Introduction
Methods
Search strategy and study eligibility
Study selection
Study and patient characteristics
Data synthesis and analysis
Identification of alternative diagnoses
Head-to-head comparative studies
Results
Search strategy and study selection
Study characteristics
Other study design characteristics
Study/year | Country | No. of patients | Inclusion criteria | Reference standard (no. of patients) | Observer experience |
---|---|---|---|---|---|
Ultrasound
| |||||
Verbanck, 1989a [30] | Belgium | 123 | Suspectedd
| Surgerye (10), endoscopy (5), contrast enema (43) | Not specified |
Schwerk, 1993a [29] | Germany | 161 | Suspectedd
| Surgerye (24), clinical follow-upf (50) | Experiencedg
|
Zielke, 1997a [31] | Germany | 143 | Suspectedd
| Surgerye (32), clinical follow-upf (42) | > 3 monthsh
|
Garcia-Aguayo, 2002 [34] | Spain | 76 | Pain in LLQ with fever and/or leucocytosis | Surgerye (10), clinical follow-upf (66) | Experiencedg
|
Computed tomography
| |||||
Cho, 1990 [35] | USA | 56 | Pain in LLQ with fever and/or leucocytosis | Surgerye (22), clinical follow-upf (34) | Not specified |
Doringer, 1990 [36] | Germany | 33 | Lower abdominal pain, leucocytosis and an elevated sedimentation rate | Surgerye (9), clinical follow-upf (24) | Not specified |
Stefansson, 1997 [37] | Sweden | 88 | Pain in LLQ or lower abdomen | Surgerye (30), clinical follow-upf (58) | Experiencedl
|
Rao, 1998 [38] | USA | 150 | Suspectedd
| Histopathologyb (41), clinical follow-upi (109) | Staff member or fellowj
|
Werner, 2003 [39] | Germany | 120 | Suspectedd
| Surgerye (49), clinical follow-upk (71) | Experiencedl
|
Tack, 2005 [40] | Belgium | 110 | Pain in LLQ < 2 weeks | Expert panel m (110) | 20 years body CT |
Ultrasound vs. Computed tomography
| |||||
Pradel, 1997 [32] | France | 64 | Suspectedc
| Surgerye (18), clinical follow-upf (46) | 3–5 years |
Farag Soliman, 2004 [33] | Germany | 63 | Suspectedd
| Surgerye (34), clinical follow-upf (29) | Not specified |
Study/year | No. of patients | Clinical setting | Women (%)a
| Mean age (range)c
| Prevalence % (n)d
| Complicated diverticulitis %e
|
---|---|---|---|---|---|---|
Ultrasound
| ||||||
Verbanck, 1989 [30] | 123 | N.A. f
| N.A | N.A | 43 (52) | 16 (8/52) |
Schwerk, 1993 [29] | 161 | N.A. f
| 52 | 57 (22–88) g
| 46 (74) | 27 (20/74) |
Zielke, 1997 [31] | 143 | Hospitalised | 55 | 56 (20–89) | 52 (74) | 15 (11/74) |
Garcia-Aguayo, 2002 [34] | 76 | N.A. f
| 47 | 58 (24–83) | 68 (52) | 10 (5/52) |
Computed tomography
| ||||||
Cho, 1990 [35] | 56 | Hospitalised | 66 | 63 (28–98) | 48 (27) | 60 (16/27) |
Doringer, 1990 [36] | 33 | N.A. f
| 60 | 71 (40–84) | 64 (21) | 10 (2/21) |
Stefansson, 1997 [37] | 88 | N.A. f
| 72 | 63 (29–91) g
| 59 (52) | 12 (6/52) |
Rao, 1998 [38] | 150 | Emergency dept. b
| 61 | 59 (19–92) | 43 (64) | 20 (13/64) |
Werner, 2003 [39] | 120 | N.A. f
| 54 | 62 (21–88) | 56 (67) | 16 (11/67) |
Tack, 2005 [40] | 110 | N.A. f
| 64 | 57 (30–82) | 36 (39) | 36 (14/39) |
Ultrasound vs. Computed tomography
| ||||||
Pradel, 1997 [32] | 64 | N.A. f
| N.A. | 64 (38–87) | 52 (33) | 27 (9/33) |
Farag Soliman, 2004 [33] | 63 | Hospitalised | N.A. | 61.8e
| 68 (43) | 47 (20/43) |
Study/year | Type of probe | Probe frequency (MHz) | Type of scanning | Diagnostic criteria for diverticulitis |
---|---|---|---|---|
Verbanck, 1989 [30] | Linear and curved | 3.5–5 | Graded compression | Bowel wall thickeninga
|
Schwerk, 1993 [29] | Linear and curved | 5 | Graded compression | Peri-colic fat inflammation with bowel wall thickeningb
|
Zielke, 1997 [31] | Linear and curved | 3.5–5 | Graded compression | Bowel wall thickeningb with decreased peristalsis |
Pradel, 1997 [32] | Linear and curved | 5–10 and 2–4 | Graded compression | Peri-colic fat inflammation with bowel wall thickeningb
|
Garcia-Aguayo, 2002 [34] | Linear and curved | 3.7–7.5 and 3.7–7.5 | Graded compression | Peri-colic fat inflammation with bowel wall thickeningb
|
Farag Soliman, 2004 [33] | Linear and curved | 6–10 and 3.5–6 | Graded compression | Peri-colic fat inflammation with bowel wall thickeningb
|
Study/year | Type of scanner | CT protocol, slice thickness/interval | Contrast agents (amount) | Diagnostic criteria for diverticulitis |
---|---|---|---|---|
Cho, 1990 [35] | Non-helical | Lower abdomen: 10 × 10 mma
| I.v. in 50% of patients | Peri-colic fat inflammation with bowel wall thickeningb
|
Standard oral and rectal contrast | ||||
Air insufflation in 77% of patients | ||||
Doringer, 1990 [36] | Non-helical | N.A. | I.v. and rectal (not specified) | Peri-colic fat inflammation with bowel wall thickeningb and diverticula |
Pradel, 1997 [32] | Non-helical | Upper abdomen: 8 × 12–16 mm | Intravenous in 88% patients (2 l/kg) | Bowel wall thickeningb or diverticula with either peri-colic fat inflammation or abscess |
Lower abdomen: 8 × 8 mm | Oral in 64% of patients (800 mL) c
| |||
Stefansson, 1997 [37] | Helical, multi-slice | Upper abdomen: 8 × 12 mm | I.v. (100 ml) | Peri-colic fat inflammation with bowel wall thickeningb and diverticula |
Lower abdomen: 8 × 8 mm | Oral (800 ml) | |||
Rectal air insufflation | ||||
Rao, 1998 [38] | Helical | Abdominal: 5 × 7.5 mm | I.v. in 2% of patients | Peri-colic fat inflammation with bowel wall thickeningb and diverticula |
Rectal (1000 ml) | ||||
Werner, 2003 [39] | Helical, multi-slice | Pelvic floor to lower liver edge: 4 × 2.5 mm | I.v. (1.3 ml/kg) | Peri-colic fat inflammation with bowel wall thickeningb and diverticula |
Rectal (1000 ml) | ||||
Farag Soliman, 2004 [33] | Helical, multi-slice | Abdominal: 5 × 7 mm and 5 × 5 mm | I.v. (100 ml) Rectal (1000 ml) | Peri-colic fat inflammation with bowel wall thickeningb
|
Tack, 2005 [40] | Helical, multi-slice | Abdominal: 4 × 2.5 mm | I.v. (120 ml) | Peri-colic fat inflammation with bowel wall thickeningb
|
Study/year | Patients with diverticulitis | Patients without diverticulitis | Sensitivitya
| Specificitya
| Positive likelihood ratioa
| Negative likelihood ratioa
| ||
---|---|---|---|---|---|---|---|---|
TP | FN | TN | FP | |||||
Ultrasound
| ||||||||
Verbanck, 1989 [30] | 44 | 8 | 57 | 14 | 0.85 (44/52) | 0.80 (57/71) | 4.3 (0.85/0.20) | 0.19 (0.15/0.80) |
Schwerk, 1993 [29] | 73 | 1 | 84 | 3 | 0.99 (73/74) | 0.97 (84/87) | 28.6 (0.99/0.03) | 0.01 (0.01/0.97) |
Zielke, 1997 [31] | 62 | 12 | 64 | 5 | 0.84 (62/74) | 0.93 (64/69) | 11.6 (0.84/0.07) | 0.17 (0.16/0.93) |
Pradel, 1997 [32] | 28 | 5 | 26 | 5 | 0.85 (28/33) | 0.84 (26/31) | 5.3 (0.85/0.16) | 0.18 (0.15/0.84) |
Garcia-Aguayo, 2002 [34] | 42 | 10 | 19 | 5 | 0.81 (42/52) | 0.79 (42/52) | 3.9 (0.81/0.20) | 0.24 (0.19/0.79) |
Farag Soliman, 2004 [33] | 43 | 0 | 20 | 0 | 1.00 (43/43) | 1.00 (43/43) | N.A. | N.A. |
Summary estimate (95%CI)
b
|
0.92 (80–97)
|
0.90 (82–95)
| ||||||
Summary likelihood ratio (95%CI)
b
|
9.6 (5.0–18.6)
|
0.09 (0.04–0.23)
| ||||||
Computed tomography
| ||||||||
Cho, 1990 [35] | 25 | 2 | 29 | 0 | 0.93 (25/27) | 1.00 (29/29) | N.A. | 0.07 (0.07/1.00) |
Doringer, 1990 [36] | 20 | 1 | 9 | 3 | 0.95 (20/21) | 0.75 (9/12) | 3.8 (0.95/0.25) | 0.06 (0.05/0.75) |
Pradel, 1997 [32] | 30 | 3 | 24 | 7 | 0.91 (30/33) | 0.77 (24/31) | 4.0 (0.91/0.23) | 0.12 (0.09/0.77) |
Stefansson, 1997 [37] | 36 | 16 | 36 | 0 | 0.69 (36/52) | 1.00 (36/36) | N.A. | 0.31 (0.31/1.00) |
Rao, 1998 [38] | 62 | 2 | 86 | 0 | 0.97 (62/64) | 1.00 (86/86) | N.A. | 0.03 (0.03/1.00) |
Werner, 2003 [39] | 65 | 2 | 52 | 1 | 0.97 (65/67) | 0.98 (52/53) | 51.4 (0.97/0.02) | 0.03 (0.03/0.98) |
Farag Soliman, 2004 [33] | 42 | 1 | 20 | 0 | 0.98 (42/43) | 1.00 (20/20) | N.A. | 0.02 (0.02/1.00) |
Tack, 2005 [40] | 36 | 3 | 70 | 1 | 0.92 (36/39) | 0.99 (70/71) | 65.5 (0.92/0.01) | 0.08 (0.08/0.99) |
Summary estimate (95% CI)
b
|
0.94 (87–97)
|
0.99 (90–100)
| ||||||
Summary likelihood ratio (95% CI)
b
|
78.4 (8.7–706.6)
|
0.06 (0.03–0.13)
|
Sensitivity and specificity
Likelihood ratio
Identification of alternative diseases
Study/year | No. of patients | No. of ACD | No. of NSAP* | No. of alternative diseases | Sensitivity for alternative diagnosis (no. detected by US or CT) |
---|---|---|---|---|---|
Ultrasound
| |||||
Verbanck, 1989 [30] | 123 | 52 | N.A. | N.A. | N.A. |
Schwerk, 1993 [29] | 161 | 74 | 50 | 37 | 70% (26) |
Pradel, 1997 [32] | 64 | 33 | 7 | 24 | 33% (8) |
Zielke, 1997 [31] | 143 | 74 | 34 | 35 | 46% (16) |
Garcia-Aguayo, 2002 [34] | 76 | 52 | N.A. | N.A. | N.A. |
Farag Soliman, 2004 [33] | 63 | 43 | 11 | 9 | 78% (7) |
Computed tomography
| |||||
Cho, 1990 [35] | 56 | 27 | 6 | 23 | 87% (20) |
Doringer, 1990 [36] | 33 | 21 | N.A. | N.A. | N.A. |
Pradel, 1997 [32] | 64 | 33 | 7 | 24 | 50% (12) |
Stefansson, 1997 [37] | 88 | 52 | N.A. | N.A. | N.A. |
Rao, 1998 [38] | 150 | 64 | 22 | 64 | 78% (50) |
Werner, 2003 [39] | 120 | 67 | 22 | 31 | 71% (22) |
Farag Soliman, 2004 [33] | 63 | 43 | 11 | 9 | 89% (8) |
Tack, 2005 [40] | 110 | 39 | 49 | 22 | 100% (22) |