Value of dual-energy CT enterography in the analysis of pathological bowel segments in patients with Crohn's disease

Campos, A.M. Villanueva; Fuente, G. Tardáguila de la; Pérez, E. Utrera; Basildo, C. Jurado; Fernández, D. Mera; Rodríguez, Carlos

doi:10.1016/j.rxeng.2018.03.001

Cited by 9 publications

(12 citation statements)

References 19 publications

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“…In a recent retrospective study, Villanueva Campos et al. have measured absolute iodine density (mg/dL) and fat fraction (%) in bowel segments with radiological signs of active inflammation as well as in normal appearing bowel segments in 33 CD patients (18). Similar to our study, they have found that absolute iodine density was significantly higher in affected bowel loops than in normal appearing bowel segments.…”

Section: Discussionmentioning

confidence: 99%

“…Quantification of iodine content on iodine images may provide a more consistent measurement compared with attenuation measurements in Hounsfield Units (HU) in a SECT acquisition as the latter takes into account both the tissue density and the iodine amount whereas the iodine images give specific information about the iodine content of a tissue (11,13,14). While previous studies using conventional single-energy CTE (SECTE) already validated the ability of quantitative measures of wall thickness and mural attenuation to detect active small bowel inflammation (15–17), the use of dual-energy CTE (DECTE) with iodine quantification for diagnosis of active CD has only been scarcely investigated (18).…”

Section: Introductionmentioning

confidence: 99%

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Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease

et al. 2018

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Background Assessment of Crohn's disease (CD) activity is important to identify patients with active inflammation for therapy management. Quantitative analysis can provide objective measurement of disease presence. Purpose To evaluate the feasibility of quantitative analysis of contrast-enhanced dual-energy computed tomography (DECT) data in detection of small bowel inflammation in patients with CD with an emphasis on iodine quantification. Material and Methods DECT enterography was prospectively performed in 20 patients with active CD and in 20 healthy individuals, as the control group. Iodine overlay images were created. Wall thickness, attenuation, absolute iodine density, relative iodine density, and fat fraction were measured in the terminal ileum of all patients by two radiologists. Intraclass correlation coefficients were calculated to assess inter-rater agreement. Parameters were compared between patient groups using mixed model analysis. Receiver operating characteristic (ROC) analysis was performed. Results Both absolute and relative iodine density were significantly higher in active disease than in normal small bowel (all P < 0.001). In contrast, measurement of fat fraction was not significantly different in affected terminal ileal loops compared to normal terminal ileum ( P = 0.075). ROC analysis demonstrated a similar excellent diagnostic accuracy of wall thickness, attenuation, and absolute and relative iodine density with area under the ROC curve (AUC) values in the range of 0.96 for attenuation to 1 for relative iodine density. Conclusion DECT with iodine quantification can be used in distinguishing normal small bowel from active inflammatory CD. Further research should investigate the value of iodine quantification in grading CD activity and in monitoring therapeutic response.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease

et al. 2018

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“…DECT is an iodine-based CT imaging technique that improves tissue characterization by examining tissue behavior with 2 separate X-ray energy beams. In a small number of studies, DECT was demonstrated to correlate strongly with CDAI (r=0.744) [ 99 ], allowing the accurate discrimination between normal and affected bowel segments (AUC 0.96) [ 100 ], and enabling the quantification and objective evaluation of CD activity [ 101 ] as well as discrimination between fibrotic and inflammatory lesions [ 99 ].…”

Section: Methodsmentioning

confidence: 99%

Current noninvasive modalities in Crohn’s disease monitoring

Mitselos

Fousekis

Lamouri

et al. 2021

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Crohn’s disease (CD) is characterized by a remitting and relapsing course. Longstanding active CD may result in accumulating intestinal damage and disease-related complications. In contrast, mucosal healing is associated with significant improvement in the health-related quality of life, longer periods of disease remission and lower risk of disease progression, complications, hospitalizations, intestinal surgeries, as well as a lower risk of developing colorectal cancer. Mucosal healing, the new treatment endpoint in CD, made necessary the development of noninvasive, accurate, objective and reliable tools for the evaluation of CD activity. Ileocolonoscopy with biopsies remains the reference standard method for the evaluation of the colonic and terminal ileal mucosa. However, it is an invasive procedure with a low risk of complications, allowing the investigation of only a small part of the small bowel mucosa without being able to assess transmural inflammation. These disadvantages limit its role in the frequent follow up of CD patients. In this review, we present the currently available biomarkers and imaging modalities for the noninvasive assessment of CD activity.

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“…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).…”

Section: Quadasmentioning

confidence: 99%

“…QUADAS-2 evaluation of the studies included in the review: summary of the risk of bias and applicability concerns for each study. 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) Furthermore, two studies (28,32) focused on the stratification of lesions' grading; two studies (26,32) proposed an IC threshold for the diagnosis of CD and one study (33) presented the heterogeneity of IC within the involved small bowel segments.…”

Section: Decte Studiesmentioning

confidence: 99%

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

et al. 2023

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Background No quantitative computed tomography (CT) biomarker is actually sufficiently accurate to assess Crohn’s disease (CD) lesion activity, with adequate precision to guide clinical decisions. Purpose To assess the available literature on the use of iodine concentration (IC), from multi-spectral CT acquisition, as a quantitative parameter able to distinguish healthy from affected bowel and assess CD bowel activity and heterogeneity of activity along the involved segments. Material and Methods A literature search was conducted to identify original research studies published up to February 2022. The inclusion criteria were original research papers (>10 human participants), English language publications, focus on dual-energy CT (DECT) of CD with iodine quantification (IQ) as an outcome measure. The exclusion criteria were animal-only studies, languages other than English, review articles, case reports, correspondence, and study populations <10 patients. Results Nine studies were included in this review; all of which showed a strong correlation between IC measurements and CD activity markers, such as CD activity index (CDAI), endoscopy findings and simple endoscopic score for Crohn's disease (SES-CD), and routine CT enterography (CTE) signs and histopathologic score. Statistically significant differences in IC were reported between affected bowel segments and healthy ones (higher P value was P < 0.001), normal segments and those with active inflammation ( P < 0.0001) as well as between patients with active disease and those in remission ( P < 0.001). Conclusion The mean normalized IC at DECTE could be a reliable tool in assisting radiologists in the diagnosis, classification and grading of CD activity.

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Value of dual-energy CT enterography in the analysis of pathological bowel segments in patients with Crohn's disease

Cited by 9 publications

References 19 publications

Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease

Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease

Current noninvasive modalities in Crohn’s disease monitoring

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

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