Purpose
To determine optimal iodine density thresholds for active inflammation in CD patients with PCCT enterography and determine if iodine density can be used to stratify CD activity severity.
...Methods
A retrospective PACS search identified patients with CD imaged with PCCT enterography from 4/11/2022 to 10/30/2022 and with clinical notes, endoscopic/surgical pathology and available source PCCT data for iodine density analysis. Two abdominal radiologists with expertise in CD each drew two region of interest measurements within the visibly most affected region of terminal or neoterminal ileum wall on commercially available system (SyngoVia). Radiologists were blinded to clinical information and pathologic findings. Disease activity and severity were recorded from the pathology report. Harvey–Bradshaw Index, medications, and laboratory values were recorded. Receiver operating characteristic (ROC) curves were utilized to determine the optimum iodine density threshold for active inflammation and mild versus moderate-to-severe inflammation. Intra- and inter-reader agreement was assessed by intra-class correlation coefficient (ICC).
Results
23 CD patients (15 females; mean SD age: 52 17 years) imaged with PCCT enterography were included. 15/23 had active inflammation: 9/15 mild, 4/15 moderate, and 2/15 severe active inflammation. The optimal iodine density threshold for active inflammation was 2.7 mg/mL, with 97% sensitivity, 100% specificity, and 98% accuracy (AUC = 1.00). The optimal iodine density threshold for distinguishing mild from moderate-to-severe inflammation was 3.4 mg/mL, with 83% sensitivity, 89% specificity, and 87% accuracy (AUC = 0.85). Intra-reader reliability (R1/R2) ICC was 0.81/0.86. Inter-reader reliability ICC was 0.94.
Conclusion
Iodine density from PCCT enterography can distinguish mild from moderate-to-severe active inflammation.
Graphical abstract
MRI of the ileal pouch Huang, Chenchan; Dane, Bari; Santillan, Cynthia ...
Abdominal radiology (New York),
09/2023, Letnik:
48, Številka:
9
Journal Article
Recenzirano
Ileal pouch surgery is the surgical gold standard treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). However, ileal pouch surgery is a technically ...challenging procedure and is associated with high morbidity. Clinical presentations of pouch complications are often nonspecific but imaging can identify many of these complications and is essential in clinical management. This paper will focus on magnetic resonance imaging (MRI) of the ileal pouch, including recommended MRI protocol and approach to imaging interpretation with an emphasis on those ileal pouch complications particularly well evaluated with MRI.
Objective
To analyze the findings of proctitis in patients with laboratory-confirmed Mpox and correlate the patient clinical presentation and laboratory findings.
Methods
21 patients with ...PCR-positive Mpox who obtained abdominopelvic CT were retrospectively identified by electronic medical record search. Three radiologists independently evaluated CT images, measuring rectal wall thickness (cm), degree of perirectal fat stranding on a 5-point Likert scale, and size of perirectal lymph nodes (cm, short axis). Mann–Whitney U-test (Wilcoxon rank sum test) was used to assess the association of rectal wall thickness and perirectal fat standing between patients with rectal symptoms and patients without rectal symptoms.
Results
20 of 21 patients presented with perirectal fat stranding, with mean Likert score of 3.0 ± 1.4, indicating moderate perirectal stranding. Mean transverse rectal wall thickness was 1.1 ± 0.5 cm (range 0.3–2.3 cm); it was thicker among patients with HIV (1.2 cm vs 0.7 cm;
p
= .019). Mean perirectal fat stranding was greater among patients presenting with HIV, and with rectal symptoms, though not significantly so. 17/21 (81%) patients had abnormal mesorectal lymph nodes by at least two of three readers, with mean short-axis measurement 1.0 ± 0.3 cm (range 0.5–1.6 cm). Multiple linear regression showed no significant correlation between rectal thickness and laboratory values or HIV status.
Conclusion
Nearly all patients with Mpox who presented with additional symptoms warranting a CT demonstrated proctitis. Degree of proctitis varied greatly within the cohort, with greatest thickening among patients with HIV. Physicians should have a high suspicion for proctitis in patients with suspected Mpox.
MR enterography (MRE) protocols used in patients with Crohn disease are burdened by long acquisition time, high cost, and suboptimal patient experience. For several indications, highly diagnostic MRE ...can be performed in five or fewer sequences, without IV contrast material or antiperistaltic medication and with an examination room time of less than 12 minutes. As such, MRE could be more patient friendly, more frequently performed, and require fewer health care resources.
•Body composition at CT can identify Covid-19 patients that may need hospitalization.•A model with CT parameters outperforms clinical model in predicting hospitalization.•Reliable prediction of ...hospitalization in Covid-19 patients can optimize resources.
To assess prognostic value of body composition parameters measured at CT to predict risk of hospitalization in patients with COVID-19 infection.
177 patients with SARS-CoV-2 infection and with abdominopelvic CT were included in this retrospective IRB approved two-institution study. Patients were stratified based on disease severity as outpatients (no hospital admission) and patients who were hospitalized (inpatients). Two readers blinded to the clinical outcome segmented axial CT images at the L3 vertebral body level for visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), muscle adipose tissue (MAT), muscle mass (MM). VAT to total adipose tissue ratio (VAT/TAT), MAT/MM ratio, and muscle index (MI) at L3 were computed. These measures, along with detailed clinical risk factors, were compared in patients stratified by severity. Various logistic regression clinical and clinical + imaging models were compared to discriminate inpatients from outpatients.
There were 76 outpatients (43%) and 101 inpatients. Male gender (p = 0.013), age (p = 0.0003), hypertension (p = 0.0003), diabetes (p = 0.0001), history of cardiac disease (p = 0.007), VAT/TAT (p < 0.0001), and MAT/MM (p < 0.0001), but not BMI, were associated with hospitalization. A clinical model (age, gender, BMI) had AUC of 0.70. Addition of VAT/TAT to the clinical model improved the AUC to 0.73. Optimal model that included gender, BMI, race (Black), MI, VAT/TAT, as well as interaction between gender and VAT/TAT and gender and MAT/MM demonstrated the highest AUC of 0.83.
MAT/MM and VAT/TAT provides important prognostic information in predicting patients with COVID-19 who are likely to require hospitalization.
The management and understanding of Crohn's disease (CD) continues to evolve quickly. Intestinal strictures were previously thought to be an inevitable result of irreversible fibrosis caused by ...chronic inflammation. However, increased understanding of the dynamic nature of strictures and of the pathophysiology of this condition has highlighted emerging targets for potential treatment. In the diagnosis of strictures, a distinction must be made between inflammatory and fibrotic types, as the former may respond to medical therapy. Emerging technologies, such as dual-energy computed tomography enterography and iodine density, have allowed more accurate characterization of strictures. Surgical and endoscopic treatment remains the mainstay for fibrotic strictures, but developments in systemic and intralesional biologic therapy have shown efficacy. This article reviews the pathophysiology of this debilitating complication of CD as well as current and emerging diagnostics and treatments.
The purpose of this article is to describe arterial and venous thromboembolism in the abdomen, pelvis, and lower extremities in patients with coronavirus disease (COVID-19). Eighty-two patients with ...COVID-19 who underwent abdominal ultrasound or CT were retrospectively compared with 82 patients without COVID-19 for thromboembolism and solid-organ infarction. Nine (11%) patients with COVID-19 had thromboembolic findings, with medium to large arterial thrombi in five. One patient without COVID-19 had known portal vein thrombus on CT. Thromboembolic findings occurred more frequently in patients with than without COVID-19 (
= 0.02).
The objective of this study was to determine if dual-energy computed tomography enterography (DECTE)-obtained iodine density can predict medical management change or surgery in Crohn disease ...patients.
The most active-appearing bowel segment on DECTE in 21 Crohn disease patients was retrospectively interrogated with prototype software determining the percentage of bowel wall (I) in specified ranges. Patients were categorized into 3 groups after DECTE: (1) no management change, (2) outpatient medication change, and (3) inpatient admission or surgery. Crohn's disease activity index was calculated. Group 3's percentage iodine density of >3 mg/mL and Crohn's disease activity index were compared with group 1/2. Crohn's disease activity index and percentage iodine density of >2 mg/mL were compared for groups 2/3 versus group 1 patients.
There were 5 group 1, 6 group 2, and 10 group 3 patients. Group 3 patients had higher frequency of iodine density >3 mg/mL (27%) compared with groups 1/2 patients (12.6%) (P < 0.05). Crohn's disease activity index was similar (P = 0.98). Groups 2/3 patients had 60.5% iodine density of >2 mg/mL, whereas group 1 patients had 31.7% iodine density of >2 mg/mL (P < 0.05). Crohn's disease activity index was similar (P = 0.12).
Iodine density from DECTE may predict medical or surgical Crohn disease management.
This study aimed to compare the image quality of portal venous phase-derived virtual noncontrast (VNC) images from photon-counting computed tomography (PCCT) with energy-integrating dual-energy ...computed tomography (EI-DECT) in the same patient using quantitative and qualitative analyses.
Consecutive patients retrospectively identified with available portal venous phase-derived VNC images from both PCCT and EI-DECT were included. Patients without available VNC in picture archiving and communication system in PCCT or prior EI-DECT and non-portal venous phase acquisitions were excluded. Three fellowship-trained radiologists blinded to VNC source qualitatively assessed VNC images on a 5-point scale for overall image quality, image noise, small structure delineation, noise texture, artifacts, and degree of iodine removal. Quantitative assessment used region-of-interest measurements within the aorta at 4 standard locations, both psoas muscles, both renal cortices, spleen, retroperitoneal fat, and inferior vena cava. Attenuation (Hounsfield unit), quantitative noise (Hounsfield unit SD), contrast-to-noise ratio (CNR) (CNR vascular , CNR kidney , CNR spleen , CNR fat ), signal-to-noise ratio (SNR) (SNR vascular , SNR kidney , SNR spleen , SNR fat ), and radiation dose were compared between PCCT and EI-DECT with the Wilcoxon signed rank test. A P < 0.05 indicated statistical significance.
A total of 74 patients (27 men; mean ± SD age, 63 ± 13 years) were included. Computed tomography dose index volumes for PCCT and EI-DECT were 9.2 ± 3.5 mGy and 9.4 ± 9.0 mGy, respectively ( P = 0.06). Qualitatively, PCCT VNC images had better overall image quality, image noise, small structure delineation, noise texture, and fewer artifacts (all P < 0.00001). Virtual noncontrast images from PCCT had lower attenuation (all P < 0.05), noise ( P = 0.006), and higher CNR ( P < 0.0001-0.04). Contrast-enhanced structures had lower SNR on PCCT ( P = 0.001, 0.002), reflecting greater contrast removal. The SNRfat (nonenhancing) was higher for PCCT than EI-DECT ( P < 0.00001).
Virtual noncontrast images from PCCT had improved image quality, lower noise, improved CNR and SNR compared with those derived from EI-DECT.
Purpose
To quantitatively and qualitatively compare the degree of iodine removal in the collecting system from PCCT urographic phase-derived virtual noncontrast (VNC) images obtained at 140 kV versus ...120 kV.
Methods
A retrospective PACS search identified adult patients (>18 years) who underwent a PCCT urogram for hematuria from 4/2022 to 4/2023 with available urographic phase-derived VNC images in PACS. Tube voltage (120 kV, 140 kV), body mass index, CTDIvol, dose length product (DLP), and size-specific dose estimate (SSDE) were recorded. Hounsfield Unit (HU) in both renal pelvises and the urinary bladder on urographic-derived VNC were recorded. Three radiologists qualitatively assessed the degree of iodine removal (renal pelvis, urinary bladder) and diagnostic confidence for urinary stone detection. Continuous variables were compared for 140 kV versus 120 kV with the Wilcoxon rank sum test. A
p
< .05 indicated statistical significance.
Results
63 patients (34 male; median (Q1, Q3) age: 30 (26, 34) years; 140 kV/120 kV: 30 patients/33 patients) were included. BMI, CTDIvol, DLP, and SSDE were not different for 140 kV and 120 kV (all
p
> .05). Median (Q1, Q3) collecting system HU (renal pelvis and bladder) was 0.9 (− 3.6, 4.4) HU at 140 kV and 10.5 (3.6, 26.7) HU at 120 kV (
p
= .04). Diagnostic confidence for urinary calculi was 4.6 1.1 at 140 kV and 4.1 1.4 at 120 kV (
p
= .005). Diagnostic confidence was 5/5 (all readers) in 82.2% (74/90) at 140 kV and 59.6% (59/99) at 120 kV (
p
< .001).
Conclusion
PCCT urographic phase-derived VNC images obtained at 140 kV had better collecting system iodine removal than 120 kV with similar patient radiation exposure. With excellent PCCT urographic phase iodine removal at 140 kV, consideration can be made to utilize a single-phase CT urogram in young patients.
Graphical abstract
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