Imaging Institute - Cleveland Clinic, Cleveland, Ohio, USA.
Siemens Medical Solutions USA, Malvern, Pennsylvania, USA.
J Appl Clin Med Phys. 2024 Jan;25(1):e14235. doi: 10.1002/acm2.14235. Epub 2023 Dec 7.
The purpose of this investigation was to assess the effect of visceral adipose tissue volume (VA) on reader efficacy in diagnosing and characterizing small bowel Crohn's disease using lower exposure CT enterography (CTE). Secondarily, we investigated the effect of lower exposure and VA on reader diagnostic confidence.
Prospective paired investigation of 256 CTE, 129 with Crohn's disease, were reconstructed at 100% and simulated 50% and 30% exposure. The senior author provided the disease classification for the 129 patients with Crohn's disease. Patient VA was measured, and exams were evaluated by six readers for presence or absence of Crohn's disease and phenotype using a 0-10-point scale. Logistic regression models assessed the effect of VA on sensitivity and specificity.
The effect of VA on sensitivity was significantly reduced at 30% exposure (odds radio [OR]: 1.00) compared to 100% exposure (OR: 1.12) (p = 0.048). There was no statistically significant difference among the exposures with respect to the effect of visceral fat on specificity (p = 0.159). The study readers' probability of agreement with the senior author on disease classification was 60%, 56%, and 53% at 100%, 50%, and 30% exposure, respectively (p = 0.004). When detecting low severity Crohn's disease, readers' mean sensitivity was 83%, 75%, and 74% at 100%, 50%, and 30% exposure, respectively (p = 0.002). In low severity disease, sensitivity also tended to increase as visceral fat increased (ORs per 1000 cm increase in visceral fat: 1.32, 1.31, and 1.18, p = 0.010, 0.016, and 0.100, at 100%, 50%, and 30% exposure).
While the interaction is complex, VA plays a role in detecting and characterizing small bowel Crohn's disease when exposure is altered, particularly in low severity disease.
本研究旨在评估内脏脂肪组织体积（VA）对使用低剂量 CT 肠造影（CTE）诊断和特征化小肠克罗恩病的读者效能的影响。其次，我们研究了低剂量和 VA 对读者诊断信心的影响。
前瞻性配对研究了 256 例 CTE，其中 129 例患有克罗恩病，以 100%和模拟 50%和 30%的曝光率进行重建。资深作者对 129 例克罗恩病患者的疾病分类进行了评估。测量患者的 VA，并由六名读者使用 0-10 分制评估是否存在克罗恩病和表型。逻辑回归模型评估了 VA 对敏感性和特异性的影响。
与 100%暴露相比，30%暴露时 VA 对敏感性的影响显著降低（比值比 [OR]：1.00）（p=0.048）。在特异性方面，三种暴露方式之间 VA 对特异性的影响无统计学差异（p=0.159）。研究读者对疾病分类与资深作者的一致性概率分别为 60%、56%和 53%，在 100%、50%和 30%的暴露下（p=0.004）。在检测低严重程度的克罗恩病时，读者的平均敏感性分别为 83%、75%和 74%，在 100%、50%和 30%的暴露下（p=0.002）。在低严重程度的疾病中，随着内脏脂肪的增加，敏感性也有增加的趋势（每增加 1000cm 内脏脂肪的 OR：1.32、1.31 和 1.18，在 100%、50%和 30%的暴露下，p=0.010、0.016 和 0.100）。
尽管相互作用很复杂，但当暴露改变时，VA 在检测和特征化小肠克罗恩病方面发挥作用，尤其是在低严重程度的疾病中。
