Lamant Flora, Simon Gabriel, Busse-Coté Andreas, Hassoun Youness, Roussel Bastien, Verdot Pierre, Doussot Alexandre, Lakkis Zaher, Delabrousse Eric, Calame Paul
Department of Radiology, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France.
Department of Digestive Surgery, University of Franche-Comté, CHRU Besançon, 25000 Besançon, France.
Diagn Interv Imaging. 2025 Apr;106(4):126-134. doi: 10.1016/j.diii.2024.10.009. Epub 2024 Nov 16.
The purpose of this study was to determine whether dual-energy computed tomography (DECT), specifically by measuring bowel wall iodine concentration (BWIC), is superior to monoenergetic reconstructions (MR) for the diagnosis and staging of small bowel ischemia in patients with mechanical small bowel obstruction (SBO).
From November 2021 to December 2023, all patients with mechanical SBO who underwent contrast-enhanced DECT of the abdomen and pelvis were evaluated for inclusion. Demographic, clinical and biochemical data were collected. Two abdominal radiologists, blinded to all patient information, reviewed all DECT examinations. Conventional CT features (including a closed loop mechanism, mesenteric haziness, decreased bowel wall enhancement (DBE), and increased unenhanced attenuation of the bowel wall) were first reviewed on 70-keV-MR and 40-keV-MR, followed by BWIC measurements in five regions of interest in the walls of both normal and abnormal small bowel loops. The diagnostic performance of a simple CT score, which included a closed loop mechanism, mesenteric haziness and DBE, was compared to that of BWIC measurements made on dilated and/or abnormal small bowel segments for the diagnosis of small bowel ischemia. The diagnostic capabilities were compared using areas under the receiver operating characteristic curves (AUCs).
A total of 142 patients were included (80 men, 62 women; mean age, 67 ± 17 [standard deviation (SD)] years). Fifty-six patients underwent surgery; 22 of them had confirmed small bowel ischemia, including 12 patients with small bowel necrosis requiring surgical resection. Significant differences in mean BWIC were found between patients without small bowel ischemia (1.73 ± 0.44 [SD] mg/mL), those with small bowel ischemia without necrosis (0.79 ± 0.37 [SD] mg/mL), and those with small bowel ischemia and necrosis (0.48 ± 0.32 [SD] mg/mL) (P < 0.001). The overall AUC of the BWIC measurement for diagnosing small bowel ischemia was 0.98 (95 % confidence interval [CI]: 0.97-1.00), similar to the AUC of the simple CT score (0.97; 95 % CI: 0.92-1.00). However, using a cut off-value of 1.16 mgI/mL, BWIC outperformed subjective assessment of DBE at 70-keV-MR and 40-keV-MR (Youden index, 0.90 vs. 0.54 and vs. 0.71, respectively) (P < 0.001 for both).
BWIC measurement outperforms subjective assessment of DBE for the diagnosis of small bowel ischemia in patients with SBO and can allow stratification of ischemia. However, BWIC does not outperfomr a global comprehensive analysis of conventional CT images.
本研究旨在确定双能计算机断层扫描（DECT），特别是通过测量肠壁碘浓度（BWIC），在诊断和分期机械性小肠梗阻（SBO）患者的小肠缺血方面是否优于单能重建（MR）。
2021年11月至2023年12月，对所有接受腹部和盆腔对比增强DECT检查的机械性SBO患者进行纳入评估。收集人口统计学、临床和生化数据。两位腹部放射科医生在对所有患者信息不知情的情况下，对所有DECT检查进行了复查。首先在70 keV-MR和40 keV-MR上复查常规CT特征（包括闭袢机制、肠系膜模糊、肠壁强化减弱（DBE）和肠壁平扫衰减增加），然后在正常和异常小肠袢壁的五个感兴趣区域测量BWIC。将包括闭袢机制、肠系膜模糊和DBE的简单CT评分的诊断性能与在扩张和/或异常小肠段上进行的BWIC测量对小肠缺血的诊断性能进行比较。使用受试者操作特征曲线（AUC）下的面积比较诊断能力。
共纳入142例患者（80例男性，62例女性；平均年龄67±17[标准差（SD）]岁）。56例患者接受了手术；其中22例确诊为小肠缺血，包括12例需要手术切除的小肠坏死患者。在无小肠缺血的患者（1.73±0.44[SD]mg/mL）、有小肠缺血但无坏死的患者（0.79±0.37[SD]mg/mL）和有小肠缺血且坏死的患者（0.48±0.32[SD]mg/mL）之间，平均BWIC存在显著差异（P<0.001）。BWIC测量诊断小肠缺血的总体AUC为0.98（95%置信区间[CI]：0.97 - 1.00），与简单CT评分的AUC（0.97；95%CI：0.92 - 1.00）相似。然而，使用1.16 mgI/mL的截断值时，BWIC在诊断性能上优于70 keV-MR和40 keV-MR上的DBE主观评估（约登指数分别为0.90对0.54和0.71）（两者P均<0.001）。
在诊断SBO患者的小肠缺血方面，BWIC测量优于DBE主观评估，并且可以对缺血进行分层。然而，BWIC在对传统CT图像进行全面综合分析方面并不优于传统方法。
