Abstract
Dual-energy computed tomography (DECT) can estimate tissue vascularity and perfusion via iodine quantification. The aim of this systematic review was to outline current and emerging clinical applications of iodine quantification within the gastrointestinal tract using DECT. The search was conducted with three databases: EMBASE, Pubmed and The Cochrane Library. This identified 449 studies after duplicate removal. From a total of 570 selected studies, 30 studies were enrolled for the systematic review. The studies were categorized into four main topics: gastric tumors (12 studies), colorectal tumors (8 studies), Crohn’s disease (4 studies) and miscellaneous applications (6 studies). Findings included a significant difference in iodine concentration (IC) measurements in perigastric fat between T1–3 vs. T4 stage gastric cancer, poorly and well differentiated gastric and colorectal cancer, responders vs. non-responders following chemo- or chemoradiotherapy treatment among cancer patients, and a positive correlation between IC and Crohn’s disease activity. In conclusion, iodine quantification with DECT may be used preoperatively in cancer imaging as well as for monitoring treatment response. Future studies are warranted to evaluate the capabilities and limitations of DECT in splanchnic flow.
Highlights
Multi-detector computed tomography (MDCT) is the first-line imaging modality for various conditions ranging from acute bleedings [1] and acute intestinal ischemia [2] to Crohn’s disease [3]and gastrointestinal cancer [4,5]
The search was restricted to peer-reviewed publications of original research using the population, intervention, comparison and outcome approach (PICO) model [34]: the patient group had gastrointestinal-related conditions; the intervention consisted of Dual-energy computed tomography (DECT) examination from which iodine quantification (IQ) was measured; the comparison was to other verified methods of evaluation for the given condition, such as conventional CT, surgical findings, pathology, biochemistry, etc.; and the main outcome was establishing whether DECT examination and IQ measurements correlate with verified measures of evaluation
449 studies were screened based on set inclusion and exclusion criteria resulting in the inclusion of 30 studies (Figure 1)
Summary
Multi-detector computed tomography (MDCT) is the first-line imaging modality for various conditions ranging from acute bleedings [1] and acute intestinal ischemia [2] to Crohn’s disease [3]and gastrointestinal cancer [4,5]. Multi-detector computed tomography (MDCT) is the first-line imaging modality for various conditions ranging from acute bleedings [1] and acute intestinal ischemia [2] to Crohn’s disease [3]. While MDCT is based on X-ray emissions of one energy level, dual-energy computed tomography (DECT) acquires datasets at two different energy levels, either through emission or through separation at the detector level, providing new imaging and reconstruction possibilities [6]. Previous studies have reviewed DECT applications within the abdomen and gastrointestinal tract using virtual non-contrast (VNC) [12,13] and virtual monoenergetic (VM) reconstructions [14]. The purpose of this systematic review was to outline the clinical DECT applications of iodine quantification (IQ) in the gastrointestinal tract
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