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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

Isabelle De Kock (UGent) , Louke Delrue (UGent) , Clarisse Lecluyse (UGent) , Pieter Hindryckx (UGent) , Martine De Vos (UGent) and Geert Villeirs (UGent)
(2019) ACTA RADIOLOGICA. 60(6). p.679-686
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Abstract
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.
Keywords
Computed tomography, CT, dual-energy CT, CT enterography, Crohn's disease, iodine quantification, COMPUTED-TOMOGRAPHY ENTEROGRAPHY, EVIDENCE-BASED CONSENSUS, MURAL ATTENUATION, MR ENTEROGRAPHY, HISTOLOGIC-FINDINGS, MAGNETIC-RESONANCE, SEVERITY, MANAGEMENT, THICKNESS, PATIENT

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MLA
De Kock, Isabelle, et al. “Feasibility Study Using Iodine Quantification on Dual-Energy CT Enterography to Distinguish Normal Small Bowel from Active Inflammatory Crohn’s Disease.” ACTA RADIOLOGICA, vol. 60, no. 6, 2019, pp. 679–86.
APA
De Kock, I., Delrue, L., Lecluyse, C., Hindryckx, P., De Vos, M., & Villeirs, G. (2019). Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease. ACTA RADIOLOGICA, 60(6), 679–686.
Chicago author-date
De Kock, Isabelle, Louke Delrue, Clarisse Lecluyse, Pieter Hindryckx, Martine De Vos, and Geert Villeirs. 2019. “Feasibility Study Using Iodine Quantification on Dual-Energy CT Enterography to Distinguish Normal Small Bowel from Active Inflammatory Crohn’s Disease.” ACTA RADIOLOGICA 60 (6): 679–86.
Chicago author-date (all authors)
De Kock, Isabelle, Louke Delrue, Clarisse Lecluyse, Pieter Hindryckx, Martine De Vos, and Geert Villeirs. 2019. “Feasibility Study Using Iodine Quantification on Dual-Energy CT Enterography to Distinguish Normal Small Bowel from Active Inflammatory Crohn’s Disease.” ACTA RADIOLOGICA 60 (6): 679–686.
Vancouver
1.
De Kock I, Delrue L, Lecluyse C, Hindryckx P, De Vos M, Villeirs G. Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease. ACTA RADIOLOGICA. 2019;60(6):679–86.
IEEE
[1]
I. De Kock, L. Delrue, C. Lecluyse, P. Hindryckx, M. De Vos, and G. Villeirs, “Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease,” ACTA RADIOLOGICA, vol. 60, no. 6, pp. 679–686, 2019.
@article{8573111,
  abstract     = {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.},
  author       = {De Kock, Isabelle and Delrue, Louke and Lecluyse, Clarisse and Hindryckx, Pieter and De Vos, Martine and Villeirs, Geert},
  issn         = {0284-1851},
  journal      = {ACTA RADIOLOGICA},
  keywords     = {Computed tomography,CT,dual-energy CT,CT enterography,Crohn's disease,iodine quantification,COMPUTED-TOMOGRAPHY ENTEROGRAPHY,EVIDENCE-BASED CONSENSUS,MURAL ATTENUATION,MR ENTEROGRAPHY,HISTOLOGIC-FINDINGS,MAGNETIC-RESONANCE,SEVERITY,MANAGEMENT,THICKNESS,PATIENT},
  language     = {eng},
  number       = {6},
  pages        = {679--686},
  title        = {Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease},
  url          = {http://dx.doi.org/10.1177/0284185118799508},
  volume       = {60},
  year         = {2019},
}

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