hyperattenuated ring sign. In cases of left ACD, the patients presented with a more diffuse abdominal tenderness throughout the left side (52.0% vs 14.3%; P = 0.003). The patients with left ACD had fever and rebound tenderness more often than those with left PEA (40.0% vs 7.1%, P = 0.004; 52.0% vs 14.3%, P = 0.003, respectively). Laboratory abnormalities such as leukocytosis were also more frequently observed in left ACD (52.0% vs 15.4%, P = 0.006). 3
35. Jalaguier A, Zins M, Rodallec M, Nakache JP, Boulay-Coletta I, Julles MC. Accuracy of multidetector computed tomography in differentiating primary epiploic appendagitis from left acute colonic diverticulitis associated with secondary epiploic appendagitis. Emerg Radiol. 2010; 17(1):51-56. Observational-Dx 46 patients with left acute colonic diverticulitis and 26 patients with primary epiploic appendagitis Retrospective study to : 1) evaluate the prevalence of left acute colonic diverticulitis associated with secondary epiploic appendagitis detected by CT; 2) describe CT features that distinguish left acute colonic diverticulitis associated with secondary epiploic appendagitis from primary epiploic appendagitis; and 3) to assess the accuracy of CT in diagnosing left acute colonic diverticulitis associated with secondary epiploic appendagitis vs primary epiploic appendagitis. The prevalence of left acute colonic diverticulitis-associated secondary epiploic appendagitis was 71% (33/46) in the left acute colonic diverticulitis group. The accuracy of CT was 100% for diagnosing left acute colonic diverticulitis-associated secondary epiploic appendagitis (33/33), 100% for diagnosing left acute colonic diverticulitis without secondary epiploic appendagitis (13/13), and 96% for diagnosing primary epiploic appendagitis (25/26). Colon wall thickening, "inflamed diverticulum", extraluminal gas, abscess or phlegmon, multiple paracolic fatty lesions, and a thin hyperattenuated rim were significantly associated with left acute colonic diverticulitis-associated secondary epiploic appendagitis. Neither the dot sign nor parietal peritoneal thickening showed good accuracy for differentiating primary epiploic appendagitis from left acute colonic diverticulitis-associated secondary epiploic appendagitis. CT is accurate for distinguishing left acute colonic diverticulitis-associated secondary epiploic appendagitis from primary epiploic appendagitis. The findings that perform best for diagnosing secondary epiploic appendagitis are evidence of diverticulitis, multiple fatty lesions, and a thin hyperattenuated rim. 3
36. Singh AK, Gervais DA, Hahn PF, Rhea J, Mueller PR. CT appearance of acute appendagitis. AJR Am J Roentgenol. 2004;183(5):1303-1307. Review/Other-Dx 50 patients, 2 blinded reviewers To describe the spectrum of CT findings in patients with acute epiploic appendagitis and also to evaluate the changes seen with this condition. The most common part of colon involved by acute epiploic appendagitis was the sigmoid colon (31/50), and the most common position was anterior to the colonic lumen (41/50). All 50 patients with acute epiploic appendagitis had a central fatty core surrounded by inflammation. Colon wall thickening was present in only two, and a central high-density focus was noted only in 27/50 patients. In 86% (43/50) of patients, the fatty central core was between 1.5 and 3.5 cm in length. The changes seen on follow-up CT varied, including increased density with a decrease in the size of the fatty central core, no change, complete resolution of findings, and minimal residual density. On CT, acute epiploic appendagitis has a predictable appearance in terms of location, size, and density. The most common finding on CT is a fat-density oval lesion with surrounding inflammation on the anterior aspect of the sigmoid colon. The changes on CT are not predictable in the 2-week to 6-month window. 4
37. American College of Radiology. ACR Appropriateness Criteria®: Acute Pelvic Pain in the Reproductive Age Group. Available at: https://acsearch.acr.org/docs/69503/Narrative/. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. No abstract available. 4
38. Rao PM, Rhea JT, Novelline RA, et al. Helical CT with only colonic contrast material for diagnosing diverticulitis: prospective evaluation of 150 patients. AJR Am J Roentgenol. 1998;170(6):1445-1449. Observational-Dx 150 patients Prospective study to determine sensitivity, specificity, and predictive value of CT for diverticulitis. CT had a sensitivity of 97%, a specificity of 100%, a PPV of 100%, a NPV of 98%, and an overall accuracy of 99% for detection of diverticulitis. 3
39. Lohrmann C, Ghanem N, Pache G, Makowiec F, Kotter E, Langer M. CT in acute perforated sigmoid diverticulitis. Eur J Radiol. 56(1):78-83, 2005 Oct. Observational-Dx 30 patients To assess the value of computed tomography (CT) in patients with acute perforated sigmoid diverticulitis in correlation with the Hinchey classification of perforated diverticular disease. In 28 of the 30 (93%) patients examined, the Hinchey stage was correctly determined by means of computed tomography. One patient with Hinchey stage IV was falsely classified as Hinchey stage III, and one patient with Hinchey stage III as Hinchey stage II. Computed tomography revealed 12 out of 14 (86%) patients with perforation sites and 3 out of 3 (100%) patients with contained perforation. In one of 17 (6%) patients with surgically or histopathologically proven perforation or contained perforation, a bowel wall discontinuity was revealed by computed tomography. In 6 of the 17 (35%) patients with surgical or histopathological perforation or contained perforation, extraluminal contrast material was detected by computed tomography. 3
40. Alshamari M, Norrman E, Geijer M, Jansson K, Geijer H. Diagnostic accuracy of low-dose CT compared with abdominal radiography in non-traumatic acute abdominal pain: prospective study and systematic review. [Review]. Eur Radiol. 26(6):1766-74, 2016 Jun. Observational-Dx 58 patients To evaluate the diagnostic accuracy of low-dose CT compared with abdominal radiography, at similar radiation dose levels. Overall sensitivity with 95 % CI for CT was 75 % (66-83 %) and 46 % (37-56 %) for radiography. Specificity was 87 % (77-94 %) for both methods. 2
41. Laqmani A, Veldhoen S, Dulz S, et al. Reduced-dose abdominopelvic CT using hybrid iterative reconstruction in suspected left-sided colonic diverticulitis. Eur Radiol. 26(1):216-24, 2016 Jan. Observational-Dx 25 patients To assess the effect of hybrid iterative reconstruction (HIR) and filtered back projection (FBP) on abdominopelvic CT with reduced-dose (RD-APCT) in the evaluation of acute left-sided colonic diverticulitis (ALCD). OIN was reduced up to 54 % with HIR compared to FBP. Subjective image quality of HIR images was superior to FBP; subjective image noise was reduced. The detection rate of extraluminal air was higher with HIR L6. Reviewer confidence in interpreting CT findings of ALCD significantly improved with application of HIR. 3
42. Tack D, Bohy P, Perlot I, et al. Suspected acute colon diverticulitis: imaging with low-dose unenhanced multi-detector row CT. Radiology. 2005;237(1):189-196. Observational-Dx 110 patients To prospectively compare the sensitivity and specificity of unenhanced low-dose MDCT with those of contrast material-enhanced standard-dose MDCT in patients suspected of having acute diverticulitis. Colon diverticulitis was present in 39 patients (34%) and was graded as mild in 22 patients (56%) and severe in 17 (44%). Agreement within and between readers was good to excellent. No significant difference was observed in sensitivity (P ranging from .081 to >.99) or in specificity (P ranging from .326 to >.99) for any sign or overall diagnosis between radiation doses by all readers, except wall thickening, which for one reader had a higher specificity at low dose than at standard dose (P=.025). No significant difference in misclassification was detected between doses, regardless of the reader (P ranging from .481 to >.99). At both doses, the most predictive sign for acute diverticulitis was retroperitoneal fat stranding (P<.001). 2
43. Elsayes KM, Staveteig PT, Narra VR, Leyendecker JR, Lewis JS, Jr., Brown JJ. MRI of the peritoneum: spectrum of abnormalities. AJR Am J Roentgenol. 2006;186(5):1368-1379. Review/Other-Dx N/A To detail peritoneal anatomy, techniques for optimizing peritoneal MRI and the MRI characteristics of several disease processes that frequently involve the peritoneum. Homogeneous fat suppression and dynamic contrast-enhanced imaging, including delayed imaging, are critical technical factors for successful lesion detection and characterization on peritoneal MRI. 4
44. Kettritz U, Shoenut JP, Semelka RC. MR imaging of the gastrointestinal tract. [Review] [55 refs]. Magn Reson Imaging Clin N Am. 3(1):87-98, 1995 Feb. Review/Other-Dx N/A To review MR imaging of the gastrointestinal tract. No results stated in abstract. 4
45. Helou N, Abdalkader M, Abu-Rustum RS. Sonography: first-line modality in the diagnosis of acute colonic diverticulitis? J Ultrasound Med. 2013;32(10):1689-1694. Review/Other-Dx N/A To review sonography as the first time modality in the diagnosis of ACD. Sonography is safe, widely available, easily accessible, portable, and affordable, and it enables the visualization of the entire gastrointestinal tract. In addition, with the simultaneous, instantaneous ability to interpret both clinical and sonographic findings, it facilitates rapid and accurate diagnoses in trained hands. As such, and with the application of “sound judgment,” sonography becomes the first-line modality for the diagnosis of diverticulitis. 4
46. Ripolles T, Agramunt M, Martinez MJ, Costa S, Gomez-Abril SA, Richart J. The role of ultrasound in the diagnosis, management and evolutive prognosis of acute left-sided colonic diverticulitis: a review of 208 patients. Eur Radiol. 2003;13(12):2587-2595. Observational-Dx 208 hospitalized patients (262 admissions) Retrospective study to evaluate the role of US in the diagnosis and management of acute diverticulitis and its capacity to predict posterior complications in patients undergoing medical treatment. Diverticulitis was finally diagnosed in 203 patients. US exhibited sensitivity of 86% in 77 cases subjected to surgery, and of 94% in the global 203 patients (192 true-positive and 11 false-negative findings). Study shows that US constitutes a feasible technique for diagnosing acute diverticulitis. The severity of diverticulitis according to US is statistically predictive of surgical risk during the acute phase. Severity is also related to the appearance of posterior complications in patients undergoing conservative management, although only in younger patients (<50 years). 4
47. Lameris W, van Randen A, Bipat S, Bossuyt PM, Boermeester MA, Stoker J. Graded compression ultrasonography and computed tomography in acute colonic diverticulitis: meta-analysis of test accuracy. Eur Radiol. 2008;18(11):2498-2511. Meta-analysis 12 studies Systematic review and meta-analysis was performed to examine the diagnostic accuracy of graded compression US and CT in diagnosing ACD in suspected patients. Summary sensitivity estimates were 92% (95% CI: 80%-97%) for US vs 94% (95%CI: 87%-97%) for CT (P=0.65). Summary specificity estimates were 90% (95%CI: 82%-95%) for US vs 99% (95%CI: 90%-100%) for CT (P=0.07). For the identification of alternative diseases sensitivity ranged between 33% and 78% for US and between 50% and 100% for CT. The currently best available evidence shows no statistically significant difference in accuracy of US and CT in diagnosing ACD. Therefore, both US and CT can be used as initial diagnostic tool until new evidence is brought forward. However, CT is more likely to identify alternative diseases. Good
48. van Randen A, Lameris W, van Es HW, et al. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol. 2011;21(7):1535-1545. Observational-Dx 1,021 patients To report a head-to-head comparison of the accuracy of US and CT in detecting common causes of acute abdominal pain, such as appendicitis and diverticulitis, in patients presenting at the emergency department with acute abdominal pain. Frequent final diagnoses in the 1,021 patients (mean age 47; 55% female) were appendicitis (284; 28%), diverticulitis (118; 12%) and cholecystitis (52; 5%). The sensitivity of CT in detecting appendicitis and diverticulitis was significantly higher than that of US: 94% vs 76% (P<0.01) and 81% vs 61% (P=0.048), respectively. For cholecystitis, the sensitivity of both was 73% (P=1.00). PPVs did not differ significantly between US and CT for these conditions. US sensitivity in detecting appendicitis and diverticulitis was not significantly negatively affected by patient characteristics or reader experience. 2
49. King WC, Shuaib W, Vijayasarathi A, Fajardo CG, Cabrera WE, Costa JL. Benefits of sonography in diagnosing suspected uncomplicated acute diverticulitis. J Ultrasound Med. 34(1):53-8, 2015 Jan. Observational-Dx 253 patients To evaluate  potential radiation and turnaround time savings associated with performing sonography instead of CT as the initial diagnostic examination in the workup of suspected uncomplicated acute diverticulitis. The distribution of patients by the modified Hinchey classification was 210 (stages 0 and 1a), 26 (stages 1b and 2), 17 (stages 3 and 4), 0 (fistula), and 0 (obstruction). The estimated CT radiation dose per patient was 21 +/- 5.2 mSv. Mean turnaround times for CT and sonography were 138.5 +/- 76.9 and 51.3 +/- 44 minutes, respectively. 3
50. Cartwright SL, Knudson MP. Diagnostic imaging of acute abdominal pain in adults. [Review]. Am Fam Physician. 91(7):452-9, 2015 Apr 01. Review/Other-Dx N/A To review clinical guidelines that help physicians choose the most appropriate imaging study based on location of abdominal pain. No results stated in abstract. 4
51. Ambrosetti P, Gervaz P, Fossung-Wiblishauser A. Sigmoid diverticulitis in 2011: many questions; few answers. Colorectal Dis. 2012;14(8):e439-446. Review/Other-Dx N/A To define evidence-based indications for elective surgery. Young male patients (=50 years of age) had a higher risk of CT-graded severe diverticulitis. After medical treatment of the first episode, the incidence of complications was highest for young patients with CT-graded severe diverticulitis and lowest for older patients with CT-graded moderate diverticulitis. Recurrence in the form of diffuse peritonitis was rare. CT grading of initial diverticulitis seemed to be a predictor of recurrence, whereas the role of age was less clear. A family history of diverticulitis might be predictive of recurrence. 4
52. Buchs NC, Konrad-Mugnier B, Jannot AS, Poletti PA, Ambrosetti P, Gervaz P. Assessment of recurrence and complications following uncomplicated diverticulitis. Br J Surg. 100(7):976-9; discussion 979, 2013 Jun. Observational-Tx 280 patients To assess the risk of a recurrent attack following the first episode of uncomplicated diverticulitis. During a median follow-up of 24 (range 3-63) months, 46 (16.4 per cent) of 280 patients experienced a second episode of diverticulitis. Six patients (2.1 per cent) subsequently developed complicated diverticulitis and four (1.4 per cent) underwent emergency surgery for peritonitis. In multivariable analysis, a raised serum level of C-reactive protein (over 240 mg/l) during the first attack was associated with early recurrence (hazard ratio 1.75, 95 per cent confidence interval 1.04 to 2.94; P = 0.035). 2
53. Gielens MP, Mulder IM, van der Harst E, et al. Preoperative staging of perforated diverticulitis by computed tomography scanning. Tech Coloproctol. 2012;16(5):363-368. Observational-Dx 75 patients To assess the accuracy of preoperative staging of perforated diverticulitis by CT scanning. 75 patients were included, 48 of whom (64%) were classified Hinchey 3 or 4 perforated diverticulitis during surgery. The PPV of preoperative CT scanning for different stages of perforated diverticulitis ranged from 45%–89%, and accuracy was between 71%–92%. The combination of a large amount of free intra-abdominal air and fluid was strongly associated with Hinchey 3 or 4 and therefore represented a reliable indicator for required surgical treatment. 2
54. Ritz JP, Lehmann KS, Loddenkemper C, Frericks B, Buhr HJ, Holmer C. Preoperative CT staging in sigmoid diverticulitis--does it correlate with intraoperative and histological findings? Langenbecks Arch Surg. 2010;395(8):1009-1015. Observational-Dx 204 patients To evaluate whether the CT reflects the extent of the inflammation in sigmoid diverticulitis in order to draw conclusions for selecting the appropriate treatment. In the phlegmonous type (HS IIa; n = 75), we found a correlation with the preoperative stage in 52% (intraoperative) and 56% (histological), an understaging in 12% (intraoperative) and 11% (histological), and an overstaging in 36% (intraoperative) and 33% (histological). In the abscess-forming type (HS IIb, Hinchey I/II; n = 87), we found conformity in 92% (intraoperative) and 90% (histological), understaging in 3% (intraoperative) and 0% (histological), and overstaging in 5% (intraoperative) and 10% (histological). In the presence of a free perforation (HS IIc, Hinchey III/IV; n = 42), we saw conformity in 100% (intraoperative and histological). The PPV for correctly diagnosing of phlegmonous type (HS IIa), abscess-forming type (HS IIb), and free perforation (HS IIc) by CT was intraoperatively (histologically) 52% (56), 92% (90), and 100% (100), respectively. 3
55. Siewert B, Tye G, Kruskal J, et al. Impact of CT-guided drainage in the treatment of diverticular abscesses: size matters. AJR Am J Roentgenol. 2006;186(3):680-686. Observational-Dx 181 patients To evaluate CT for the presence of an abscess, its location, maximum diameter, and feasibility of PAD and to determine whether abscess size can be used as a discriminating factor to guide management of patients with diverticular abscesses. Patients with abscesses <3 cm in size can be treated with antibiotics alone and, in some cases, as outpatients, and may not uniformly require surgery. This is also likely true for patients with abscesses 3-4 cm in size. Patients with abscesses =4 cm can be managed with CT-guided abscess drainage followed by referral for surgical treatment. 3
56. Kassi F, Dohan A, Soyer P, et al. Predictive factors for failure of percutaneous drainage of postoperative abscess after abdominal surgery. Am J Surg. 207(6):915-21, 2014 Jun. Observational-Tx 81 patients To assess the efficacy of percutaneous drainage of postoperative abscess after abdominal surgery and to identify factors predictive of failed drainage. Successful drainage requiring 1 (n = 46) or 2 (n = 17) procedures was observed in 63 patients (78%; 95% confidence interval, 67%-86%). Surgery was needed in 18 patients (22%; 95% confidence interval, 14%-38%). Residual collection after a first percutaneous drainage was the single predictive factor for failed drainage on univariate and multivariate analyses (P = .0275). 3
57. Lorenz J, Thomas JL. Complications of percutaneous fluid drainage. Semin Intervent Radiol. 2006;23(2):194-204. Review/Other-Dx N/A To discuss complications of abscess drainage and treatment of all adverse sequelae. Percutaneous abscess drainage is one of the most common and rewarding procedures performed by interventional radiologists. Technical success is immediately apparent by aspiration of purulent contents and is nearly always achieved, with rates exceeding 90% in most literature studies. Clinical success is typical even for many abscesses colonized with multidrug-resistant organisms. In patients presenting with sepsis, this procedure offers an immediate and minimally invasive solution to a life-threatening condition, often resulting in defervescence and restoration of hemodynamic stability within 1 to 2 days. 4
58. McDermott FD, Collins D, Heeney A, Winter DC. Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis. [Review]. Br J Surg. 101(1):e90-9, 2014 Jan. Review/Other-Tx N/A To highlight recent concepts and advances in management of diverticulitis through a literature search. Diverticulitis occurs frequently in the Western world, but only one in five patients develops complications (such as abscess and perforation) during the first acute presentation. The reported perforation rate is 3.5 per 100,000 population. Based on recent data, including the AVOD and DIVER trials, antibiotic therapy for mild episodes may be unnecessary and outpatient management reasonable in most patients. Antibiotics and admission to hospital is required for complicated diverticulitis confirmed on imaging and for patients with sepsis. Diverticular abscesses (about 5 per cent of patients) may require percutaneous drainage if antibiotics alone fail. Laparoscopic management of non-faecal perforated diverticulitis is feasible in selected patients, and peritoneal lavage in combination with antibiotic therapy may avoid colonic resection and a stoma. However, the collective, published worldwide experience is limited to fewer than 800 patients, and results from ongoing randomized trials (LapLAND, SCANDIV, DILALA and LADIES trials) are needed to inform better decision-making. 4
59. Faggian A, Berritto D, Iacobellis F, Reginelli A, Cappabianca S, Grassi R. Imaging Patients With Alimentary Tract Perforation: Literature Review. [Review]. Semin Ultrasound CT MR. 37(1):66-9, 2016 Feb. Review/Other-Dx N/A To discuss imaging in the diagnosis of alimentary tract perforation. No results stated in abstract. 4
60. Niebling M, van Nunspeet L, Zwaving H, Eddes EH, Bosker R, Eeftinck Schattenkerk M. Management of colovesical fistulae caused by diverticulitis: 12 years of experience in one medical centre. Acta Chir Belg. 2013;113(1):30-34. Observational-Dx 31 patients To evaluate diagnostic and surgical management of colovesical fistulae at our medical center. The most common presenting symptoms were pneumaturia, urinary tract infections, abdominal pain, and fecaluria. CT identified colovesical fistulae in 28 patients (92.2%), cystoscopy in 4 patients (23.5%), and BE in 3 patients (13.6%). Surgical management was resection of the diseased colon segment with primary anastomosis in 29/31 patients. The bladder fistulae were oversewn and an omental plasty was placed between bowel anastomosis and bladder. There was only one postoperative leak and one case of mortality (3.2%). 3
61. Miyaso H, Iwakawa K, Hamada Y, et al. Ten Cases of Colovesical Fistula due to Sigmoid Diverticulitis. Hiroshima J Med Sci. 64(1-2):9-13, 2015 Jun. Observational-Dx 10 patients To review colovesical fistula due to sigmoid diverticulitis over a 9-year period to clarify presentation and diagnostic confirmation. Preoperative urinalysis showing bacteriuria (100%) was the most common presentation, followed by fecaluria (40%), abdominal pain (40%), pneumaturia (30%), hematuria (30%), pain on urination (30%), pollakiuria (10%), and dysuria (10%). The abilities of various preoperative investigations to identify CVF were: computed tomography (CT), 88.9%; magnetic resonance imaging, 40%; cystoscopy, 30%, and gastrografin irrigoscopy, 22.2%. Colonoscopy (0%) was not diagnostic. Bowel resection was performed in nine of ten patients. When inflammation was intense, covering ileostomy was performed, and an omental plasty was placed between the bowel anastomosis and bladder. 4
62. Kirsh GM, Hampel N, Shuck JM, Resnick MI. Diagnosis and management of vesicoenteric fistulas. Surg Gynecol Obstet. 173(2):91-7, 1991 Aug. Observational-Dx 56 patients To present experience with patients with vesicoenteric fistulas. Fecaluria (48 per cent), abdominal pain (43 per cent) and pneumaturia (41 per cent) were the most common presenting symptoms among the patients we studied. Fistulas were most frequently attributable to diverticulitis (52 per cent), Crohn's disease (18 per cent), carcinoma of the colon (11 per cent) or other pelvic malignant conditions (9 per cent). The most accurate diagnostic modalities in our series were cystoscopy (88 per cent), cystography (56 per cent) and barium enema (32 per cent). The combined findings of these studies led to the diagnosis of a fistula in all patients. Intravenous urography, intestinal endoscopy and computed tomography were less useful, providing a diagnosis in only 5, 6 and 11 per cent, respectively. Surgical treatment was single staged in 57 per cent and multistaged in 35 per cent, while 8 per cent of the patients underwent intestinal diversion only. 4
63. Najjar SF, Jamal MK, Savas JF, Miller TA. The spectrum of colovesical fistula and diagnostic paradigm. Am J Surg. 188(5):617-21, 2004 Nov. Review/Other-Dx 12 patients To evaluate this condition over a 12-year period with special emphasis on its clinical presentation, etiologic factors involved, and modalities used to verify its diagnosis. Underlying etiologies were diverticular disease (75%), colon cancer (16%), and bladder cancer (8%). Pneumaturia (77%) was the most common presentation, followed by urinary tract infections, dysuria and frequency (45%), fecaluria (36%), hematuria (22%), and orchitis (10%). The ability of various preoperative investigations to identify a CVF were: computed tomography (CT) (90%), barium enema (BE) (20%), and cystography (11%), whereas cystoscopy, intravenous pyelogram (IVP), and colonoscopy were nondiagnostic. All patients underwent single- or multiple-staged repair of the fistula. 4
64. Nielsen K, Richir MC, Stolk TT, et al. The limited role of ultrasound in the diagnostic process of colonic diverticulitis. World J Surg. 38(7):1814-8, 2014 Jul. Observational-Dx 232 patients To determine the diagnostic accuracy of US compared with CT for patients with uncomplicated and complicated diverticulitis. A total of 123 patients underwent an US and a CT scan. In 78/94 patients with uncomplicated diverticulitis, results of US and CT scan were compatible (83 %); in 6 of the remaining 29 patients both modalities showed a complicated diverticulitis (21 %). US misdiagnosed 17 % of patients with uncomplicated diverticulitis and 79 % with complicated diverticulitis. 3
65. Dietrich CF, Lorentzen T, Appelbaum L, et al. EFSUMB Guidelines on Interventional Ultrasound (INVUS), Part III - Abdominal Treatment Procedures (Short Version). Ultraschall Med. 37(1):27-45, 2016 Feb. Review/Other-Dx N/A To present recommendations for clinical practice covering indications, contraindications, safety and efficacy of the broad variety of abdominal ultrasound-guided and assisted interventions. No results stated in abstract. 4
66. Ripolles T, Martinez-Perez MJ, Paredes JM, Vizuete J, Garcia-Martinez E, Jimenez-Restrepo DH. Contrast-enhanced ultrasound in the differentiation between phlegmon and abscess in Crohn&#39;s disease and other abdominal conditions. Eur J Radiol. 82(10):e525-31, 2013 Oct. Observational-Dx 50 patients To evaluate the diagnostic accuracy of the contrast-enhanced ultrasound (CEUS) to differentiate between intra-abdominal phlegmon and abscess. 71 inflammatory masses in 50 patients were identified in CEUS examination. 57 masses, 21 phlegmons and 36 abscesses, were confirmed by other imaging techniques, percutaneous drainage or surgery. CEUS specificity for the diagnosis of abscess was 100%. Kappa coefficient between CEUS and other techniques in the diagnosis of phlegmon or abscess was excellent (kappa=0.972). Only in one patient surgery detected a small abscess (<2 cm) within a phlegmon that not was detected by CEUS. Statistically significant differences were found between the size of the abscesses before and after contrast agent injection. The interobserver agreement in the diagnosis of phlegmon or abscess was excellent (kappa=0.953). 3
67. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4