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Crohn’s disease active inflammation assessment with iodine density from dual-energy CT enterography: comparison with endoscopy and conventional interpretation

Abdominal Radiology volume 47, pages 3406–3413 (2022)Cite this article

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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Data availability

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Code availability

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Acknowledgements

We thank Kun Qian for assistance with statistical analysis.

Disclosures

BD: None, AL: None, TO: Siemens Healthineers employee, RP: None, WR: None, SB: None, SC None, AM: Consultant for Bracco Diagnostic Inc.

Funding

None.

Author information

Authors and Affiliations

  1. Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA

    Bari Dane, Amelia Kernizan, Robert Petrocelli & Alec Megibow

  2. Siemens Healthineers, 40 Liberty Blvd, Malvern, PA, 19355, USA

    Thomas O’Donnell

  3. Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA

    Bari Dane, Amelia Kernizan, Thomas O’Donnell, Robert Petrocelli, Wendy Rabbenou, Sumona Bhattacharya, Shannon Chang & Alec Megibow

  4. Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA

    Wendy Rabbenou, Sumona Bhattacharya & Shannon Chang

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  1. Bari Dane
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Correspondence to Bari Dane.

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Alec Megibow consultant for Bracco Inc, Thomas O’Donnell Siemens Healthineers employee.

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This study was institutional review board approved and Health Insurance Portability and Accountability Act compliant.

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Dane, B., Kernizan, A., O’Donnell, T. et al. Crohn’s disease active inflammation assessment with iodine density from dual-energy CT enterography: comparison with endoscopy and conventional interpretation. Abdom Radiol 47, 3406–3413 (2022). https://doi.org/10.1007/s00261-022-03605-2

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  • DOI: https://doi.org/10.1007/s00261-022-03605-2

Keywords

  • Crohn disease
  • Dual-energy CT enterography
  • CT enterography
  • Iodine density
  • Inflammatory bowel disease