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.	中華醫學會放射學分會, 中國醫師協會放射醫師分會, 安徽省影像臨床醫學研究中心. 能量CT臨床應用中國專家共識. 中華放射學雜志, 2022, 56(5): 476-487.
3.	嚴福華, 金征宇. 開辟雙能量CT臨床應用的新時代. 中華放射學雜志, 2020, 54(6): 505-507.
4.	劉珮君, 王怡寧, 金征宇. 光譜CT在心血管病診斷中的臨床應用. 中華放射學雜志, 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.	陳晨, 魏曉磊, 朱小倩, 等. 雙層探測器光譜CT腸系膜上動脈成像: 虛擬單能級圖像與常規圖像質量對比. 放射學實踐, 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.	崔百強, 馬婭瓊, 王文娜, 等. 雙層探測器光譜CT在腫瘤疾病的臨床應用進展. 放射學實踐, 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.	譚晶文, 朱蘭, 王蘭, 等. 新型雙層探測器光譜CT在直腸癌術前T分期中的價值. 中華放射學雜志, 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.	陳琰, 文自強, 馬鈺茹, 等. 雙層探測器光譜CT診斷結直腸癌區域轉移淋巴結的價值. 中華放射學雜志, 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.	萬幸, 趙心竹, 羅敏, 等. 結直腸癌雙層探測器光譜CT成像: 轉移性與非轉移性淋巴結的對照研究. 放射學實踐, 2021, 36(12): 1543-1547.
32.	潘馨夢, 趙衛, 付藍琦, 等. 雙層探測器光譜CT胃癌原發灶有效原子序數及碘濃度預測淋巴結轉移. 臨床放射學雜志, 2022, 41(11): 2068-2072.
33.	孟德杰, 劉洋, 王立兵, 等. 光譜雙層探測器CT碘含量定量預測評估晚期胃癌治療效果的價值. 醫學影像學雜志, 2021, 31(7): 1200-1203, 1219.
34.	張玲玉, 張凱, 鄧凱, 等. 能譜CT在食管胃結合部鱗癌與腺癌鑒別診斷中的初步研究. 中華放射學雜志, 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, 鄭文霞, 賈應梅, 等. 基于雙層探測器光譜CT定量參數分析直腸癌生物學特征. 放射學實踐, 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. 中華醫學會放射學分會, 中國醫師協會放射醫師分會, 安徽省影像臨床醫學研究中心. 能量CT臨床應用中國專家共識. 中華放射學雜志, 2022, 56(5): 476-487.
3. 嚴福華, 金征宇. 開辟雙能量CT臨床應用的新時代. 中華放射學雜志, 2020, 54(6): 505-507.
4. 劉珮君, 王怡寧, 金征宇. 光譜CT在心血管病診斷中的臨床應用. 中華放射學雜志, 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. 陳晨, 魏曉磊, 朱小倩, 等. 雙層探測器光譜CT腸系膜上動脈成像: 虛擬單能級圖像與常規圖像質量對比. 放射學實踐, 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. 崔百強, 馬婭瓊, 王文娜, 等. 雙層探測器光譜CT在腫瘤疾病的臨床應用進展. 放射學實踐, 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. 譚晶文, 朱蘭, 王蘭, 等. 新型雙層探測器光譜CT在直腸癌術前T分期中的價值. 中華放射學雜志, 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. 陳琰, 文自強, 馬鈺茹, 等. 雙層探測器光譜CT診斷結直腸癌區域轉移淋巴結的價值. 中華放射學雜志, 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. 萬幸, 趙心竹, 羅敏, 等. 結直腸癌雙層探測器光譜CT成像: 轉移性與非轉移性淋巴結的對照研究. 放射學實踐, 2021, 36(12): 1543-1547.
32. 潘馨夢, 趙衛, 付藍琦, 等. 雙層探測器光譜CT胃癌原發灶有效原子序數及碘濃度預測淋巴結轉移. 臨床放射學雜志, 2022, 41(11): 2068-2072.
33. 孟德杰, 劉洋, 王立兵, 等. 光譜雙層探測器CT碘含量定量預測評估晚期胃癌治療效果的價值. 醫學影像學雜志, 2021, 31(7): 1200-1203, 1219.
34. 張玲玉, 張凱, 鄧凱, 等. 能譜CT在食管胃結合部鱗癌與腺癌鑒別診斷中的初步研究. 中華放射學雜志, 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, 鄭文霞, 賈應梅, 等. 基于雙層探測器光譜CT定量參數分析直腸癌生物學特征. 放射學實踐, 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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