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http://dx.doi.org/10.3348/kjr.2018.19.6.1077

Iodine Quantification on Spectral Detector-Based Dual-Energy CT Enterography: Correlation with Crohn's Disease Activity Index and External Validation  

Kim, Yeon Soo (Department of Radiology, Seoul National University College of Medicine)
Kim, Se Hyung (Department of Radiology, Seoul National University College of Medicine)
Ryu, Hwa Sung (Department of Radiology, Seoul National University College of Medicine)
Han, Joon Koo (Department of Radiology, Seoul National University College of Medicine)
Publication Information
Korean Journal of Radiology / v.19, no.6, 2018 , pp. 1077-1088 More about this Journal
Abstract
Objective: To correlate CT parameters on detector-based dual-energy CT enterography (DECTE) with Crohn's disease activity index (CDAI) and externally validate quantitative CT parameters. Materials and Methods: Thirty-nine patients with CD were retrospectively enrolled. Two radiologists reviewed DECTE images by consensus for qualitative and quantitative CT features. CT attenuation and iodine concentration for the diseased bowel were also measured. Univariate statistical tests were used to evaluate whether there was a significant difference in CTE features between remission and active groups, on the basis of the CDAI score. Pearson's correlation test and multiple linear regression analyses were used to assess the correlation between quantitative CT parameters and CDAI. For external validation, an additional 33 consecutive patients were recruited. The correlation and concordance rate were calculated between real and estimated CDAI. Results: There were significant differences between remission and active groups in the bowel enhancement pattern, subjective degree of enhancement, mesenteric fat infiltration, comb sign, and obstruction (p < 0.05). Significant correlations were found between CDAI and quantitative CT parameters, including number of lesions (correlation coefficient, r = 0.573), bowel wall thickness (r = 0.477), iodine concentration (r = 0.744), and relative degree of enhancement (r = 0.541; p < 0.05). Iodine concentration remained the sole independent variable associated with CDAI in multivariate analysis (p = 0.001). The linear regression equation for CDAI (y) and iodine concentration (x) was y = 53.549x + 55.111. For validation patients, a significant correlation (r = 0.925; p < 0.001) and high concordance rate (87.9%, 29/33) were observed between real and estimated CDAIs. Conclusion: Iodine concentration, measured on detector-based DECTE, represents a convenient and reproducible biomarker to monitor disease activity in CD.
Keywords
Crohn's disease; Dual-energy computed tomography; Activity index; Iodine quantification;
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1 Lee SS, Kim AY, Yang SK, Chung JW, Kim SY, Park SH, et al. Crohn disease of the small bowel: comparison of CT enterography, MR enterography, and small-bowel followthrough as diagnostic techniques. Radiology 2009;251:751-761   DOI
2 Hara AK, Leighton JA, Heigh RI, Sharma VK, Silva AC, De Petris G, et al. Crohn disease of the small bowel: preliminary comparison among CT enterography, capsule endoscopy, small-bowel follow-through, and ileoscopy. Radiology 2006;238:128-134   DOI
3 Wold PB, Fletcher JG, Johnson CD, Sandborn WJ. Assessment of small bowel Crohn disease: noninvasive peroral CT enterography compared with other imaging methods and endoscopy--feasibility study. Radiology 2003;229:275-281   DOI
4 Choi IY, Park SH, Park SH, Yu CS, Yoon YS, Lee JL, et al. CT enterography for surveillance of anastomotic recurrence within 12 months of bowel resection in patients with Crohn's disease: an observational study using an 8-year registry. Korean J Radiol 2017;18:906-914   DOI
5 Choi D, Lee SJ, Cho YA, Lim HK, Kim SH, Lee JW, et al. Bowel wall thickening in patients with Crohn's disease: CT patterns and correlation with inflammatory activity. Clin Radiol 2003;58:68-74   DOI
6 Bodily KD, Fletcher JG, Solem CA, Johnson CD, Fidler JL, Barlow JM, et al. Crohn disease: mural attenuation and thickness at contrast-enhanced CT Enterography--correlation with endoscopic and histologic findings of inflammation. Radiology 2006;238:505-516   DOI
7 Fulwadhva UP, Wortman JR, Sodickson AD. Use of dualenergy CT and iodine maps in evaluation of bowel disease. Radiographics 2016;36:393-406   DOI
8 Mako EK, Mester AR, Tarjan Z, Karlinger K, Toth G. Enteroclysis and spiral CT examination in diagnosis and evaluation of small bowel Crohn's disease. Eur J Radiol 2000;35:168-175   DOI
9 Booya F, Fletcher JG, Huprich JE, Barlow JM, Johnson CD, Fidler JL, et al. Active Crohn disease: CT findings and interobserver agreement for enteric phase CT enterography. Radiology 2006;241:787-795   DOI
10 Goo HW, Goo JM. Dual-energy CT: new horizon in medical imaging. Korean J Radiol 2017;18:555-569   DOI
11 Marin D, Boll DT, Mileto A, Nelson RC. State of the art: dualenergy CT of the abdomen. Radiology 2014;271:327-342   DOI
12 Thia KT, Sandborn WJ, Lewis JD, Loftus EV Jr, Feagan BG, Steinhart AH, et al. Defining the optimal response criteria for the Crohn's disease activity index for induction studies in patients with mildly to moderately active Crohn's disease. Am J Gastroenterol 2008;103:3123-3131   DOI
13 Potretzke TA, Brace CL, Lubner MG, Sampson LA, Willey BJ, Lee FT Jr. Early small-bowel ischemia: dual-energy CT improves conspicuity compared with conventional CT in a swine model. Radiology 2015;275:119-126   DOI
14 Huda W, Ogden KM, Khorasani MR. Converting dose-length product to effective dose at CT. Radiology 2008;248:995-1003   DOI
15 Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology 2004;126:1504-1517   DOI
16 Frager D, Medwid SW, Baer JW, Mollinelli B, Friedman M. CT of small-bowel obstruction: value in establishing the diagnosis and determining the degree and cause. AJR Am J Roentgenol 1994;162:37-41   DOI
17 Steward MJ, Punwani S, Proctor I, Adjei-Gyamfi Y, Chatterjee F, Bloom S, et al. Non-perforating small bowel Crohn's disease assessed by MRI enterography: derivation and histopathological validation of an MR-based activity index. Eur J Radiol 2012;81:2080-2088   DOI
18 Silva AC, Morse BG, Hara AK, Paden RG, Hongo N, Pavlicek W. Dual-energy (spectral) CT: applications in abdominal imaging. Radiographics 2011;31:1031-1046; discussion 1047-1050   DOI
19 Patino M, Prochowski A, Agrawal MD, Simeone FJ, Gupta R, Hahn PF, et al. Material separation using dual-energy CT: current and emerging applications. Radiographics 2016;36:1087-1105   DOI
20 Coursey CA, Nelson RC, Boll DT, Paulson EK, Ho LM, Neville AM, et al. Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging? Radiographics 2010;30:1037-1055   DOI
21 Modigliani R, Mary JY, Simon JF, Cortot A, Soule JC, Gendre JP, et al. Clinical, biological, and endoscopic picture of attacks of Crohn's disease. Evolution on prednisolone. Groupe d'Etude Therapeutique des Affections Inflammatoires Digestives. Gastroenterology 1990;98:811-818   DOI
22 Purysko AS, Primak AN, Baker ME, Obuchowski NA, Remer EM, John B, et al. Comparison of radiation dose and image quality from single-energy and dual-energy CT examinations in the same patients screened for hepatocellular carcinoma. Clin Radiol 2014;69:e538-e544   DOI
23 Eklund C, Lehtimaki T, Hurme M. Epistatic effect of C-reactive protein (CRP) single nucleotide polymorphism (SNP) +1059 and interleukin-1B SNP +3954 on CRP concentration in healthy male blood donors. Int J Immunogenet 2005;32:229-232   DOI
24 Russell AI, Cunninghame Graham DS, Shepherd C, Roberton CA, Whittaker J, Meeks J, et al. Polymorphism at the C-reactive protein locus influences gene expression and predisposes to systemic lupus erythematosus. Hum Mol Genet 2004;13:137-147
25 Uhrig M, Simons D, Kachelriess M, Pisana F, Kuchenbecker S, Schlemmer HP. Advanced abdominal imaging with dual energy CT is feasible without increasing radiation dose. Cancer Imaging 2016;16:15   DOI
26 Xin L, Yang X, Huang N, Du X, Zhang J, Wang Y, et al. The initial experience of the upper abdominal CT angiography using low-concentration contrast medium on dual energy spectral CT. Abdom Imaging 2015;40:2894-2899   DOI
27 Gandhi NS, Baker ME, Goenka AH, Bullen JA, Obuchowski NA, Remer EM, et al. Diagnostic accuracy of CT enterography for active inflammatory terminal ileal Crohn disease: comparison of full-dose and half-dose images reconstructed with FBP and half-dose images with SAFIRE. Radiology 2016;280:436-445   DOI
28 Fishman EK, Wolf EJ, Jones B, Bayless TM, Siegelman SS. CT evaluation of Crohn's disease: effect on patient management. AJR Am J Roentgenol 1987;148:537-540   DOI
29 Goldberg HI, Gore RM, Margulis AR, Moss AA, Baker EL. Computed tomography in the evaluation of Crohn disease. AJR Am J Roentgenol 1983;140:277-282   DOI
30 Gore RM, Balthazar EJ, Ghahremani GG, Miller FH. CT features of ulcerative colitis and Crohn's disease. AJR Am J Roentgenol 1996;167:3-15   DOI
31 Ordas I, Rimola J, Rodriguez S, Paredes JM, Martinez-Perez MJ, Blanc E, et al. Accuracy of magnetic resonance enterography in assessing response to therapy and mucosal healing in patients with Crohn's disease. Gastroenterology 2014;146:374-382.e1   DOI
32 Wills JS, Lobis IF, Denstman FJ. Crohn disease: state of the art. Radiology 1997;202:597-610   DOI
33 Orel SG, Rubesin SE, Jones B, Fishman EK, Bayless TM, Siegelman SS. Computed tomography vs barium studies in the acutely symptomatic patient with Crohn disease. J Comput Assist Tomogr 1987;11:1009-1016   DOI
34 Rimola J, Rodriguez S, Garcia-Bosch O, Ordas I, Ayala E, Aceituno M, et al. Magnetic resonance for assessment of disease activity and severity in ileocolonic Crohn's disease. Gut 2009;58:1113-1120   DOI
35 van Hees PA, van Elteren PH, van Lier HJ, van Tongeren JH. An index of inflammatory activity in patients with Crohn's disease. Gut 1980;21:279-286   DOI