Optimization of dual-energy CT enterography parameters for the assessment of Crohn’s disease activity: a retrospective study

Discuss the selection of imaging parameters in dual-energy CT enterography (DECTE) assessment for patients with Crohn’s disease (CD) at different activity levels.

This study analyzed data from 55 CD patients who had DECTE and endoscopy from 2020 to 2022. Patients were divided into moderate-severe (Crohn’s Disease Endoscopic Index of Severity (CDEIS) ≥ 10) and remission-mild (CDEIS < 10) groups. Imaging indicators such as intestinal wall thickness, iodine concentration (IC), and lesion wall enhancement (ΔHu) were compared, and their correlations with CDEIS scores were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate DECTE’s effectiveness in assessing CD activity with multiparameter versus single-parameter methods. Decision curve analysis (DCA) and calibration curve analysis (CCA) were applied to assess patient benefits from the multiparameter assessment model.

IC, ΔHu, wall thickness, and comb sign varied significantly between groups (P < 0.05). In the moderate–severe group, ΔHu correlated more strongly with CDEIS than in the remission–mild group. Lesion IC also highly correlated with CDEIS in both groups. DECTE, using multiparameter assessment, achieved an AUC of 0.933(95% CI 0.982–0.999, sensitivity was 0.906, specificity was 0.870) for diagnosing moderate to severe CD activity, surpassing single parameters assessment. CCA and DCA showed that multiparameter assessment had good calibration and net clinical benefits.

Compared to moderate-severe CD, the assessment of disease activity in patients with mild-moderate CD was more important using DECTE. A multiparameter assessment can enhance the diagnostic efficacy of DECT for patients with CD.