Boyer Sophie, Lombard Charles, Urbaneja Ayla, Vogrig Céline, Regent Denis, Blum Alain, Teixeira Pedro Augusto Gondim
Guilloz imaging department, Central Hospital, University Hospital Center of Nancy, 29 avenue du Maréchal de Lattre de Tassigny, 54035 Nancy cedex, France.
Res Diagn Interv Imaging. 2022 Aug 8;2:100010. doi: 10.1016/j.redii.2022.100010. eCollection 2022 Jun.
To evaluate the benefit of unenhanced CT and single energy iodine mapping (SIM) to conventional contrast-enhanced CT for bowel wall enhancement characterization in an acute abdomen setting.
CT images from 45 patients with a suspected acute abdomen who underwent abdominopelvic CT from April 2018 to June 2018 were analyzed retrospectively by two independent radiologists. These patients had been referred by emergency department physicians in a context of acute abdominal pain and had a confirmed etiological diagnosis. Three image sets were evaluated separately (portal phase images alone; portal phase images and unenhanced images, portal phase images, and single energy iodine maps). Diagnostic accuracy and confidence were assessed. Quantitative analysis of bowel wall enhancement was also performed.
The number of correct diagnoses increased by 8% and 12% with unenhanced images and 6% and 13% with SIM for readers 1 and 2, respectively, compared to the portal phase only. There was an improvement in the confidence of the etiological diagnosis with the number of certain diagnoses increasing from 23% to 100%, which was statistically significant for reader 2 and of borderline significance for reader 1 ( = 0.002 and 0.052, respectively) when unenhanced phase and SIM were added. The inter-rater agreement improved when unenhanced and portal phase images were associated, compared to portal phase images alone (kappa = 0.652 [ICC=0.482-0.822] and 0.42 [ICC=0.241-0.607] respectively).
SIM and unenhanced images improve the reproducibility and the diagnostic confidence to diagnose ischemic and inflammatory/infectious bowel wall thickening compared to portal phase images alone.
The analysis of unenhanced and SIM images in association with portal phase images improves the reproducibility and the radiologist's confidence in the etiological diagnosis of acute non-traumatic bowel wall thickening in adults.
评估在急腹症情况下，非增强CT及单能量碘图（SIM）相较于传统对比增强CT在肠壁强化特征分析方面的优势。
对2018年4月至2018年6月期间因疑似急腹症接受腹部盆腔CT检查的45例患者的CT图像进行回顾性分析，由两名独立的放射科医生进行评估。这些患者由急诊科医生因急性腹痛转诊而来，且病因诊断明确。分别评估三组图像（仅门静脉期图像；门静脉期图像与非增强图像；门静脉期图像与单能量碘图）。评估诊断准确性和信心度，并对肠壁强化进行定量分析。
与仅门静脉期图像相比，对于读者1和读者2，非增强图像分别使正确诊断数量增加了8%和12%，单能量碘图分别使其增加了6%和13%。病因诊断的信心度有所提高，明确诊断数量从23%增至100%，添加非增强期和单能量碘图时，读者2的差异具有统计学意义，读者1的差异具有临界统计学意义（分别为P = 0.002和0.052）。与仅门静脉期图像相比，当非增强图像与门静脉期图像联合使用时，观察者间一致性得到改善（kappa值分别为0.652 [ICC = 0.482 - 0.822]和0.42 [ICC = 0.241 - 0.607]）。
与仅门静脉期图像相比，单能量碘图和非增强图像可提高诊断缺血性及炎症/感染性肠壁增厚的可重复性和诊断信心度。
非增强图像和单能量碘图与门静脉期图像联合分析可提高成人急性非创伤性肠壁增厚病因诊断的可重复性及放射科医生的信心度。
