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Frequency, Sensitivity, and Specificity of Individual Signs of Diverticulitis on Thin-Section Helical CT with Colonic Contrast Material: Experience with 312 Cases

Moritz F. Kircher1,2, James T. Rhea1, Danylo Kihiczak1 and Robert A. Novelline1

1 Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 32 Fruit St., Boston, MA 02114.
2 Department of Radiology, Center for Molecular Imaging Research, Massachusetts General Hospital/Harvard Medical School, CNY 149, 13th St., R.5406, Charlestown, MA 02129.



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  		Fig. 1A. —68-year-old man with acute diverticulitis of sigmoid colon. Axial CT scans obtained with colonic contrast material and 5-mm collimation show asymmetric inflammatory wall thickening (curved arrow, A) superimposed on muscular wall hypertrophy (black arrow, B), diverticula, fat stranding, and fascial thickening (thin arrow, A). Note contained perforation with formation of phlegmon and extraluminal air (thick arrow, A and B). No free intraperitoneal extravasation of colonic contrast material is seen.

 


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  		Fig. 1B. —68-year-old man with acute diverticulitis of sigmoid colon. Axial CT scans obtained with colonic contrast material and 5-mm collimation show asymmetric inflammatory wall thickening (curved arrow, A) superimposed on muscular wall hypertrophy (black arrow, B), diverticula, fat stranding, and fascial thickening (thin arrow, A). Note contained perforation with formation of phlegmon and extraluminal air (thick arrow, A and B). No free intraperitoneal extravasation of colonic contrast material is seen.

 


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  		Fig. 2A. —43-year-old man with acute diverticulitis at junction of descending and sigmoid colon. Axial CT scan obtained with colonic contrast material and 5-mm collimation shows inflammatory wall thickening (arrow), fat stranding, and fascial thickening.

 


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  		Fig. 2B. —43-year-old man with acute diverticulitis at junction of descending and sigmoid colon. Axial CT scan obtained with colonic contrast material and 5-mm collimation at cranial level shows triangularly shaped soft-tissue density, which most likely represents free fluid (arrow).

 


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  		Fig. 3A. —41-year-old woman with acute diverticulitis of ascending colon. Axial CT scan obtained with colonic contrast material and 5-mm collimation at level of mid ascending colon shows fascial thickening (curved arrow), fat stranding, and asymmetric inflammatory wall thickening (straight arrow) greater than 4 mm.

 


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  		Fig. 3B. —41-year-old woman with acute diverticulitis of ascending colon. Axial CT scan obtained with colonic contrast material and 5-mm collimation at level cranial to A depicts "arrowhead" sign (arrow) as result of edema at orifice of inflamed diverticulum.

 


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  		Fig. 4. —41-year-old man with acute diverticulitis of sigmoid colon. Axial CT scan obtained with colonic contrast material and 5-mm collimation shows inflammatory wall thickening (straight arrow) and fat stranding (curved arrow).

 


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  		Fig. 5. —53-year-old woman with acute diverticulitis of ascending colon. Axial CT scan obtained with colonic contrast material and 5-mm collimation shows inflammatory bowel wall thickening (straight arrow), diverticula, and fat stranding (curved arrows).

 

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