Magnetic Resonance Imaging for the diagnosis and management of acute colonic diverticulitis: a review of current and future use
Franziska Jerjen BSc, BA, MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Franziska Jerjen and Tooba Zaidi are joint first authors.Search for more papers by this authorTooba Zaidi BMedSc(Hons), MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Franziska Jerjen and Tooba Zaidi are joint first authors.Search for more papers by this authorShannon Chan BMedBiotechHon, MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorAjay Sharma BMedSc, MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorReuel Mudliar BMedScAdv(Hons), MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorKhadija Soomro BMedSc, MPH, MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorYobelli Jimenez PhD, MHlthSc(MRS), BAppSc(RT), BSc
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorWarren Reed PhD
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorFranziska Jerjen BSc, BA, MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Franziska Jerjen and Tooba Zaidi are joint first authors.Search for more papers by this authorTooba Zaidi BMedSc(Hons), MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Franziska Jerjen and Tooba Zaidi are joint first authors.Search for more papers by this authorShannon Chan BMedBiotechHon, MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorAjay Sharma BMedSc, MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorReuel Mudliar BMedScAdv(Hons), MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorKhadija Soomro BMedSc, MPH, MDR
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorYobelli Jimenez PhD, MHlthSc(MRS), BAppSc(RT), BSc
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorWarren Reed PhD
Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, Franziska Jerjen and Tooba Zaidi are joint first authors, The University of Sydney, Sydney, NSW, Australia
Search for more papers by this author*Correspondence
Warren Reed, The University of Sydney, Cumberland Campus, 75 East Street, Lidcombe, Sydney, NSW, 2146, Australia. Tel: +61 4 3540 4285; Fax: +61 2 93519146 E-mail: [email protected]
Abstract
Diverticular disease is one of the most common causes of outpatient visits and hospitalisations across Australia, North America and Europe. According to the Gastroenterological Society of Australia (GESA, 2010), approximately 33% of Australians over 45 years of age and 66% over 85 years of age have some form of colonic diverticulosis. Patients with colonic diverticulosis are known to develop subsequent complications such as acute colonic diverticulitis (ACD), and when more than one attack of diverticulitis occurs, there is a 70-90% chance that the individual will experience ongoing problems and recurring infections throughout their lifetime. Medical imaging is fundamental in the diagnosis, treatment and ongoing management of ACD and its complications, with Computed Tomography (CT) identified as the prevailing gold standard in the last few decades. Cross-database searching highlighted a large gap in the literature regarding the effectiveness of Magnetic Resonance Imaging (MRI) as a non-ionising radiation alternative imaging tool for ACD imaging after the mid-2000s, despite ongoing technological advancements in this modality. This narrative review identified 13 key publications (11 primary prospective cohort studies, 1 systematic review and 1 meta-analysis) that evaluate MRI for ACD imaging, of which five were published within the last decade. Several existing MRI protocols are deemed suitable for ACD imaging, and it is recommended they be re-evaluated in larger cohorts. Future studies should consider the rapidly growing technological improvements of MRI, its cost efficiency and its applicability in modern day healthcare settings when addressing ACD management. This is especially important considering the gradual rise in radiation dose among the Australian population attributable to increased CT referrals, alongside increased reporting of ACD cases in younger individuals.
Conflict of Interest
The authors declare no conflict of interests regarding this literature review.
References
- 1Weizman A, Nguyen G. Diverticular disease: Epidemiology and management. Can J Gastroenterol 2011; 25(7): 385–389.
- 2You H, Sweeny A, Cooper M, Von Papen M, Innes J. The management of diverticulitis: A review of the guidelines. Med J Aust 2019; 211(9): 421–427.
- 3Pfützer R, Kruis W. Management of diverticular disease. Nat Rev Gastroenterol Hepatol 2015; 12(11): 629–638.
- 4 Information about Diverticular Disease [Internet]. 4th ed. Mulgrave, Victoria: Digestive Health Foundation (DHF); 2010 [cited 10 May 2020]. Available from: https://cart.gesa.org.au/membes/files/Consumer%20Information/Diverticular%20Disease.pdf. GESA: Information about diverticular disease
- 5Ajaj W, Ruehm S, 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.
- 6Etzioni D, Mack T, Beart R, Kaiser A. Diverticulitis in the United States: 1998–2005. Ann Surg 2009; 249(2): 210–217.
- 7Cristaudo A, Pillay P, Naidu S. Caecal diverticulitis: Presentation and management. Ann Med Surg 2015; 4(1): 72–75.
- 8Kang J, Hoare J, Tinto A, et al. Diverticular disease of the colon - on the rise: A study of hospital admissions in England between 1989/1990 and 1999/2000. Aliment Pharmacol Ther 2003; 17(9): 1189–1195.
- 9Brenner D, Elliston C, Hall E, Berdon W. Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 2001; 176(2): 289–296.
- 10Brenner D, Hall E. Computed tomography - An increasing source of radiation exposure. N Engl J Med 2007; 357(22): 2277–2284.
- 11Paterson A, Frush D, Donnelly L. Helical CT of the body. AJR Am J Roentgenol 2001; 176(2): 297–301.
- 12Schreyer AG, Fürst 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): 474–80.
- 13Buckley O, Geoghegan T, McAuley G, Persaud T, Khosa F, Torreggiani WC. Pictorial review: magnetic Resonance imaging of colonic diverticulitis. Eur Radiol 2007; 17(1): 221–7.
- 14DeStigter K, Keating D. Imaging update: Acute colonic diverticulitis. Clin Colon Rectal Surg 2009; 22(03): 147–155.
- 15Rao P, Rhea J. Colonic diverticulitis: evaluation of the arrowhead sign and the inflamed diverticulum for CT diagnosis. Radiol 1998; 209(3): 775–779.
- 16Pradel J, Adell J, Taourel P, Djafari M, Monnin-Delhom E, Bruel J. Acute colonic diverticulitis: prospective comparative evaluation with US and CT. Radiol. 1997; 205(2): 503–512.
- 17Galgano S, McNamara M, Peterson C, et al. ACR appropriateness criteria® left lower quadrant pain-suspected diverticulitis. J Am Coll Radiol 2019; 16(5): S141–S149.
- 18Andeweg C, Mulder I, Felt-Bersma R, et al. Guidelines of diagnostics and treatment of acute left-sided colonic diverticulitis. Dig Surg 2013; 30(4–6): 278–292.
- 19Andeweg C, Wegdam J, Groenewoud J, van der Wilt G, van Goor H, Bleichrodt R. Toward an evidence-based step-up approach in diagnosing diverticulitis. Scand J Gastroenterol 2014; 49(7): 775–784.
- 20Byott S, Harris I. Rapid acquisition axial and coronal T2 HASTE MR in the evaluation of acute abdominal pain. Eur J Radiol 2015; 85(1): 286–90.
- 21Cobben LP, Groot I, Blickman JG, Puylaert JB. Right colonic diverticulitis: MR appearance. Abdom Imaging 2003; 28(6): 794–8.
- 22Halpenny DF, McNeil G, Snow A, Geoghegan T, Torreggiani WC. Prospective evaluation of the value of magnetic resonance imaging in suspected acute sigmoid diverticulitis. Dis Colon Rectum 2009; 52(5): 1030–1031.author reply 1031.
- 23Heverhagen JT, Ishaque N, Zielke A, et al. Feasibility of MRI in the diagnosis of acute diverticulitis: initial results. MAGMA 2001; 12(1): 4–9.
- 24Heverhagen J, Zielke A, Ishaque N, Bohrer T, El-Sheik M, Klose K. Acute colonic diverticulitis: Visualization in magnetic resonance imaging. Magn Reson Imaging 2001; 19(10): 1275–1277.
- 25Heverhagen J, Sitter H, Zielke A, Klose K. Prospective evaluation of the value of magnetic resonance imaging in suspected acute sigmoid diverticulitis. Dis Colon Rectum 2008; 51(12): 1810–1815.
- 26Liljegren G, Chabok A, Wickbom M, Smedh K, Nilsson K. Acute colonic diverticulitis: A systematic review of diagnostic accuracy. Colorectal Dis 2007; 9(6): 480–488.
- 27Oistamo 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): 237–41.
- 28Romagnoli F, Colaiacomo MC, De Milito R, Modini C, Gualdi G, Catani M. The alterations of the sigmoid-rectal junction in diverticular disease of the colon revealed by MR-defecography. Surg Radiol Anat 2014; 36(1): 85–90.
- 29Storz C, Rothenbacher T, Rospleszcz S, et al. Characteristics and associated risk factors of diverticular disease assessed by magnetic resonance imaging in subjects from a Western general population. Eur Radiol 2019; 29(3): 1094–103.
- 30Gangadhar K, Kielar A, Dighe M, et al. Multimodality approach for imaging of non-traumatic acute abdominal emergencies. Abdom Radiol 2015; 41(1): 136–148.
- 31Frickenstein AN, Jones MA, Behkam B, McNally LR. Imaging inflammation and infection in the gastrointestinal tract. Int J Mol Sci 2020; 21(1): 243.
- 32Feingold D, Steele S, Lee S, et al. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum 2014; 57(3): 284–294.
- 33Schlaudecker JD, Bernheisel CR. Gadolinium-associated nephrogenic systemic fibrosis. Am Fam Physician 2009; 80(7): 711–4.
- 34Crownover BK, Bepko JL. Appropriate and safe use of diagnostic imaging. Am Fam Physician 2013; 87(7): 494–501.
- 35Manetta R, Capretti I, Belleggia N, et al. Magnetic resonance enterography (MRE) and ultrasonography (US) in the study of the small bowel in Crohn's disease: state of the art and review of the literature. Acta Biomed 2019; 90(5-S): 38–50.
- 36Guo B, Yang Z, Zhang L. Gadolinium deposition in brain: Current scientific evidence and future perspectives. Front Mol Neurosci. 2018; 11: 335.
- 37Choi J, Moon W. Gadolinium deposition in the brain: Current updates. Korean Journal of Radiology. 2019; 20(1): 134.
- 38Hein PA, Eskey CJ, Dunn JF, Hug EB. Diffusion-weighted imaging in the follow-up of treated high-grade gliomas: Tumor recurrence versus radiation injury. AJNR Am J Neuroradiol 2004; 25(2): 201–9.
- 39Malayeri AA, El Khouli RH, Zaheer A, et al. Principles and applications of diffusion-weighted imaging in cancer detection, staging, and treatment follow-up. Radiographics 2011; 31(6): 1773–91.
- 40Serai SD, Hu HH, Ahmad R, et al. Newly developed methods for reducing motion artifacts in pediatric Abdominal MRI: Tips and pearls. AJR Am J Roentgenol 2020; 214(5): 1042–53.
- 41Munn Z, Jordan Z. The patient experience of high technology medical imaging: A systematic review of the qualitative evidence. JBI Libr Syst Rev 2011; 9(19): 631–78.
- 42 Chapter 3- Use of MRI in Australia – Parliament of Australia [Internet]; 2018 [cited 7 May 2020]. Available from: https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/Diagnosticimaging/Report/c03#c03f77
- 43Siewert B, Tye G, Kruskal J, Sosna J, Opelka F. Impact of CT-guided drainage in the treatment of diverticular abscesses: Size matters. AJR Am J Roentgenol 2006; 186(3): 680–686.
- 44Snyder MJ. Imaging of colonic diverticular disease. Clin Colon Rectal Surg 2004; 17(3): 155–62.
- 45De Filippo M, Gira F, Corradi D, Sverzellati N, Zompatori M, Rossi C. Benefits of 3D technique in guiding percutaneous retroperitoneal biopsies. Radiol Med 2011; 116(3): 407–16.
- 46Moche M, Zajonz D, Kahn T, Busse H. MRI-guided procedures in various regions of the body using a robotic assistance system in a closed-bore scanner: Preliminary clinical experience and limitations. J Magn Reson Imaging 2010; 31(4): 964–974.
- 47Imschweiler T, Haueisen H, Kampmann G, et al. MRI-guided vacuum-assisted breast biopsy: Comparison with stereotactically guided and ultrasound-guided techniques. Eur Radiol 2014; 24(1): 128–35.
- 48Flor 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. AJR Am J Roentgenol 2016; 207(1): 15–24.
Citing Literature
