Comparison of Non-Contrast CT vs. Contrast-Enhanced CT with Both Intravenous and Rectal Contrast Application for Diagnosis of Acute Colonic Diverticulitis: A Multireader, Retrospective Single-Center Study

Abstract

Objectives: To evaluate the non-inferiority of non-contrast CT compared to contrast-enhanced CT with both intravenous and rectal contrast application for the diagnosis of acute colonic diverticulitis. Methods: Five readers retrospectively evaluated the non-contrast and contrast-enhanced series of CTs of 205 consecutive patients with clinical suspicion of acute diverticulitis. Two randomized reading sessions, both containing all 205 cases as either contrast-enhanced or non-contrast (1:1) series, were performed with ≥8 weeks washout between them. The non-inferiority margin was set to 0.1. Results: The pooled prevalence (all readers) of diverticulitis was similar for non-contrast CT (63.9%, range: 60.5–65.0%) and contrast-enhanced CT (64.4%, 61.5–67.8%). Non-contrast CT was non-inferior for the diagnosis of diverticulitis (accuracy 0.90 [95% confidence interval: 0.89, 0.92]) compared to contrast-enhanced CT (0.92 [0.90, 0.94]; the difference in accuracy: −0.01 [−0.04, 0.01]) (normal deviate test: p-valueone-sided = 5.20 × 10−6). Sensitivities for perforation and abscess were slightly but significantly lower for the non-contrast CT than for the contrast-enhanced CT (differences: −0.15 [−0.20, −0.05], −0.17 [−0.27, −0.07]), while no differences in accuracies and specificities were observed. Conclusions: Non-contrast CT is non-inferior to contrast-enhanced CT (intravenous and rectal contrast) for the diagnosis of acute colonic diverticulitis. Contrast-enhanced CT is associated with significantly higher sensitivities for the presence of an abscess or perforation.