Dual energy computed tomography in Crohn's disease: a targeted review

Crohn's disease (CD) is a common chronic inflammatory bowel disease characterized by transmural inflammation and extra-intestinal complications. The diagnosis of CD is made using a combination of clinical, biochemical, endoscopic, imaging and histological features. Among imaging methods, computed tomography enterography (CTE) is the most commonly used. Dual-energy CTE allows objective evaluation of patients with CD. Along with the findings seen in conventional CTE, dual-energy CTE can generate iodine density maps and quantify the iodine content in the involved segments of the bowel, thus providing a measure of the perfusion of the affected bowel. In addition, the virtual monochromatic images generated from dual-energy CTE allow better qualitative evaluation of the mural and extramural findings.

We performed a targeted systemic review of all the studies in the literature to understand the role of dual-energy CT in the diagnosis and assessment of the severity of CD.

Dual-energy CTE is superior to conventional CTE in the evaluation of CD. Besides quantifying iodine in the pathological segments, other quantitative parameters like the mural thickness of affected bowel segments, the number of segments involved, ulcerations, comb sign, lymphadenopathy, and the mural heterogeneity can also be assessed in dual-energy CTE.