Research in diagnostic and interventional imaging · 2022
CT in non-traumatic acute abdominal emergencies: Comparison of unenhanced acquisitions and single-energy iodine mapping for the characterization of bowel wall enhancement.
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Boyer Sophie, Lombard Charles, Urbaneja Ayla, Vogrig Céline, Regent Denis, Blum Alain, Teixeira Pedro Augusto Gondim
Аннотация
OBJECTIVES: 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.
METHODS: 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.
RESULTS: 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 (P = 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).
CONCLUSION: 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.
SUMMARY SENTENCE: 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.
METHODS: 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.
RESULTS: 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 (P = 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).
CONCLUSION: 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.
SUMMARY SENTENCE: 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.