Point-of-care ultrasound (POCUS) performs well in detecting diverticulitis in the colon in Asian populations, but the exact location of the inflammation affects performance, suggest findings published April 8 in Ultrasound in Medicine & Biology.
A team led by Dr. Chun-Hsiang Huang, PhD, from the National Taiwan University Hospital in Taipei found that the diagnostic accuracy of POCUS was lower in the cecum compared with other locations. Additionally, most false-positive cases were eventually diagnosed as appendicitis.
"The results indicate that the use of a 'POCUS first' model in emergency department settings for uncomplicated diverticulitis is feasible and effective, but caution is warranted when diagnosing patients with clinically suspected cecal diverticulitis," Huang and co-authors wrote.
Previous reports indicate that POCUS has high sensitivity and specificity in diagnosing uncomplicated colonic diverticulitis in Western patients. However, the researchers noted that such data is lacking for Asian patients, in which diverticulitis "frequently" occurs in the right side of the colon.
Huang et al wanted to add to the literature in their multicenter study, which took place between 2008 and 2018. They wanted to look at POCUS' performance in various locations of uncomplicated diverticulitis.
The team included 326 patients in their study. Eligible patients included those who had clinically suspected colonic diverticulitis who had undergone CT, as well as those who received POCUS followed by CT.
The researchers found that POCUS had an overall accuracy of 92%. However, when the diverticulitis was located in the cecum, POCUS' accuracy dipped to 84.3%, significantly lower when compared with other locations (p < 0.0001). Also, specificity and negative predictive value were lower in the cecum compared to other locations at 41.2% and 43.8%, respectively (p < 0.0001).
"Point-of-care ultrasound exhibits high diagnostic accuracy in diagnosing uncomplicated diverticulitis in the Asian population," the authors wrote.
The researchers also reported that the accuracy of POCUS was lower in the cecum than in the ascending colon (p = 0.008). POCUS was most accurate when used for the transverse and descending colon.
Additionally, they found that nine of 10 false positives recorded had the final diagnosis of appendicitis. Of these, five had an outpouching structure whose origin in the cecum could not be traced and four had elongated diverticula.
Finally, the team reported that body mass index (BMI) had a negative association with the accuracy of POCUS in cecal diverticulitis cases. This included an odds ratio of 0.79 after adjusting for other covariates.
The study authors wrote that while using POCUS first is appropriate "in many cases," they advised that inconclusive or doubtful diagnoses should be followed with CT.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnie.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
