Application of spectral CT in diagnosis of gastrointestinal diseases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIE Linxu ¹ , ZENG Hanjiang ¹ , LI Zhengyan ¹ ,  LIU Xijiao ¹ , SHUAI Tao ¹ , HUANG Zixing ¹ , WU Bing ¹ , SONG Bin ^1,2

1. Department of Radiology, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of Radiology, Sanya People’s Hospital, Sanya, Hainan 572000, P. R. China;

Corresponding author：

LIU Xijiao, Email: bless_jiao@163.com

Keywords：

spectral CT; gastrointestinal disease; tomography; X-ray computer

DOI：

10.7507/1007-9424.202308066

Video：

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Objective To summarize the application of spectral CT in the diagnosis of common, frequently occurring, and acute severe gastrointestinal diseases. Method The literature and guidelines on spectral CT were reviewed, and the main conclusions and opinions were summarized. Results The spectral CT could obtain a variety of tissue parameters through a single scan. Through post-processing, multiple sequence images could be obtained, including virtual single-level images, virtual unenhanced images, iodine density images, effective atomic number images, etc. And multiple quantitative indicators could also be obtained, including iodine concentration, standardized iodine concentration, spectral curve, effective atomic number, etc. It could improve the signal-to-noise ratio of the image, reduce artifacts, increase iodine contrast, and decrease iodine load, then could improve the detection rate of active gastrointestinal bleeding and ischemic bowel diseases, improve the assessment accuracy of inflammatory activity of Crohn disease, and help to identify benign and malignant gastrointestinal tumors, determine the histological origin and evaluate the therapeutic effect. Conclusion From the conclusion summarized in this review, spectral CT images and quantitative indicators could provide more valuable information for detection, diagnosis, and prognosis of gastrointestinal diseases.

Citation： XIE Linxu, ZENG Hanjiang, LI Zhengyan, LIU Xijiao, SHUAI Tao, HUANG Zixing, WU Bing, SONG Bin. Application of spectral CT in diagnosis of gastrointestinal diseases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(11): 1313-1318. doi: 10.7507/1007-9424.202308066 Copy

1.	Adam SZ, Rabinowich A, Kessner R, et al. Spectral CT of the abdomen: where are we now?. Insights Imaging, 2021, 12(1): 138.
2.	中华医学会放射学分会, 中国医师协会放射医师分会, 安徽省影像临床医学研究中心. 能量CT临床应用中国专家共识. 中华放射学杂志, 2022, 56(5): 476-487.
3.	严福华, 金征宇. 开辟双能量CT临床应用的新时代. 中华放射学杂志, 2020, 54(6): 505-507.
4.	刘珮君, 王怡宁, 金征宇. 光谱CT在心血管病诊断中的临床应用. 中华放射学杂志, 2020, 54(6): 613-616.
5.	Okamura-Kawasaki M, Uesugi Y, Yabusaki S. Dual-energy CT for gastrointestinal bleeding. BJR Open, 2023, 5(1): 20220054.
6.	Murray N, Darras KE, Walstra FE, et al. Dual-energy CT in evaluation of the acute abdomen. Radiographics, 2019, 39(1): 264-286.
7.	Liu WD, Wu XW, Hu JM, et al. Monochromatic energy computed tomography image for active intestinal hemorrhage: a model investigation. World J Gastroenterol, 2015, 21(1): 214-220.
8.	Sun H, Hou XY, Xue HD, et al. Dual-source dual-energy CT angiography with virtual non-enhanced images and iodine map for active gastrointestinal bleeding: image quality, radiation dose and diagnostic performance. Eur J Radiol, 2015, 84(5): 884-891.
9.	Davarpanah AH, Ghamari Khameneh A, Khosravi B, et al. Many faces of acute bowel ischemia: overview of radiologic staging. Insights Imaging, 2021, 12(1): 56.
10.	Potretzke TA, Brace CL, Lubner MG, et al. Early small-bowel ischemia: dual-energy CT improves conspicuity compared with conventional CT in a swine model. Radiology, 2015, 275(1): 119-126.
11.	Lourenco PDM, Rawski R, Mohammed MF, et al. Dual-energy CT iodine mapping and 40-keV monoenergetic applications in the diagnosis of acute bowel ischemia. AJR Am J Roentgenol, 2018, 211(3): 564-570.
12.	陈晨, 魏晓磊, 朱小倩, 等. 双层探测器光谱CT肠系膜上动脉成像: 虚拟单能级图像与常规图像质量对比. 放射学实践, 2020, 35(12): 1572-1575.
13.	Albrecht MH, Vogl TJ, Martin SS, et al. Review of clinical applications for virtual monoenergetic dual-energy CT. Radiology, 2019, 293(2): 260-271.
14.	Obmann MM, Punjabi G, Obmann VC, et al. Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY), 2022, 47(5): 1660-1683.
15.	D’Angelo T, Cicero G, Mazziotti S, et al. Dual energy computed tomography virtual monoenergetic imaging: technique and clinical applications. Br J Radiol, 2019, 92(1098): 20180546.
16.	Petagna L, Antonelli A, Ganini C, et al. Pathophysiology of Crohn’s disease inflammation and recurrence. Biol Direct, 2020, 15(1): 23.
17.	Cushing K, Higgins PDR. Management of Crohn disease: a review. JAMA, 2021, 325(1): 69-80.
18.	Kim YS, Kim SH, Ryu HS, et al. Iodine quantification on spectral detector-based dual-energy CT enterography: correlation with Crohn’s disease activity index and external validation. Korean J Radiol, 2018, 19(6): 1077-1088.
19.	Lee SM, Kim SH, Ahn SJ, et al. Virtual monoenergetic dual-layer, dual-energy CT enterography: optimization of keV settings and its added value for Crohn’s disease. Eur Radiol, 2018, 28(6): 2525-2534.
20.	Peng JC, Feng Q, Zhu J, et al. Usefulness of spectral computed tomography for evaluation of intestinal activity and severity in ileocolonic Crohn’s disease. Therap Adv Gastroenterol, 2016, 9(6): 795-805.
21.	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 (NY), 2022, 47(10): 3406-3413.
22.	Dane B, Li X, Goldberg JD, et al. Crohn’s disease phenotype analysis with iodine density from dual-energy CT enterography. Abdom Radiol (NY), 2023, 48(7): 2219-2227.
23.	Eliahou R, Azraq Y, Carmi R, et al. Dual-energy based spectral electronic cleansing in non-cathartic computed tomography colonography: an emerging novel technique. Semin Ultrasound CT MR, 2010, 31(4): 309-314.
24.	Taguchi N, Oda S, Imuta M, et al. Dual-energy computed tomography colonography using dual-layer spectral detector computed tomography: utility of virtual monochromatic imaging for electronic cleansing. Eur J Radiol, 2018, 108: 7-12.
25.	崔百强, 马娅琼, 王文娜, 等. 双层探测器光谱CT在肿瘤疾病的临床应用进展. 放射学实践, 2022, 37(7): 904-909.
26.	Al-Najami I, Mahmoud Sheta H, Baatrup G. Differentiation between malignant and benign rectal tumors by dual-energy computed tomography—a feasibility study. Acta Oncol, 2019, 58(sup1): S55-S59.
27.	谭晶文, 朱兰, 王兰, 等. 新型双层探测器光谱CT在直肠癌术前T分期中的价值. 中华放射学杂志, 2020, 54(7): 671-676.
28.	Yang CB, Yu N, Jian YJ, et al. Spectral CT imaging in the differential diagnosis of small bowel adenocarcinoma from primary small intestinal lymphoma. Acad Radiol, 2019, 26(7): 878-884.
29.	陈琰, 文自强, 马钰茹, 等. 双层探测器光谱CT诊断结直肠癌区域转移淋巴结的价值. 中华放射学杂志, 2021, 55(12): 1253-1258.
30.	Qiu L, Hu J, Weng Z, et al. A prospective study of dual-energy computed tomography for differentiating metastatic and non-metastatic lymph nodes of colorectal cancer. Quant Imaging Med Surg, 2021, 11(8): 3448-3459.
31.	万幸, 赵心竹, 罗敏, 等. 结直肠癌双层探测器光谱CT成像: 转移性与非转移性淋巴结的对照研究. 放射学实践, 2021, 36(12): 1543-1547.
32.	潘馨梦, 赵卫, 付蓝琦, 等. 双层探测器光谱CT胃癌原发灶有效原子序数及碘浓度预测淋巴结转移. 临床放射学杂志, 2022, 41(11): 2068-2072.
33.	孟德杰, 刘洋, 王立兵, 等. 光谱双层探测器CT碘含量定量预测评估晚期胃癌治疗效果的价值. 医学影像学杂志, 2021, 31(7): 1200-1203, 1219.
34.	张玲玉, 张凯, 邓凯, 等. 能谱CT在食管胃结合部鳞癌与腺癌鉴别诊断中的初步研究. 中华放射学杂志, 2017, 51(8): 572-576.
35.	Ma YC, Zhang SH, Xie ZY, et al. Comparison of spectral computed tomography imaging parameters between squamous cell carcinoma and adenocarcinoma at the gastroesophageal junction. Technol Health Care, 2021, 29(4): 619-627.
36.	Zhou Y, Hou P, Zha K, et al. Spectral computed tomography for the quantitative assessment of patients with carcinoma of the gastroesophageal junction: initial differentiation between a diagnosis of squamous cell carcinoma and adenocarcinoma. J Comput Assist Tomogr, 2019, 43(2): 187-193.
37.	Wei W, Yu Y, Lv W, et al. Predictive value of dual-energy spectral computed tomographic imaging on the histological origin of carcinomas in the ampullary region. Abdom Imaging, 2014, 39(4): 702-710.
38.	Zhang X, Bai L, Wang D, et al. Gastrointestinal stromal tumor risk classification: spectral CT quantitative parameters. Abdom Radiol (NY), 2019, 44(7): 2329-2336.
39.	Mao LT, Chen WC, Lu JY, et al. Quantitative parameters in novel spectral computed tomography: assessment of Ki-67 expression in patients with gastric adenocarcinoma. World J Gastroenterol, 2023, 29(10): 1602-1613.
40.	王莉莉, 郑文霞, 贾应梅, 等. 基于双层探测器光谱CT定量参数分析直肠癌生物学特征. 放射学实践, 2022, 37(12): 1555-1560.
41.	Grosu S, Wang ZJ, Obmann MM, et al. Reduction of peristalsis-related streak artifacts on the liver with dual-layer spectral CT. Diagnostics (Basel), 2022, 12(4): 782.

1. Adam SZ, Rabinowich A, Kessner R, et al. Spectral CT of the abdomen: where are we now?. Insights Imaging, 2021, 12(1): 138.
2. 中华医学会放射学分会, 中国医师协会放射医师分会, 安徽省影像临床医学研究中心. 能量CT临床应用中国专家共识. 中华放射学杂志, 2022, 56(5): 476-487.
3. 严福华, 金征宇. 开辟双能量CT临床应用的新时代. 中华放射学杂志, 2020, 54(6): 505-507.
4. 刘珮君, 王怡宁, 金征宇. 光谱CT在心血管病诊断中的临床应用. 中华放射学杂志, 2020, 54(6): 613-616.
5. Okamura-Kawasaki M, Uesugi Y, Yabusaki S. Dual-energy CT for gastrointestinal bleeding. BJR Open, 2023, 5(1): 20220054.
6. Murray N, Darras KE, Walstra FE, et al. Dual-energy CT in evaluation of the acute abdomen. Radiographics, 2019, 39(1): 264-286.
7. Liu WD, Wu XW, Hu JM, et al. Monochromatic energy computed tomography image for active intestinal hemorrhage: a model investigation. World J Gastroenterol, 2015, 21(1): 214-220.
8. Sun H, Hou XY, Xue HD, et al. Dual-source dual-energy CT angiography with virtual non-enhanced images and iodine map for active gastrointestinal bleeding: image quality, radiation dose and diagnostic performance. Eur J Radiol, 2015, 84(5): 884-891.
9. Davarpanah AH, Ghamari Khameneh A, Khosravi B, et al. Many faces of acute bowel ischemia: overview of radiologic staging. Insights Imaging, 2021, 12(1): 56.
10. Potretzke TA, Brace CL, Lubner MG, et al. Early small-bowel ischemia: dual-energy CT improves conspicuity compared with conventional CT in a swine model. Radiology, 2015, 275(1): 119-126.
11. Lourenco PDM, Rawski R, Mohammed MF, et al. Dual-energy CT iodine mapping and 40-keV monoenergetic applications in the diagnosis of acute bowel ischemia. AJR Am J Roentgenol, 2018, 211(3): 564-570.
12. 陈晨, 魏晓磊, 朱小倩, 等. 双层探测器光谱CT肠系膜上动脉成像: 虚拟单能级图像与常规图像质量对比. 放射学实践, 2020, 35(12): 1572-1575.
13. Albrecht MH, Vogl TJ, Martin SS, et al. Review of clinical applications for virtual monoenergetic dual-energy CT. Radiology, 2019, 293(2): 260-271.
14. Obmann MM, Punjabi G, Obmann VC, et al. Dual-energy CT of acute bowel ischemia. Abdom Radiol (NY), 2022, 47(5): 1660-1683.
15. D’Angelo T, Cicero G, Mazziotti S, et al. Dual energy computed tomography virtual monoenergetic imaging: technique and clinical applications. Br J Radiol, 2019, 92(1098): 20180546.
16. Petagna L, Antonelli A, Ganini C, et al. Pathophysiology of Crohn’s disease inflammation and recurrence. Biol Direct, 2020, 15(1): 23.
17. Cushing K, Higgins PDR. Management of Crohn disease: a review. JAMA, 2021, 325(1): 69-80.
18. Kim YS, Kim SH, Ryu HS, et al. Iodine quantification on spectral detector-based dual-energy CT enterography: correlation with Crohn’s disease activity index and external validation. Korean J Radiol, 2018, 19(6): 1077-1088.
19. Lee SM, Kim SH, Ahn SJ, et al. Virtual monoenergetic dual-layer, dual-energy CT enterography: optimization of keV settings and its added value for Crohn’s disease. Eur Radiol, 2018, 28(6): 2525-2534.
20. Peng JC, Feng Q, Zhu J, et al. Usefulness of spectral computed tomography for evaluation of intestinal activity and severity in ileocolonic Crohn’s disease. Therap Adv Gastroenterol, 2016, 9(6): 795-805.
21. 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 (NY), 2022, 47(10): 3406-3413.
22. Dane B, Li X, Goldberg JD, et al. Crohn’s disease phenotype analysis with iodine density from dual-energy CT enterography. Abdom Radiol (NY), 2023, 48(7): 2219-2227.
23. Eliahou R, Azraq Y, Carmi R, et al. Dual-energy based spectral electronic cleansing in non-cathartic computed tomography colonography: an emerging novel technique. Semin Ultrasound CT MR, 2010, 31(4): 309-314.
24. Taguchi N, Oda S, Imuta M, et al. Dual-energy computed tomography colonography using dual-layer spectral detector computed tomography: utility of virtual monochromatic imaging for electronic cleansing. Eur J Radiol, 2018, 108: 7-12.
25. 崔百强, 马娅琼, 王文娜, 等. 双层探测器光谱CT在肿瘤疾病的临床应用进展. 放射学实践, 2022, 37(7): 904-909.
26. Al-Najami I, Mahmoud Sheta H, Baatrup G. Differentiation between malignant and benign rectal tumors by dual-energy computed tomography—a feasibility study. Acta Oncol, 2019, 58(sup1): S55-S59.
27. 谭晶文, 朱兰, 王兰, 等. 新型双层探测器光谱CT在直肠癌术前T分期中的价值. 中华放射学杂志, 2020, 54(7): 671-676.
28. Yang CB, Yu N, Jian YJ, et al. Spectral CT imaging in the differential diagnosis of small bowel adenocarcinoma from primary small intestinal lymphoma. Acad Radiol, 2019, 26(7): 878-884.
29. 陈琰, 文自强, 马钰茹, 等. 双层探测器光谱CT诊断结直肠癌区域转移淋巴结的价值. 中华放射学杂志, 2021, 55(12): 1253-1258.
30. Qiu L, Hu J, Weng Z, et al. A prospective study of dual-energy computed tomography for differentiating metastatic and non-metastatic lymph nodes of colorectal cancer. Quant Imaging Med Surg, 2021, 11(8): 3448-3459.
31. 万幸, 赵心竹, 罗敏, 等. 结直肠癌双层探测器光谱CT成像: 转移性与非转移性淋巴结的对照研究. 放射学实践, 2021, 36(12): 1543-1547.
32. 潘馨梦, 赵卫, 付蓝琦, 等. 双层探测器光谱CT胃癌原发灶有效原子序数及碘浓度预测淋巴结转移. 临床放射学杂志, 2022, 41(11): 2068-2072.
33. 孟德杰, 刘洋, 王立兵, 等. 光谱双层探测器CT碘含量定量预测评估晚期胃癌治疗效果的价值. 医学影像学杂志, 2021, 31(7): 1200-1203, 1219.
34. 张玲玉, 张凯, 邓凯, 等. 能谱CT在食管胃结合部鳞癌与腺癌鉴别诊断中的初步研究. 中华放射学杂志, 2017, 51(8): 572-576.
35. Ma YC, Zhang SH, Xie ZY, et al. Comparison of spectral computed tomography imaging parameters between squamous cell carcinoma and adenocarcinoma at the gastroesophageal junction. Technol Health Care, 2021, 29(4): 619-627.
36. Zhou Y, Hou P, Zha K, et al. Spectral computed tomography for the quantitative assessment of patients with carcinoma of the gastroesophageal junction: initial differentiation between a diagnosis of squamous cell carcinoma and adenocarcinoma. J Comput Assist Tomogr, 2019, 43(2): 187-193.
37. Wei W, Yu Y, Lv W, et al. Predictive value of dual-energy spectral computed tomographic imaging on the histological origin of carcinomas in the ampullary region. Abdom Imaging, 2014, 39(4): 702-710.
38. Zhang X, Bai L, Wang D, et al. Gastrointestinal stromal tumor risk classification: spectral CT quantitative parameters. Abdom Radiol (NY), 2019, 44(7): 2329-2336.
39. Mao LT, Chen WC, Lu JY, et al. Quantitative parameters in novel spectral computed tomography: assessment of Ki-67 expression in patients with gastric adenocarcinoma. World J Gastroenterol, 2023, 29(10): 1602-1613.
40. 王莉莉, 郑文霞, 贾应梅, 等. 基于双层探测器光谱CT定量参数分析直肠癌生物学特征. 放射学实践, 2022, 37(12): 1555-1560.
41. Grosu S, Wang ZJ, Obmann MM, et al. Reduction of peristalsis-related streak artifacts on the liver with dual-layer spectral CT. Diagnostics (Basel), 2022, 12(4): 782.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of spectral CT in diagnosis of gastrointestinal diseases

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