scholarly journals Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review

Diagnostics ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 814
Author(s):  
Jack Junchi Xu ◽  
Mikkel Taudorf ◽  
Peter Sommer Ulriksen ◽  
Michael Patrick Achiam ◽  
Timothy Andrew Resch ◽  
...  
Keyword(s):  
Systematic Review ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Iodine Concentration ◽  
Dual Energy ◽  
Cochrane Library ◽  
Dual Energy Ct ◽  
Iodine Quantification ◽  
Significant Difference ◽  
Well Differentiated

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.

scholarly journals Methotrexate for the Treatment of Pediatric Crohn’s Disease: A Systematic Review and Meta-analysis

2018 ◽  
Vol 24 (10) ◽  
pp. 2135-2141 ◽  
Author(s):  
Ruben J Colman ◽  
Rachel C Lawton ◽  
Marla C Dubinsky ◽  
David T Rubin
Keyword(s):  
Systematic Review ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Treatment Efficacy ◽  
Clinical Remission ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Free Text ◽  
Pediatric Ibd

Abstract Background Methotrexate (MTX) is an immunomodulator used for the treatment of pediatric inflammatory bowel disease (IBD). There are currently no RCTs that assess the treatment efficacy of methotrexate within the pediatric IBD patient population. This systematic review and meta-analysis assesses the efficacy of MTX therapy among the existing pediatric literature. Methods A systematic literature search was performed using MEDLINE and the Cochrane library from inception until March 2016. Synonyms for ‘pediatric’, ‘methotrexate’ and ‘IBD’ were utilized as both free text and MESH search terms. The studies included contained clinical remission (CR) rates for MTX treatment of pediatric IBD patients 18 yrs old, as mono- or combination therapy. Case studies with <10 patients were excluded. Quality assessment was performed with the Newcastle-Ottawa Scale. Meta-analysis calculated pooled CR rates. A random-effects meta-analysis with forest plots was performed using R. Results Fourteen (11 monotherapy, 1 combination therapy, 2 both; n = 886 patients) observational studies were eligible out of 202 studies. No interventional studies were identified. The pooled achieved CR rate for pediatric CD patients on monotherapy within 3-6 months was 57.7% (95% CI 48.2-66.6%), (P =0.22; I2 = 29.8%). The CR was 37.1% (95% CI 29.5-45.5%), (P = 0.20; I2 = 37.4%) for maintenance therapy at 12 months. Sub-analysis could not identify CR differences between MTX administration types, thiopurine exposure. Conclusions This meta-analysis demonstrated that, over 50% of pediatric Crohn’s disease patients induced with methotrexate achieved clinical remission, while 12-month remission rate was only 37%. Prospective controlled interventional trials should assess treatment efficacy among patient subgroups.

Dual-energy CT enterography in evaluation of Crohn’s disease: the role of virtual monochromatic images

2020 ◽  
Author(s):  
Ezgi Guler ◽  
Nalan Gulsen Unal ◽  
Ilhan Hekimsoy ◽  
Timur Kose ◽  
Mustafa Harman ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Ct Enterography

Virtual monoenergetic dual-layer, dual-energy CT enterography: optimization of keV settings and its added value for Crohn’s disease

2018 ◽  
Vol 28 (6) ◽  
pp. 2525-2534 ◽  
Author(s):  
Sang Min Lee ◽  
Se Hyung Kim ◽  
Su Joa Ahn ◽  
Hyo-Jin Kang ◽  
Ji Hee Kang ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Dual Energy ◽  
Added Value ◽  
Dual Energy Ct ◽  
Ct Enterography

scholarly journals Probiotics as a Coadjuvant Factor in Active or Quiescent Inflammatory Bowel Disease of Adults—A Meta-Analytical Study

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2628
Author(s):  
Manuel Pabón-Carrasco ◽  
Lucia Ramirez-Baena ◽  
Samuel Vilar-Palomo ◽  
Aurora Castro-Méndez ◽  
Raúl Martos-García ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ulcerative Colitis ◽  
Crohn’S Disease ◽  
Relative Risk ◽  
Crohn's Disease ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Unknown Etiology ◽  
Human Beings ◽  
Inflammatory Bowel

(1) Background: Inflammatory bowel diseases are pathologies of unknown etiology and auto-immune pathogenia. The use of probiotics is studied in order to increase the arsenal of treatments. The aim was to assess the efficacy of the probiotics in these diseases in the active or quiescent phases; (2) Methods: A systematic review with meta-analysis was performed by an exhaustive bibliographic search in Medline, Cinahl, Embase, Scopus, Web of Science, and Cochrane Library. The inclusion criteria were studies of more than 10 years, English/Spanish, clinical trials, and involving human beings. Relative risk was used to compare efficacy, which was meta-analyzed using a fixed effects model. Heterogeneity was evaluated with the Higgins I2 test; (3) Results: Nineteen studies were included in the systematic review and 17 in the meta-analysis, with a total of 1537 patients (nexperimental group = 762; nplacebo group = 775). There are significant remission differences in ulcerative colitis (relative risk (RR) = 0.81; 95% CI = 0.72–0.91; I2 = 32%; p = 0.16). However, no significant differences were found in the use of probiotics for the prevention of ulcerative colitis, and for the remission of Crohn’s disease; (4) Conclusions: There are data showing an additional beneficial effect of probiotics on active ulcerative colitis. More and better studies are needed which assess its possible therapeutic efficacy for quiescent ulcerative colitis and for Crohn’s disease.

scholarly journals CORRELATION BETWEEN TROUGH LEVELS OF INFLIXIMAB AND POSTOPERATIVE ENDOSCOPIC RECURRENCE IN CROHN’S DISEASE PATIENTS SUBMITTED TO ILEOCOLONIC RESECTIONS: A SYSTEMATIC REVIEW

2021 ◽  
Vol 58 (1) ◽  
pp. 107-113
Author(s):  
Fernanda da Silva Barbosa BARAÚNA ◽  
Paulo Gustavo KOTZE
Keyword(s):  
Systematic Review ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Randomized Clinical Trials ◽  
Controlled Trial ◽  
Cochrane Library ◽  
Inclusion Criteria ◽  
Endoscopic Recurrence ◽  
Postoperative Setting ◽  
Trough Levels

ABSTRACT BACKGROUND: The rates of postoperative endoscopic recurrence (PER) in patients with Crohn’s disease (CD) are consistent. Anti-TNF therapy has been increasingly used in the postoperative setting, despite the lack of robust data in the literature on the measurement of trough levels and consequences of their use. OBJECTIVE: The aim of this review was to assess trough levels of infliximab (IFX) in CD patients after ileocolonic resections in correlation with the presence of PER. METHODS: We searched for studies that evaluated trough levels of IFX in patients with CD, who underwent ileocaecal resections, and correlated them with the presence of PER. We used MEDLINE through PubMed and CENTRAL Cochrane library databases, and after matching the inclusion criteria, the studies were methodologically evaluated with qualitative analysis of the data. RESULTS: A total of 155 studies were initially identified in the databases search and only four matched the inclusion criteria. They comprised one prospective cohort study, one randomized controlled trial and two retrospective cohort studies, the last one performed in pediatric patients. This evidence suggested the correlation of PER with low trough levels of IFX and the presence of antibodies to the drug. The quality of the evidence generated varied from very low to high, due to the heterogeneity found between the studies and the risks of bias that were identified. CONCLUSION: Low levels of IFX and the presence of antibodies to the drug were directly associated with increased PER rates in patients with CD, who underwent ileocolonic resections. Controlled and randomized clinical trials with adequate methodological quality are warranted to confirm the conclusions from this systematic review.

Feasibility study using iodine quantification on dual-energy CT enterography to distinguish normal small bowel from active inflammatory Crohn’s disease

2018 ◽  
Vol 60 (6) ◽  
pp. 679-686 ◽  
Author(s):  
Isabelle De Kock ◽  
Louke Delrue ◽  
Clarisse Lecluyse ◽  
Pieter Hindryckx ◽  
Martine De Vos ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Quantitative Analysis ◽  
Small Bowel ◽  
Crohn's Disease ◽  
Wall Thickness ◽  
Terminal Ileum ◽  
Roc Analysis ◽  
Dual Energy ◽  
Iodine Quantification ◽  
Fat Fraction

Background Assessment of Crohn’s disease (CD) activity is important to identify patients with active inflammation for therapy management. Quantitative analysis can provide objective measurement of disease presence. Purpose To evaluate the feasibility of quantitative analysis of contrast-enhanced dual-energy computed tomography (DECT) data in detection of small bowel inflammation in patients with CD with an emphasis on iodine quantification. Material and Methods DECT enterography was prospectively performed in 20 patients with active CD and in 20 healthy individuals, as the control group. Iodine overlay images were created. Wall thickness, attenuation, absolute iodine density, relative iodine density, and fat fraction were measured in the terminal ileum of all patients by two radiologists. Intraclass correlation coefficients were calculated to assess inter-rater agreement. Parameters were compared between patient groups using mixed model analysis. Receiver operating characteristic (ROC) analysis was performed. Results Both absolute and relative iodine density were significantly higher in active disease than in normal small bowel (all P < 0.001). In contrast, measurement of fat fraction was not significantly different in affected terminal ileal loops compared to normal terminal ileum ( P = 0.075). ROC analysis demonstrated a similar excellent diagnostic accuracy of wall thickness, attenuation, and absolute and relative iodine density with area under the ROC curve (AUC) values in the range of 0.96 for attenuation to 1 for relative iodine density. Conclusion DECT with iodine quantification can be used in distinguishing normal small bowel from active inflammatory CD. Further research should investigate the value of iodine quantification in grading CD activity and in monitoring therapeutic response.

scholarly journals Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn’s Disease: Systematic Review and Meta-Analysis

2019 ◽  
Vol 40 (05) ◽  
pp. 646-654 ◽  
Author(s):  
Amanda Vestito ◽  
Giovanni Marasco ◽  
Giovanni Maconi ◽  
Davide Festi ◽  
Franco Bazzoli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Meta Analysis ◽  
Strain Ratio ◽  
Ultrasound Elastography ◽  
Cochrane Library ◽  
Large Sample Size ◽  
Bowel Segments ◽  
Mean Strain

Abstract Purpose To perform a systematic review with meta-analysis to assess whether ultrasound elastography can have a diagnostic role in detecting fibrotic bowel strictures in patients with Crohn’s disease. Materials and Methods MEDLINE via the PubMed, Ovid Embase, Scopus and Cochrane Library databases, and abstracts of international conference proceedings were searched up to March 31, 2018. Studies were included if they assessed the performance of abdominal ultrasound elastography in detecting fibrotic bowel strictures in patients with Crohn’s disease using histology or the need for surgery after medical treatment as a reference standard. The quality of the studies was assessed using Quality Assessment of Diagnostic Accuracy Studies. Results 6 studies including a total of 217 patients with Crohn’s disease and 231 bowel segments, of which 76 were bowel segments with fibrotic stricture, were selected. Three studies used strain ratio and three studies used strain value as parameters of bowel stiffness. Both the pooled standardized mean strain ratio and the pooled standardized mean strain value were higher in bowel segments with fibrotic strictures than in those without fibrotic strictures with a standardized mean difference of 0.85 (95 % confidence level [CI]: 0 to 1.71; p = 0.05) and 1.0 (95 % CI: –0.11 to 2.10; p = 0.08), respectively. There was a high heterogeneity between studies. All studies were at “high risk” or “unclear risk” of bias. Conclusion Ultrasound elastography could be able to detect fibrotic bowel strictures in patients with Crohn’s disease. Well-designed high quality diagnostic studies with a large sample size are needed.

Stepwise analysis of potential accuracy-influencing factors of iodine quantification on a fast kVp-switching second-generation dual-energy CT: from 3D-printed phantom to a simple solution in clinical routine use

2019 ◽  
Vol 61 (3) ◽  
pp. 424-431 ◽  
Author(s):  
Georg Böning ◽  
Paul Jahnke ◽  
Felix Feldhaus ◽  
Uli Fehrenbach ◽  
Johannes Kahn ◽  
...  
Keyword(s):  
Influencing Factors ◽  
Iodine Concentration ◽  
Target Volume ◽  
Dual Energy ◽  
Concentration Measurement ◽  
Dual Energy Ct ◽  
Anthropomorphic Phantom ◽  
Significant Difference ◽  
Applied Dose ◽  
3D Printed

Background Measurement of iodine concentration from dual-energy or spectral computed tomography (CT) provides useful diagnostic information especially in patients suffering from malignant tumors of various origins. Purpose The purpose of this study was to systematically investigate the accuracy of the measurement of iodine concentration, focusing on potential influencing factors and assessing its suitability for routine clinical use. Material and Methods First, a 3D-printed cylindrical phantom was used to assess reliability of dual-energy CT-based iodine concentration measurement. Second, a semi-anthropomorphic phantom was used to evaluate the potential impact of positional variation of the target volume as typically seen in clinical scans. Finally, a reference vial was placed on the body surface of 38 patients undergoing abdominal dual-energy CT to analyze correlations between applied doses and patient diameters. Results The position of the target volume within the cylindrical phantom and the applied dose level significantly influenced the magnitude of measured iodine concentrations ( P < 0.001). We also found a significant difference in accuracy depending on target volume position in the semi-anthropomorphic phantom ( P = 0.028). In patient scans, we observed an error of 19.6 ± 5.6% in iodine concentration measurements of a reference and significant, moderate to strong, negative correlations between measured iodine concentration, maximum patient diameter, and applied dose (maximum sagittal diameter: r = −0.455, P = 0.004; maximum coronal diameter: r=−0.517, P = 0.001; CTDIvol: r = −0.385, P = 0.017) Conclusion Dual-energy CT-based iodine concentration measurement should be interpreted with caution. In clinical examinations, placement of a reference vial could be a potential solution to relativize errors.

Value of dual-energy CT enterography in the analysis of pathological bowel segments in patients with Crohn's disease

2018 ◽  
Vol 60 (3) ◽  
pp. 223-229
Author(s):  
A.M. Villanueva Campos ◽  
G. Tardáguila de la Fuente ◽  
E. Utrera Pérez ◽  
C. Jurado Basildo ◽  
D. Mera Fernández ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
Ct Enterography ◽  
Bowel Segments
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