Diverticulitis Detection


Purpose

To detect colonic diverticulitis on CT

Tag(s)


Panel

Abdominal

Define-AI ID

19020005

Originator

Luther B Adair, II, MD

Lead

Luther B Adair, II, MD

Panel Chair

Arun Krishnaraj, MD

Panel Reviewers

Abdominal Panel

License

Creative Commons 4.0

Status

Public Comment



Clinical Implementation


Value Proposition

Colonic diverticulitis is an acute infection and common cause of emergency visits. AI can creatve value to a variety of stakeholders by detecting, quantitating, comparing, and alerting both nonspecialists and radiologists to this abnormality. In clinical settings where a radiologist is not readily available such detection would be benefit non-radiologists such as technologists who perform the CT and alert them if diverticulitis is present. In clinical settings where radiologists are available, such detection could be used to alert the radiologist and prioritize its reporting and notification to the treating physicians. One possible extension to this use case is to detect diverticulitis on CT and assess the need for further treatment based on the absence or presence of complications.

Narrative(s)

A 58-year old patient presents to an urgent care facility with worsening left lower quadrant pain, loose stools and fever and is taken to the emergency room at which time a CT scan is ordered.

Workflow Description

The relevant images are obtained from the modality and sent to PACS and the AI engine based on anatomic landmarks. The images are analyzed by the engine. The system then detects the relevant outputs providing associated categorical data or measurements. An alert messages sent it back to the engine with information, identification, and graphics highlighting the wall thickening, pericolonic infiltrative changes, pericolonic lymph nodes, extramural fluid, or free air.

An algorithm evaluates the CT scan and categorizes whether colonic wall thickening is present, absent, or undetermined. If present, it then assesses whether pericolonic infiltrative changes are present, absent, undetermined; assesses whether extramural fluid present, absent, or undetermined; assesses whether pericolonic lymph nodes are present, absent, or undetermined; whether an organized extramural fluid is present, absent, or undetermined; assesses whether free air is present, absent, or undetermined. For cases returned where the algorithm returns colonic wall thickening is present and certain secondary output elements are present (lymph nodes present and pericolonic infiltrative changes not present), the radiologist is made aware to look for malignancy and/or diverticulitis. For cases returned where the algorithm returns colonic wall thickening is present and more than 2 secondary inputs are present (I.e pericolonic infiltrative changes present and extramural fluid present), the exam is prioritized in the radiologist’s worklist for urgent interpretation and reporting.

Considerations for Dataset Development


Procedures: {CT Abdomen, with contrast, without contrast, CT Abdomen and pelvis}}

View(s): {sagittal, axial, coronal}
Clinical Note: Subtle colonic wall thickening can be overlooked

Sex at Birth: {Male, Female}

Age: [20,90]

Abdominal pain: {left lower quadrant pain}

Percutaneous Tube: { percutaneous drainage tube}

Other: {extramural abscess, colonic malignancy, colonic perforation}

Technical Specifications


Inputs

DICOM Study

Procedure

CT Abdomen with contrast, CT Abdomen without contrast, CT Abdomen and Pelvis with contrast, CT Abdomen and Pelvis without contrast

Views

Axial, coronal, and sagittal

Data Type

DICOM

Modality

CT

Body Region

Abdomen

Anatomic Focus

Colon

Pharmaceutical

Oral contrast

Scenario




Primary Outputs

Sigmoid colonic wall thickness

RadElement ID


Definition

sigmoid colonic wall thickness

Data Type

Numeric

Value Set


Units

millimeters



Secondary Outputs

Detection of pericolonic infiltrative changes

RadElement ID


Definition

Pericolonic infiltrative changes

Data Type

Categorical

Value Set

0-Pericolonic infiltrative changes absent

1- Pericolonic infiltrative change present

2-Undetermined

Units

NA


 

Pericolonic lymph node Detection

RadElement ID


Definition

Detect if pericolonic lymph node is present or absent.

Data Type

Categorical

Value Set

0-Pericolonic lymph node absent

1- Pericolonic lymph node present

2-Undetermined

Units

NA



 

Extramural fluid detection

RadElement ID


Definition

Detect if extramural fluid is present or absent.

Data Type

Categorical

Value Set

0-Extramural fluid absent

1- Extramural fluid present

2-Undetermined

Units

NA



 

Extramural fluid classification

RadElement ID


Definition

Extramural fluid characterization

Data Type

Categorical

Value Set

0-Organization absent

1- Organization present

2-Undetermined

Units

NA



 

Detect Free Air

RadElement ID


Definition

Free air detection in abdomen CT.

Data Type

Categorical

Value Set

0-Free air absent

1- Free air present

2-Undetermined

Units

NA