Dual-Energy CT Enterography a Viable Alternative to Endoscopy for Crohn Disease

Crohn illness and intestine disease or crohns medical concept as human digestive colon with inflammation symptoms causing obstruction as a 3D illustration.
Researchers compared terminal ileum mucosal iodine density obtained with dual-energy computed tomography enterography vs endoscopy in patients with Crohn disease.

Dual-energy computed tomography (CT) enterography (DECTE) may be an acceptable surrogate to endoscopy for patients with Crohn disease (CD), according to study findings published in Abdominal Radiology.

Researchers conducted a retrospective database search from NYU Langone Health of patients (N=31) with CD who had CT and endoscopy data collected within 30 days of each other through 2021. Patients’ DECTE and endoscopy results were evaluated for their comparability in inflammation classifications.

Among the study cohort, patients had a mean age of 50.9±16.5 years, 58% were men, and 42% were women. Endoscopies were performed within a median 14 days of DECTE.

At endoscopy, 58.1% of patients were endoscopically active, with a median Simple Endoscopic Score for Crohn Disease of 3 (range, 0-90) and Rutgeert score of i2a (range, 0-4).

The mean normalized iodine density at DECTE was 37.6±13.6% among the cohort with active inflammation at endoscopy compared with 19.8±6.9% for those without active inflammation at endoscopy. The receiver operating characteristic curve (ROC) analysis found that the optimal iodine density cutoff for predicting inflammation was 24.6% (sensitivity, 94.4%; specificity, 92.3%; accuracy, 90.3%; area under the curve [AUC], 0.923; 95% CI, 0.815-1.000).

Patients with and without endoscopic inflammation had a mean absolute iodine density of 2.41±0.7 mg/mL and 1.78±1.1 mg/mL, respectively. The optimal ROC absolute iodine density cutoff was 1.77 mg/mL (sensitivity, 88.9%; specificity, 69.2%; accuracy, 80.6%; AUC, 0.739; 95% CI, 0.526-0.952).

The 2 DECTE imaging data reviewers interpreted the DECTE results correctly according to endoscopic status (sensitivity, 77.8%; specificity, 69.2%-92.3%; accuracy, 74.2%-83.9%).

Limitations of the study include the small sample size and the fact that DECTE has the ability to detect disease activity deeper than the mucosal layer, which is all that can be determined using endoscopy.

The study authors conclude, “This work establishes mean normalized iodine density as a reliable figure in defining active CD. Consequently, DECTE iodine density should be considered as a CD treatment target.” They add, “Despite trends towards improved diagnostic performance compared with conventional interpretation, future larger studies are needed.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


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. Published online July 14, 2022. doi:10.1007/s00261-022-03605-2