Colonic Wall Thickening Reported in Abdominal CT: Does It Always Imply Malignancy?

Improved Diagnostic Performance Using Dual-Energy CT-Derived Slope Parameter Images in Crohn's Disease

The objective of the study is to explore the image quality and diagnosis performance of the dual-energy CT-derived slope parameter images (SPI) generated by the algorithm based on the slope function in the diagnosis of Crohn's disease (CD). Seventy-six CD patients and 53 disease-free control group subjects who underwent dual-energy CT enterography were retrospectively collected. Portal venous phase 120kVp-like and virtual monoenergetic images at 40-100 keV (VMI40-100) were reconstructed. SPIs corresponding to the spectral curve between 40 and 100 keV (SPI40-100) were generated using Python. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of normal and abnormal intestinal walls were calculated. Image quality, noise, and contrast were independently scored by two radiologists using a 5-point scale. Four radiologists conducted CD diagnosis with three reading models (120kVp-like, 120kVp-like with optimal VMI, and 120kVp-like with SPI40-100). The diagnostic performances of the three reading models for diagnosing CD were evaluated using receiver operating characteristic (ROC) curves. The CNR in SPI40-100 was higher than in the other images (P < 0.05). The subjective evaluation showed that there was no statistical difference between the contrast of SPI40-100 and VMI40 (P > 0.05), but that of the two images was higher than the other images (P < 0.05). The scoring on the overall image quality of VMI50 was superior to that of other images (P < 0.05). The combined model of 120kVp-like with SPI40-100 had the strongest confidence (cases with high confidence: 36, 58, 49, 47 for radiologists 1, 2, 3, 4) and the highest efficiency in diagnosing CD (areas under the ROC curve: 0.973, 0.977, 0.982, 0.991 for radiologists 1, 2, 3, 4). SPI40-100 generated by the algorithm based on the slope function exhibited good image quality. The combined model of 120kVp-like with SPI40-100 could improve radiologists' diagnostic efficiency and confidence in diagnosing CD.

Malignancy predictors and treatment strategies for adult intestinal intussusception

Intussusception in adult patients is a rare medical finding, which is accompanied by an underlying tumor in some cases. However, no accepted method has been established to identify patients at risk for tumor-related intussusception. This study aimed to identify imaging features as predictors for tumor-related intussusception.CT images of patients with confirmed intussusception were retrospectively acquired between 01/2008 and 12/2022. Available follow-up images and medical health records were evaluated to identify various imaging features, the cause of intussusception, and treatment strategies. Imaging interpretation was conducted by two blinded radiologists. A third radiologist was consulted in cases of disagreement.A total of 71 consecutive patients were included in this study (42 males, 29 females) with a median age of 56 years (interquartile range: 40.5-73.8 years). Enteroenteric intussusceptions in the small bowel were the most common type observed in adult patients. In contrast, colocolic intussusception was more frequently associated with malignancy, and this association was statistically significant (p < 0.05). Among the malignant tumors, adenocarcinoma was the most common, followed by metastases and lymphoma. Additionally, bowel obstruction and wall thickening were significantly correlated with malignancy (p < 0.05). The high negative predictive values (NPVs) and high specificities for ileus (NPV 88.5%, specificity 82.1%), bowel wall thickening (NPV 90.9%, specificity 71.4%), and acute abdomen (NPV 84.6%, specificity 78.8%) suggest that the absence of these features strongly predicts a low probability of malignancy in cases of adult intussusception.Active surveillance with follow-up exams is suitable for asymptomatic and transient intussusception when imaging features suggest a low likelihood of a neoplasm. Additionally, malignancy predictors such as ileus and thickening of the bowel wall in the affected segment could guide tailored treatment. Surgical interventions are essential for symptomatic cases, with adenocarcinoma being the most common malignancy found in colocolic intussusceptions.Intussusception in adults is rare and is often associated with underlying tumors, particularly in colocolic intussusceptions. Key imaging predictors for malignancy include bowel obstruction, wall thickening in the affected segment, and the presence of acute abdomen, with high NPVs and specificities indicating low malignancy risk when these features are absent. Active surveillance is recommended for asymptomatic cases with low neoplasm probability, while surgical intervention is the method of choice for symptomatic patients. · Reschke P, Le Hong QA, Gruenewald LD et al. Malignancy predictors and treatment strategies for adult intestinal intussusception. Fortschr Röntgenstr 2024; DOI 10.1055/a-2434-7932.

Can HALP (Hemoglobin, Albumin, Lymphocytes, and Platelets) Score Differentiate Between Malignant and Benign Causes of Acute Mechanic Intestinal Obstruction?

Background: Hematological parameters, including albumin and hemoglobin (Hb) levels and lymphocyte counts, are low-cost tests that can be used to determine inflammation and nutritional status. Recent studies have shown that inflammation plays a very important role in the development of carcinogenesis. Materials and Methods: The authors aimed to investigate whether preoperative hemoglobin, albumin, lymphocyte, and platelet (HALP) score can distinguish between benign and malignant causes in patients who are admitted to hospital and operated due to acute mechanical intestinal obstruction (AMIO). The patients were divided into two groups etiologically. Group 1 included the AMIO cases, which developed from benign causes, while Group II contained the AMIO cases, which developed as a result of malignancy. HALP score was calculated based on the latest preoperative Hb, albumin, lymphocyte, and platelet values of patients. Results: HALP variable was an independent prognostic factor (p < 0.001) in determining malignancy (odds ratio = 0.91; 95% confidence interval [CI] = 0.882-0.930). Based on the results, when a cutoff value <23.94 was used for HALP score in receiver operating characteristic analysis, sensitivity for determining the malignancy was 85%, while specificity was 78% (Area under the curve [AUC] ± standard error = 0.86 ± 0.029; 95% CI = 0.80-0.91; p < 0.001). Conclusions: The HALP score could be a useful parameter for the clinician in distinguishing between AMIO due to benign and malignant origins.

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

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.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12880-021-00716-y.

The Use of Clinical Parameters as Adjuncts to Endoscopic Evaluation of Mural Thickening on Conventional Computed Tomography in Diagnosing Malignancy

BACKGROUND

Mural thickening (MT) on computed tomography (CT) poses a diagnostic dilemma in the absence of clear reporting guidelines. The aim of this study was to analyse CT reports, identifying patients in whom gastrointestinal wall MT was observed, and to correlate these reports with subsequent endoscopic evaluation.

METHODS

Patients with MT who had follow-up endoscopy were included in the study (n = 308). The cohort was subdivided into upper gastrointestinal mural thickening (UGIMT) & lower gastrointestinal mural thickening (LGIMT).

RESULTS

In total, 55.71% (n = 122) of colonoscopies and 61.8% (n = 55) of gastroscopies were found to be normal. Haemoglobin (HB) level in combination with MT was a predictor of neoplasia in both arms (p = 0.04 UGIMT cohort, p < 0.001 LGIMT cohort). In addition to this, age was a significant correlative parameter in both UGIMT and LGIMT cohorts (p = 0.003, p < 0.001 respectively). Dysphagia and weight loss were associated with UGI malignancies (38 and 63% respectively) and rectal bleeding was correlative in 20% of patients with LGI malignancies.

CONCLUSION

HB, advancing age, and red flag symptoms are potentially useful adjuncts to MT in predicting upper and lower gastrointestinal malignancies. We propose the adoption of a streamlined pathway to delineate patients who should undergo endoscopic investigation following CT identification of MT.

Predictors of Neoplasia in Colonic Wall Thickening Detected via Computerized Tomography

Introduction

Colonic wall thickening (CWT) is frequently observed incidentally via abdominal computerized tomography (aCT). Although the general approach to evaluating incidental CWT is a colonoscopic examination, there is a lack of definitive recommendation guidelines. Thus, we aimed to determine neoplasia rates and identify the factors predictive of neoplasia via colonoscopic examinations of patients with CWT incidentally diagnosed via aCT.

Methods

We retrospectively reviewed 5,300 colonoscopy reports. A total of 122 patients who had CWT incidentally observed via aCT were included in the study. CWT was graded as mild (3-5 mm), moderate (6-12 mm), or severe (≥12 mm). A logistic regression model was used to determine the predictive factors for neoplasia.

Results

The mean age of the patients was 60 years, and abnormal findings were noted in 52% of the colonoscopies. Neoplastic lesions were detected in 24 patients (19.6%), while colon adenocarcinoma was detected in 8 patients (6.5%). Multivariate analysis showed that moderate-severe, focal, and asymmetric CWT were independent factors for predicting neoplasia (p=0.049, p=0.033, and p=0.018, respectively).

Conclusion

Pathological findings can be noted via colonoscopic examination in cases of incidental CWT; therefore, patients with moderate-severe, focal, or asymmetric CWT require colonoscopic examination for the purpose of detecting neoplasia.