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Purpose <p>To prospectively evaluate the ability of extracellular volume (ECV) fraction, derived from dual-energy CT (DECT), to characterize fibrosis in bowel wall in participants with Crohn disease (CD).</p> Materials and methods <p>Routine CT enterography (CTE) and equilibrium-phase contrast-enhanced scanning were performed on DECT before elective surgery in patients with stricturing CD. For each resected bowel segment, the histopathological inflammatory activity was classified into three levels: mild, moderate, and severe, and the degree of fibrosis was similarly graded as mild, moderate, or severe based on histopathological assessment. The ECV fraction and normalized iodine density (ID) value, matched to the corresponding surgical specimen, was calculated and subsequently compared across segments with different histopathological grades of fibrosis and inflammatory activity.</p> Results <p>A total of 22 participants with 66 bowel segments were included in the study. The ECV fraction in moderate to severe fibrosis (45.4% ± 5.7%) was significantly higher than that in mild fibrosis (38.2% ± 4.7%) in the bowel segment with mild to moderate inflammatory activity (<i>p</i> &lt; 0.001), and could identify moderate to severe fibrosis in bowel segments with mild to moderate inflammatory activity, with an area under the ROC curve of 0.852 (95% confidence interval: 0.672–0.956). No significant difference in the ECV fraction was observed between segments with moderate to severe fibrosis (46.9% ± 3.9%) and those with mild fibrosis (46.0% ± 3.1%) among bowel segments with severe inflammatory activity (<i>p</i> = 0.45).</p> Conclusion <p>The ECV fraction derived from DECT was able to distinguish moderate to severe fibrosis from mild fibrosis in bowel segments with mild to moderate inflammatory activity, but failed to do so in segments with severe inflammatory activity.</p>

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Extracellular volume fraction derived from dual-energy CT characterizing the fibrosis of the bowel wall in stricturing Crohn disease

  • 期刊论文

  • 发表日期：

    2026年5月20日

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  • Meilin Gong,
  • Lili Liu,
  • Peipei He,
  • Yu Xu,
  • Jinsong Wu,
  • Hui Yao,
  • Wei Tan,
  • Xiaodi Zhang,
  • Lifeng li,
  • Yuanyuan Li,
  • Kang Li,
  • Furong Lv

摘要

Purpose

To prospectively evaluate the ability of extracellular volume (ECV) fraction, derived from dual-energy CT (DECT), to characterize fibrosis in bowel wall in participants with Crohn disease (CD).

Materials and methods

Routine CT enterography (CTE) and equilibrium-phase contrast-enhanced scanning were performed on DECT before elective surgery in patients with stricturing CD. For each resected bowel segment, the histopathological inflammatory activity was classified into three levels: mild, moderate, and severe, and the degree of fibrosis was similarly graded as mild, moderate, or severe based on histopathological assessment. The ECV fraction and normalized iodine density (ID) value, matched to the corresponding surgical specimen, was calculated and subsequently compared across segments with different histopathological grades of fibrosis and inflammatory activity.

Results

A total of 22 participants with 66 bowel segments were included in the study. The ECV fraction in moderate to severe fibrosis (45.4% ± 5.7%) was significantly higher than that in mild fibrosis (38.2% ± 4.7%) in the bowel segment with mild to moderate inflammatory activity (p < 0.001), and could identify moderate to severe fibrosis in bowel segments with mild to moderate inflammatory activity, with an area under the ROC curve of 0.852 (95% confidence interval: 0.672–0.956). No significant difference in the ECV fraction was observed between segments with moderate to severe fibrosis (46.9% ± 3.9%) and those with mild fibrosis (46.0% ± 3.1%) among bowel segments with severe inflammatory activity (p = 0.45).

Conclusion

The ECV fraction derived from DECT was able to distinguish moderate to severe fibrosis from mild fibrosis in bowel segments with mild to moderate inflammatory activity, but failed to do so in segments with severe inflammatory activity.