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Dane B, Li X, Goldberg JD, O'Donnell T, Le L, Megibow A. Crohn's disease phenotype analysis with iodine density from dual-energy CT enterography. Abdom Radiol (NY) 2023; 48:2219-2227. [PMID: 37097450 DOI: 10.1007/s00261-023-03923-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To compare dual-source dual-energy CT enterography (dsDECTE) obtained iodine density (I) (mg/mL) and I normalized to the aorta (I%) with Crohn's disease (CD) phenotypes defined by the SAR-AGA small bowel CD consensus statement. METHODS Fifty CD patients (31 male, 19 female; mean [SD] age: 50.4 [15.2] years) who underwent dsDECTE were retrospectively identified. Two abdominal radiologists assigned CD phenotypes: no active inflammation (group-2), active inflammation without (group-3) or with luminal narrowing (group-4), stricture with active inflammation (group-5), stricture without active inflammation (group-1), and penetrating disease (group-6). Semiautomatic prototype software was used to determine the median I and I% of CD-affected small bowel mucosa for each patient. The means of the I and I% medians were compared among 4 groups ("1 + 2", "3 + 4", "5", "6") using one-way ANOVA (significance level 0.05 for each outcome) for each outcome individually followed by Tukey's range test for pairwise comparisons with adjusted p-values (overall alpha = 0.05). RESULTS Mean [SD] I was 2.14 [1.07] mg/mL for groups 1 + 2 (n = 16), 3.54 [1.71] mg/mL for groups 3 + 4 (n = 15), 5.5 [3.27] mg/mL for group- "5" (n = 9), and 3.36 [1.43] mg/mL for group-"6" (n = 10) (ANOVA p = .001; group "1 + 2" versus "5" adj-p = .0005). Mean [SD] I% was 21.2 [6.13]% for groups 1 + 2, 39.47 [9.71]% for groups 3 + 4, 40.98 [11.76]% for group-5, and 35.01 [7.58]% for group-6 (ANOVA p < .0001; groups "1 + 2" versus "3 + 4" adj-p < .0001, group "1 + 2" versus "5" adj-p < .0001, and groups "1 + 2" versus "6" adj-p = .002). CONCLUSION Iodine density obtained from dsDECTE significantly differed among CD phenotypes defined by SAR-AGA, with I (mg/mL) increasing with phenotype severity and decreasing for penetrating disease. I and I% can be used to phenotype CD.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY, 10016, USA.
| | - Xiaochun Li
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Judith D Goldberg
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | | | - Linda Le
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY, 10016, USA
| | - Alec Megibow
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY, 10016, USA
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Dane B, Kernizan A, O'Donnell T, Petrocelli R, Rabbenou W, Bhattacharya S, Chang S, Megibow A. Crohn's disease active inflammation assessment with iodine density from dual-energy CT enterography: comparison with endoscopy and conventional interpretation. Abdom Radiol (NY) 2022; 47:3406-3413. [PMID: 35833999 DOI: 10.1007/s00261-022-03605-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare terminal ileum (TI) mucosal iodine density obtained at dual-energy CT enterography (DECTE) with conventional CT interpretation and endoscopy in patients with Crohn's disease (CD). MATERIALS AND METHODS Twenty-three CD patients (14 men; mean[SD] age:48.1[16.7] years) with endoscopy within 30 days of DECTE were retrospectively identified. An inflammatory bowel disease gastroenterologist reviewed endoscopic images. Two radiologists qualitatively assessed the presence of active TI inflammation. Mean iodine density normalized to the aorta (I%), mean absolute iodine density (I), and iodine density standard deviation (ISD) from the distal 2 cm ileum (TI) mucosa obtained using semiautomatic prototype software were compared with endoscopic assessment using Mann Whitney tests. The optimal threshold I% and I were determined from receiver operating curves (ROC). Sensitivity and specificity of conventional interpretation and determined iodine thresholds were compared using McNemar's test. Inter-reader agreement was assessed using kappa. A p < 0.05 indicated statistical significance. RESULTS Twelve (52.1%) patients had endoscopic active inflammation. I% was 37.9[13.3]% for patients with and 21.7[7.5]% for patients without endoscopic active inflammation (p = 0.001). The optimal ROC threshold 24.6% had 100% sensitivity and 81.8% specificity (AUC = 0.909, 95% CI 0.777-1). I was 2.44[0.73]mg/mL for patients with and 1.77[1.00]mg/mL for patients without active endoscopic inflammation (p = 0.0455). The optimal ROC threshold 1.78 mg/mL I had 91.7% sensitivity and 63.6% specificity (AUC = 0.75, 95% CI 0.532-0.968). ISD was similar for patients with and without endoscopic active inflammation (0.82[0.33]mg/mL and 0.77[0.28]mg/mL, respectively, p = 0.37). Conventional interpretation sensitivity and specificity (R1/R2) were 83.3%/91.7% and 72.7%/54.5%, respectively (all p > 0.05) with moderate inter-reader agreement (Κ = 0.542[95% CI 0.0202-0.088]). CONCLUSION Mean normalized iodine density is highly sensitive and specific for endoscopic active inflammation. DECTE could be considered as a surrogate to endoscopy in CD patients. Despite trends towards improved sensitivity and specificity compared with conventional interpretation, future larger studies are needed.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA. .,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.
| | - Amelia Kernizan
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
| | - Thomas O'Donnell
- Siemens Healthineers, 40 Liberty Blvd, Malvern, PA, 19355, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
| | - Robert Petrocelli
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
| | - Wendy Rabbenou
- Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.,Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA
| | - Sumona Bhattacharya
- Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.,Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA
| | - Shannon Chang
- Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.,Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA
| | - Alec Megibow
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
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Guler E, Unal NG, Hekimsoy I, Kose T, Harman M, Ozutemiz AO, Elmas NZ. Dual-energy CT enterography in evaluation of Crohn's disease: the role of virtual monochromatic images. Jpn J Radiol 2021; 39:341-8. [PMID: 33159649 DOI: 10.1007/s11604-020-01065-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To assess the use of virtual monochromatic images (VMI) for discrimination of affected and non-affected bowel walls in patients with Crohn's disease (CD) as well as to compare mural enhancement between patients with and without CD. MATERIALS AND METHODS This retrospective study included 61 patients (47 with CD, 14 without CD). Attenuation value (AV), signal-to noise ratio (SNR), and contrast-to-noise ratio (CNR) were obtained at VMI energy levels from 40 to 110 keV in 10 keV increment. Analyses were performed among affected and non-affected bowel walls in CD patients, as well as from bowel walls in patients without CD. Image quality and mural enhancement were evaluated at VMI energy levels at 40, 70, and 110 keV. RESULTS At all energy levels of VMI, each quantitative data for AV, SNR, and CNR showed statistically significant difference between diseased and non-diseased bowel walls in CD patients. In the quantitative assessment of patients with and without CD, the optimal AV and SNR were obtained at 40 keV, and the optimal CNR was obtained at 70 keV. For the qualitative assessment, the best image quality and mural enhancement were obtained at 70 keV and 40 keV, respectively. CONCLUSION VMI are helpful for the differentiation of affected bowel walls in CD patients, providing high diagnostic accuracy.
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