Efficiency of dual-energy computed tomography enterography in the diagnosis of Crohn’s disease

Abstract

Background This retrospective study aimed to investigate the usefulness of the optimized kiloelectron volt (keV) for virtual monoenergetic imaging (VMI) combined with iodine map in dual-energy computed tomography enterography (DECTE) in the diagnosis of Crohn’s disease (CD). Methods Seventy-two patients (mean age: 41.89 ± 17.28 years) with negative computed tomography enterography (CTE) were enrolled for investigating the optimized VMI keV in DECTE by comparing subjective and objective parameters of VMIs that were reconstructed from 40 to 90 keV. Moreover, 68 patients (38.27 ± 15.10 years; 35 normal and 33 CD) were included for evaluating the diagnostic efficacy of DECTE iodine map at the optimized VMI energy level and routine CTE for CD and active CD. Statistical analysis for all data was conducted. Results Objective and subjective imaging evaluations showed the best results at 60 keV for VMIs. The CT values of the normal group, active subgroup, and CD group during the small intestinal phase at routine 120 kVp or 60 keV VMI had significant differences. The diagnostic efficacy of an iodine map was the best when NIC = 4% or fat value = 45.8% for CD, whereas NIC < 0.35 or the fat value < 0.38 for active CD. The combined routine CTE and optimized VMI improved the diagnostic efficacy (P < 0.001). Conclusions VMI at 60 keV provided the best imaging quality on DECTE. NIC and fat value provided important basis for active CD evaluation. Routine CTE combined with VMI at 60 keV improved the diagnostic efficiency for CD.

Application of multi-spectral CT imaging in Crohn's disease: a systematic review

“…Two studies (28,30) focused on the general distinction between normal bowel segments and pathological ones without specifying the status of the lesions (active or in remission); four studies (26,29,32,33) investigated the differences between normal segments and segments with active inflammation; three studies (Kim et al (25), Xiao et al (27), Chen et al 31) focused particularly on the distinction of active versus remissive disease.…”

“…However, Xiao et al found statistically significant differences in iodine content of the intestinal wall: it was higher in the active group (IC-A = 2.7 ± 0.9; IC-V = 3.0 ± 0.5) than in the remission group (IC-A = 1.5 ± 0.5; IC-V = 2.4 ± 0.4; P < 0.05), and so did Chen et al (31) (active NIC = 6.31 ± 1.85 vs. remission NIC = 4.78 ± 1.48).…”

“…Three of the included studies used the Crohn's disease activity index (CDAI) as the main reference (25)(26)(27), two studies used endoscopy, biochemistry, and clinical symptoms as reference (28,29), two other studies used routine CTE findings (30,31), one used the histopathologic score (32), and the last one used previous iodine density data (33) (Table 2).…”

“…Another technical step forward was proposed by Chen et al (31), with the combined use of VMI at 60 keV and conventional CTE at 120 kVp to improve the efficiency of a CD diagnosis.…”

Prediction of pathological activity in Crohn’s disease based on dual-energy CT enterography

“…There are a variety of reference indicators for identifying whether it is in the active period, each of which has its own advantages and disadvantages. Dual-energy CT has 2 independent bulb-detector systems that can simultaneously obtain the attenuation coefficients of substances at different radiation energy levels, which not only enables the acquisition of conventional CT enterography findings, including increased bowel wall thickness, bowel wall hyperenhancement, comb sign and mesenteric fat infiltration, but also provides several parameters for diagnosis using the corresponding postprocessing workstations [ 12 ], including iodine content, virtual single-energy CT values, energy-spectrum curve slope K values, FF and DEI. DECTE scanning results in a shorter scanning time and reduced radiation dose relative to conventional CT scanning [ 13 , 14 ].…”