array:24 [ "pii" => "S2173510718300181" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2018.03.001" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "1040" "copyright" => "SERAM" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:223-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "formatos" => array:2 [ "HTML" => 1 "PDF" => 1 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S003383381830016X" "issn" => "00338338" "doi" => "10.1016/j.rx.2018.01.004" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "1040" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:223-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 270 "formatos" => array:2 [ "HTML" => 176 "PDF" => 94 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original</span>" "titulo" => "Valor de la enterografía por tomografía computarizada con doble energía en el análisis de segmentos intestinales patológicos en pacientes con enfermedad de Crohn" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "223" "paginaFinal" => "229" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Value of dual-energy CT enterography in the analysis of pathological bowel segments in patients with Crohn's disease" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 819 "Ancho" => 1667 "Tamanyo" => 191036 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Mapa de yodo. A) Segmento patológico: una ROI circular. B) Segmento sano: tres ROI a mano alzada. Con la realización de cada ROI obtenemos los parámetros cuantitativos empleados en el estudio: densidad de yodo y fracción de grasa.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A.M. Villanueva Campos, G. Tardáguila de la Fuente, E. Utrera Pérez, C. Jurado Basildo, D. Mera Fernández, C. Martínez Rodríguez" "autores" => array:6 [ 0 => array:2 [ "nombre" => "A.M." "apellidos" => "Villanueva Campos" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Tardáguila de la Fuente" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Utrera Pérez" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Jurado Basildo" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Mera Fernández" ] 5 => array:2 [ "nombre" => "C." 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Axial image without (left) and with (right) contrast of one chronic lesion with oval morphology adjacent to the left trochanter, with a thin capsule and hypodense content that does not enhance after the administration of IV contrast.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Martel Villagrán, M.J. Díaz Candamio, A. Bueno Horcajadas" "autores" => array:3 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Martel Villagrán" ] 1 => array:2 [ "nombre" => "M.J." "apellidos" => "Díaz Candamio" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Bueno Horcajadas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833818300183" "doi" => "10.1016/j.rx.2018.02.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833818300183?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510718300235?idApp=UINPBA00004N" "url" => "/21735107/0000006000000003/v1_201805050431/S2173510718300235/v1_201805050431/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2173510718300223" "issn" => "21735107" "doi" => "10.1016/j.rxeng.2018.03.005" "estado" => "S300" "fechaPublicacion" => "2018-05-01" "aid" => "1039" "copyright" => "SERAM" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Radiologia. 2018;60:217-22" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2 "HTML" => 2 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Acetabular–epiphyseal angle and hip dislocation in cerebral palsy: A preliminary study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "217" "paginaFinal" => "222" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Ángulo acetábulo-epifisario y luxación de cadera en la parálisis cerebral: Estudio preliminar" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1175 "Ancho" => 1667 "Tamanyo" => 263011 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Chart of force lines applied on the coxofemoral joint. Direction of the compression exerted from the pelvis to the cephalic trabecular system, or main compression group in the femoral head (A). Direction of the tension exerted from the pelvis to the cervicocephalic trabecular system, or main tension group (B). Perpendicular to the force lines applied on the acetabular roof (A′) and femoral head (B′).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "O.J. Alí-Morell, F. Zurita-Ortega, I. Davó-Jiménez, S. Segura-Biedma" "autores" => array:4 [ 0 => array:2 [ "nombre" => "O.J." "apellidos" => "Alí-Morell" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Zurita-Ortega" ] 2 => array:2 [ "nombre" => "I." "apellidos" => "Davó-Jiménez" ] 3 => array:2 [ "nombre" => "S." "apellidos" => "Segura-Biedma" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0033833818300158" "doi" => "10.1016/j.rx.2018.02.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0033833818300158?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173510718300223?idApp=UINPBA00004N" "url" => "/21735107/0000006000000003/v1_201805050431/S2173510718300223/v1_201805050431/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Report</span>" "titulo" => "Value of dual-energy CT enterography in the analysis of pathological bowel segments in patients with Crohn's disease" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "223" "paginaFinal" => "229" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A.M. Villanueva Campos, G. Tardáguila de la Fuente, E. Utrera Pérez, C. Jurado Basildo, D. Mera Fernández, C. Martínez Rodríguez" "autores" => array:6 [ 0 => array:4 [ "nombre" => "A.M." "apellidos" => "Villanueva Campos" "email" => array:1 [ 0 => "avillanueva@povisa.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Tardáguila de la Fuente" ] 2 => array:2 [ "nombre" => "E." "apellidos" => "Utrera Pérez" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Jurado Basildo" ] 4 => array:2 [ "nombre" => "D." "apellidos" => "Mera Fernández" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "Martínez Rodríguez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Radiología, Hospital Povisa, Vigo, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Valor de la enterografía por tomografía computarizada con doble energía en el análisis de segmentos intestinales patológicos en pacientes con enfermedad de Crohn" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1523 "Ancho" => 2167 "Tamanyo" => 323094 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CT-enterography with axial slices. (A) Image obtained after combining data from the two tubes at voltages of 80<span class="elsevierStyleHsp" style=""></span>kV<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>kV: ileal segment with wall thickening, mucosal enhancement, and vascular ingurgitation consistent with Crohn's disease, with signs of inflammatory activity (arrow). (B) Axial image with data obtained from the tube at a voltage of 80<span class="elsevierStyleHsp" style=""></span>kV. This kV enhances the visualization of contrast uptake making it useful for mucosal enhancement. (C) Axial image with data from the tube at a voltage of 140<span class="elsevierStyleHsp" style=""></span>kV.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Crohn's disease (CD) is a chronic, granulomatous, infammatory disease capable of damaging different segments of the GI tract, that manifests itself with periods of activity (outbreaks), and inactivity (remission). CD is common northern Europe, North America, and Japan, and its incidence has grown during the last few decades. There is no sex predilection, and its highest peak occurs between 15 and 25 years of age.<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The computed tomography enterography (CT-enterography) is one useful imaging modality for the study of patients with inflammatory bowel disease. It was fists introduced by Raptopoulos et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">3</span></a> back in 1997 as a modification of the abdominopelvic CT scan for the study of the small bowel and, especially, to study the extension, severity, and complications of CD. It is one non-invasive modality that, basically, consists of the distension of intestinal lumen with the administration of neutral oral contrast, and the optimization of bowel mucosa enhancement through the use of IV contrast in order to make the signs of CD even more evident.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The radiological findings that can be identified in the CT-enterography such as CT patterns of mural enhancement, bowell wall thickening, vascular ingurgitation (the so-called “comb sign”),<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">4</span></a> and stratification of mesenteric fat are indicative signs of the disease inflammatory activity.<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">5,6</span></a> Increased mural enhancement is a well-known sign of correlation with the degree of histological inflamation.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Radiological advances made on this field such as the helical and the multidetector CT scans, including dose reduction systems, continue to increase the clinical and diagnostic applications of the CT-enterography. One recent development has been the introduction of the dual-energy CT-scan.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">8,9</span></a> In these CT systems that can include one or two X-ray tubes, images of different voltages are acquired usually with low (80<span class="elsevierStyleHsp" style=""></span>kVp) and high (140<span class="elsevierStyleHsp" style=""></span>kVp) energy, which makes it one “dual energy system”. This implies the acquisition of data with different spectra of photons in one single CT acquisition, which potentially allows us to distinguish among different tissues based on the different degrees of high and low attenuation rates in kVp.<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">10,11</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Among the numerous applications of the dual-energy CT-scan, iodine can be subtracted from one CT scan with contrast, in order to make reconstructions “without virtual contrast”, or, on the contrary, maps that only show iodine (“iodine maps”) can be generated. With these maps, one semi-quantitative view of the iodine distribution can be acquired, measures of one area or volume can be taken, and different quantitative values can be obtained.<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">8,9,12</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The goal of this article is to analyze whether there are significant differences in the quantitative parameters obtained during the post-processing of dual-energy CT-enterographies between different bowel segments with radiological signs of CD and radiologically normal segments.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Method</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Selection of patients</span><p id="par0035" class="elsevierStylePara elsevierViewall">Thirty-three (33) patients were retrospectively analyzed after being recruited from the databases of our hospital pharmacology and digestive system services from January 2010 through December 2014. The study inclusion criteria were having one known CT-scan, and one dual-energy CT-enterography with radiological signs of CD. Patients under 18, with body mass indexes <40, who were allergic to iodinated contrast, and with renal failure were all excluded from the study. All patients were duly informed and filled out the consent form prior to undergoing the CT-enterography. It was not deemed necessary to resort to the hospital ethics committee due to the retrospective nature of the study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">CT-scan protocol</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Distended bowel loops</span><p id="par0040" class="elsevierStylePara elsevierViewall">One (1) liter of neutral oral contrast was administered to every patient (sorbitol at 3%) for 45<span class="elsevierStyleHsp" style=""></span>min. The acquisition of the CT images was conducted 10<span class="elsevierStyleHsp" style=""></span>min after the oral ingestion of contrast. No IV antiperistaltic agents were used.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Intravenous contrast</span><p id="par0045" class="elsevierStylePara elsevierViewall">Injector-based contrast (120<span class="elsevierStyleHsp" style=""></span>ml of iopromide 300, Ultravist 300<span class="elsevierStyleSup">®</span>, Bayer) was administered (Medrad<span class="elsevierStyleSup">®</span>, Bayer), with an injection flow rate of 3<span class="elsevierStyleHsp" style=""></span>ml/s using a 20-gauge catheter through one antecubital vein.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Acquisition of CT images</span><p id="par0055" class="elsevierStylePara elsevierViewall">The study was conducted using one dual-energy CT machine with 128 detectors (SomatonFlashDefinition<span class="elsevierStyleSup">®</span>, Siemens). Tube A was set at a voltage of 80<span class="elsevierStyleHsp" style=""></span>kVp and 507<span class="elsevierStyleHsp" style=""></span>mA (reference), while tube B was set at a voltage of 140<span class="elsevierStyleHsp" style=""></span>kVp and 196<span class="elsevierStyleHsp" style=""></span>mA (reference). An automated dose modulation system (CARE Dose4D<span class="elsevierStyleSup">®</span>, Siemens) was used too. Images were acquired from the diaphragm toward the pubis symphysis during the portal phase, with a 75<span class="elsevierStyleHsp" style=""></span>s-delay after the administration of contrast.</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Interpretation of the CT-scan</span><p id="par0060" class="elsevierStylePara elsevierViewall">When conducting one dual-energy CT enterography with IV contrast three (3) blocks of images are always created: one first block with images resulting from the fusion of the images taken at a tube voltage of 140 and 80<span class="elsevierStyleHsp" style=""></span>kV, and two other separate blocks with data from each tube.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Both the pathological bowel segment and the healthy bowel segment were identified in each patient. For a bowel segment to be considered pathological, the classical radiological criteria of CD were taken into consideration here: wall thickening, mucosal enhancement, vascular ingurgitation, and fat stratification. Whenever different bowel loops would be considered pathological, the one with the strongest radiological evidence of CD was selected. The criteria used to consider that a bowel loop was a healthy loop were the absence of radiological signs of CD previously described, fewer amount of adjacent bowel loops, and better luminal distension (diameter<span class="elsevierStyleHsp" style=""></span>≥<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm in the bowel loop). All images were analyzed in the block that combined the images obtained at voltages of 140 and 80<span class="elsevierStyleHsp" style=""></span>kVp and, above all, mucosal enhancement was analyzed in the block of images acquired at a voltage of 80<span class="elsevierStyleHsp" style=""></span>kVp, starting with a 3<span class="elsevierStyleHsp" style=""></span>mm slice-thickness in the axial plane (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There were times when multiplanar reconstructions in the coronal and sagittal planes, and MIP reconstructions were useful.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Using the LiverVNC software to conduct the dual-energy CT scans (Dual energy, SyngoVia<span class="elsevierStyleSup">®</span>, VA30A, Siemens), the study was processed in order to obtain one color map (iodine map) with which a first semi-quantitative analysis (visual) of the disease could be conducted (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Then, with the images acquired during post-processing, the iodine density (mg/ml) and fat percentage (%) of the small bowel wall were quantified. To that end, four (4) regions of interest (ROI) were drawn in each patient; all of them covering an area of around 5<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleSup">2</span>.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Both the selection of the segments and the drawing of the ROIs were conducted by a second year-resident and supervised by a radiologist with ten years of experience.</p><p id="par0080" class="elsevierStylePara elsevierViewall">When it comes to the pathological bowel segment, one circular ROI was drawn in the mucosa, on the region with the highest uptake, without including subserosal fat and bowel lumen. When it comes to the healthy bowel segment, three (3) freehand ROIs were drawn. Since the bowel wall is usually very thin and does not always have good luminal distension, it is difficult to measure with one circular ROI only, which is why 3 freehand ROIs were drawn to reduce or average any possible measurement errors made.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Each ROI showed several colors, and in this study the two (2) typical quantitative parameters of CD studies were used: iodine density, and fat fraction (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Statistical analysis</span><p id="par0090" class="elsevierStylePara elsevierViewall">Three (3) measures of the healthy bowel loop were taken, and the results were averaged. On the other hand, the healthy and the pathological bowel segments were compared in order to establish all possible differences.</p><p id="par0095" class="elsevierStylePara elsevierViewall">To conduct the statistical analysis, the SPSS statistical software (version 12.0, SPSS) for Microsoft Windows was used.</p><p id="par0100" class="elsevierStylePara elsevierViewall">Means and percentages were used to describe the sample. For mean comparison purposes, the Student <span class="elsevierStyleItalic">t</span> test for paired data was used. <span class="elsevierStyleItalic">p</span> values <0.05 were considered statistically significant.</p></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Results</span><p id="par0105" class="elsevierStylePara elsevierViewall">Thirty-three (33) patients (17 men and 16 women) of an average age of 54 years old were included in the study. The average time of disease progression was seven (7) years, and 27 patients (81%) were just having their disease outbreak – defined by the patient's clinical manifestations and examination. All of them had abdominal pain or diarrhea, except for one patient with one perianal fistula, two with anemia and one with a digestive hemorrhage. All of them showed damage to the ileium, four patients showed damage to the jejunum, three damage to the caecum, two patients had pancolonic damage, and one patient showed renal damage. All of them had undergone one dual-energy CT-enterography with an average total dose-length product of 546<span class="elsevierStyleHsp" style=""></span>mGy/cm (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">The average concentrations of iodine density were higher in the pathological bowel segments than in the healthy ones (3.7 vs. 1.8<span class="elsevierStyleHsp" style=""></span>mg/ml). The average concentrations of fat fraction were higher in the healthy bowel segments (32.7 vs. 23.7%). All with statistically significant differences (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0115" class="elsevierStylePara elsevierViewall">In our study, the first thing we need to point out is that the values of freehand ROIs were similar and the differences found, if any, were not statistically significant.</p><p id="par0120" class="elsevierStylePara elsevierViewall">On the other hand, the concentrations of iodine density were higher in the pathological segments compared to the healthy ones, so we can confirm that in the segments with definitive radiological signs of CD and higher mural enhancement, there is also more iodine density. In our work, this can be seen in the post-processing images: the most internal layer of the wall is thicker and has a more vivid red color due to the presence of higher concentrations of iodine (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><p id="par0125" class="elsevierStylePara elsevierViewall">Also, the concentrations of fat fraction were higher in the healthy segments. This may be explained because the inflammation of the acute episodes of the disease occupies a larger space in the wall, thus reducing fat fraction in that segment. Another aspect that may justify it is the technique used for measuring, since in the pathological segment, just the mucosa is selected basically.</p><p id="par0130" class="elsevierStylePara elsevierViewall">Mural enhancement and wall thickening are the two most sensitive signs of CD and can be detected with a high grade of reproducibility,<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">6,7,13,14</span></a> which is why quantitative techniques have been used in order to be able to correlate these findings objectively.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Former CT studies suggested that mural enhancement is associated with the activity of the disease based on its attenuation values (UH). For example, in their cohort of 96 patients, Bodily et al.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> found that quantitative measures of both mural and thickening enhancement were strongly associated with the presence of disease activity (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Booya et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> showed that the attenuation of the terminal ileum was higher in patients with active CD compared to patients without Crohn's disease (119 vs. 96<span class="elsevierStyleHsp" style=""></span>UH, <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). Park and Lim<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a> said that by using mural attenuation values of 109<span class="elsevierStyleHsp" style=""></span>UH and enhancement ratios between the pathological and the healthy segment >1.3, the CT-enterography keeps a high correlation with the radiological findings of active disease, although they also say that visual assessment provides a higher degree of specificity than quantitative measures do.</p><p id="par0140" class="elsevierStylePara elsevierViewall">One alternative approach to this is to determine iodine density. Rather than estimating the attenuation values, what we do with this method is measure the iodine density, which allows a more direct measurement than the IV contrast tissue uptake does.</p><p id="par0145" class="elsevierStylePara elsevierViewall">In our study we found that the quantitative measures of iodine density were higher in those segments with radiological signs of CD and inflammatory activity (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05) formerly described as mural enhancement.</p><p id="par0150" class="elsevierStylePara elsevierViewall">Also, by generating iodine maps (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), the dual-energy CT-enterography allows us to conduct semi-quantitative analyses of CD in every patient – what Park and Lim<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a> call “visual assessment”.</p><p id="par0155" class="elsevierStylePara elsevierViewall">For all this, the post-processing o dual-energy CT-enterographies with iodine map generation allows us to make semi-quantitative (visual) and quantitative analyses of the disease, which, as it happens when measuring attenuation values (UH)—something already described in the medical literature, and may add more objectivity to the study of patients with CD. Its practical value during diagnosis may also add more sensitivity to the diagnosis of the radiological signs of inflammatory activity, especially, in the presence of suspicious conventional abdominal CT scans, and in more subtle cases of inflammatory activity.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> As a matter of fact, methods of quantitative measures have been developed, recently, trying to measure, in a more objective and reproducible manner the damage caused to the bowel wall in CD, including the severity, extension, and progression of the disease, which is useful both for the diagnosis and management of the disease.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> Although more studies are still needed, quantitative measurement using with dual-energy CT scans is one method that may have similar applications.</p><p id="par0160" class="elsevierStylePara elsevierViewall">In our study, the images were acquired during the portal phase only, with a 75<span class="elsevierStyleHsp" style=""></span>s-delay after the administration of contrast. In the medical literature, there is controversy on which is/are the optimal phase/s to conduct one CT-enterography procedure. Wold et al.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> say that the arterial phase does not contribute to a higher detection of CD, and a small series of cases did not show any significant differences between conducting the CT-enterography during the enteric or the hepatic phase. However, other authors believe that conducting it during two phases is highly useful: during the (1) arterial, and the (2) venous phase, since the arterial phase is good for the identification of mural enhancement, above all, in the early stages of the disease or when it is subtle.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a> On the other hand, authors such as Vandenbroucke et al.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a> say that there is no difference between the enteric and portal phases. In our study, we say that conducting the procedure during the arterial phase too, increases the dose of radiation and is not really necessary for diagnostic purposes. The reasons to do it during late phases were studying other causes of abdominal pain (the main reason for consultation for most patients), and assessing the remaining intra-abdominal structures, the extra-enteric manifestations of CD (such as primary sclerosing cholangitis) and the complications (such as abscesses or fistulae).</p><p id="par0165" class="elsevierStylePara elsevierViewall">We measured in distended small bowel segments. This is important if we understand that collapsed segments will have higher attenuation values than the distended ones, meaning that bowel distension really helps the radiologist and avoids over-diagnosing segments with signs of inflammation.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Booya et al.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">6</span></a> found that collapsed jejunal and ileum loops had higher attenuation values than the distended ones (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.01). Since collapsed loops look like damaged loops due to the inflammatory activity of CD, in order to reach an accurate diagnosis, other findings such as the stratification of peri-enteric fat, or the “comb sign” should be taken into consideration too.</p><p id="par0175" class="elsevierStylePara elsevierViewall">Our study has some limitations, mainly the small number of patients and its retrospective nature. On the other hand, it is well-known that in the studies of CD we not always have good bowel loops distension, which would difficult the process of taking measures. One last limitation is that the reference method is the study own radiological analysis. More research with dual-energy CT-enterography is needed before determining its optimal use in these patients.</p><p id="par0180" class="elsevierStylePara elsevierViewall">Our findings show that the dual-energy CT-enterography allows us to obtain new parameters for the analysis of bowel segments in patients with CD, showing significant differences in the quantification of iodine density and fat fraction between bowel segments with radiological signs of CD and normal radiological segments.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Authors’ contribution</span><p id="par0185" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1.</span><p id="par0190" class="elsevierStylePara elsevierViewall">Manager of the integrity of the study: AMVC.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2.</span><p id="par0195" class="elsevierStylePara elsevierViewall">Study idea: AMVC and GTF.</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3.</span><p id="par0200" class="elsevierStylePara elsevierViewall">Study design: AMVC and GTF.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4.</span><p id="par0205" class="elsevierStylePara elsevierViewall">Data mining: AMVC y CMR.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5.</span><p id="par0210" class="elsevierStylePara elsevierViewall">Data analysis and interpretation: AMVC, GTF, CMR, EUP and CJB.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6.</span><p id="par0215" class="elsevierStylePara elsevierViewall">Statistical analyses: AMVC, GTF and DMF.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7.</span><p id="par0220" class="elsevierStylePara elsevierViewall">Reference: AMVC, DMF, EUP and CJB.</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8.</span><p id="par0225" class="elsevierStylePara elsevierViewall">Writing: AMVC and GTF.</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9.</span><p id="par0230" class="elsevierStylePara elsevierViewall">Critical review of the manuscript with intellectually relevant remarks: AMVC, GTF, CMR, DMF, EUP, CJB and CMR.</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10.</span><p id="par0235" class="elsevierStylePara elsevierViewall">Approval of final version: AMVC, GTF, DMF, EUP, CJB and CMR.</p></li></ul></p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Conflicts of interest</span><p id="par0240" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interests associated with this article whatsoever.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1022339" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec980510" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1022340" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec980511" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Method" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Selection of patients" ] 1 => array:3 [ "identificador" => "sec0020" "titulo" => "CT-scan protocol" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0025" "titulo" => "Distended bowel loops" ] 1 => array:2 [ "identificador" => "sec0030" "titulo" => "Intravenous contrast" ] 2 => array:2 [ "identificador" => "sec0035" "titulo" => "Acquisition of CT images" ] ] ] 2 => array:2 [ "identificador" => "sec0040" "titulo" => "Interpretation of the CT-scan" ] 3 => array:2 [ "identificador" => "sec0045" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Authors’ contribution" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-08-25" "fechaAceptado" => "2018-01-10" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec980510" "palabras" => array:6 [ 0 => "Imaging" 1 => "Dual energy computed tomography" 2 => "Diagnosis" 3 => "Crohn disease" 4 => "Granulomatous enteritis" 5 => "Mucosa" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec980511" "palabras" => array:6 [ 0 => "Imagen" 1 => "Tomografía computarizada de doble energía" 2 => "Diagnóstico" 3 => "Enfermedad de Crohn" 4 => "Enteritis granulomatosa" 5 => "Mucosa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To analyze whether there are significant differences in the objective quantitative parameters obtained in the postprocessing of dual-energy CT enterography studies between bowel segments with radiologic signs of Crohn's disease and radiologically normal segments.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This retrospective study analyzed 33 patients (16 men and 17 women; mean age 54 years) with known Crohn's disease who underwent CT enterography on a dual-energy scanner with oral sorbitol and intravenous contrast material in the portal phase. Images obtained with dual energy were postprocessed to obtain color maps (iodine maps). For each patient, regions of interest were traced on these color maps and the density of iodine (mg/ml) and the fat fraction (%) were calculated for the wall of a pathologic bowel segment with radiologic signs of Crohn's disease and for the wall of a healthy bowel segment; the differences in these parameters between the two segments were analyzed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The density of iodine was lower in the radiologically normal segments than in the pathologic segments [1.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.4<span class="elsevierStyleHsp" style=""></span>mg/ml vs. 3.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.9<span class="elsevierStyleHsp" style=""></span>mg/ml; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05].</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The fat fraction was higher in the radiologically normal segments than in the pathologic segments [32.42%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.5 vs. 22.23%<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.4; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05].</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">There are significant differences in the iodine density and fat fraction between bowel segments with radiologic signs of Crohn's disease and radiologically normal segments.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Analizar si existen diferencias significativas en los parámetros cuantitativos obtenidos en el posprocesado de estudios con enterografía por tomografía computarizada (entero-TC) de doble energía entre segmentos intestinales con signos radiológicos de enfermedad de Crohn (EC) y segmentos radiológicamente normales.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo en el que se analizan 33 pacientes con EC conocida (16 hombres y 17 mujeres), con una media de edad de 54 años. Se seleccionan aquellos con una entero-TC con protocolo de doble energía. Todas las exploraciones están realizadas con una solución de sorbitol oral y contraste intravenoso en fase portal. Mediante técnicas de posprocesado de las imágenes adquiridas con doble energía se obtienen mapas de color (mapas de yodo). Sobre estos mapas de color, mediante la realización de regiones de interés se cuantifican en cada paciente la densidad de yodo (mg/ml) y la fracción de grasa (%) de la pared de un segmento intestinal patológico con signos radiológicos de EC y de un segmento sano, y se analiza si existen diferencias entre ambos.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La cuantificación de yodo en los segmentos sanos es 1,8 (± 0,4) mg/ml, y en los segmentos enfermos es 3,7 (± 0,9) mg/ml (p <0,05). La fracción de grasa presente en la pared de los segmentos sanos es del 32,42% (± 6,5), y en los segmentos afectados es del 22,23% (± 9,4) (p <0,05).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusión</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Existen diferencias significativas en la cuantificación de la densidad de yodo y la fracción de grasa entre segmentos intestinales con signos radiológicos de EC y segmentos radiológicamente normales.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusión" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Villanueva Campos AM, Tardáguila de la Fuente G, Utrera Pérez E, Jurado Basildo C, Mera Fernández D, Martínez Rodríguez C. Valor de la enterografía por tomografía computarizada con doble energía en el análisis de segmentos intestinales patológicos en pacientes con enfermedad de Crohn. Radiología. 2018;60:223–229.</p>" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1523 "Ancho" => 2167 "Tamanyo" => 323094 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CT-enterography with axial slices. (A) Image obtained after combining data from the two tubes at voltages of 80<span class="elsevierStyleHsp" style=""></span>kV<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>140<span class="elsevierStyleHsp" style=""></span>kV: ileal segment with wall thickening, mucosal enhancement, and vascular ingurgitation consistent with Crohn's disease, with signs of inflammatory activity (arrow). (B) Axial image with data obtained from the tube at a voltage of 80<span class="elsevierStyleHsp" style=""></span>kV. This kV enhances the visualization of contrast uptake making it useful for mucosal enhancement. (C) Axial image with data from the tube at a voltage of 140<span class="elsevierStyleHsp" style=""></span>kV.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1623 "Ancho" => 1133 "Tamanyo" => 183682 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Coronal reconstruction of iodine map. Semi-quantitative analysis (visual): ileal Crohn's disease with areas of dilation and stenosis where the pathological loop with radiological signs of inflammatory activity translates into a loop with a thicker and a more vivid red colored wall (upper arrow). Intact bowel loops with thin wall (lower arrow). In the iodine map, the structures enhanced after the administration of IV contrast, therefore, of iodine uptake, are stained in red.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1030 "Ancho" => 2084 "Tamanyo" => 249123 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Iodine map. (A) Pathological segment: one circular ROI. (B) Healthy segment: three freehand ROIs. With the drawing of every ROI we obtain the quantitative parameters used in the study: iodine density, and fat fraction.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note</span>: All values express numbers of patients, with percentages in brackets except:</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Data \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age (sex)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">54<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17 (52) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16 (48) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Years with the disease</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Disease outbreak</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27 (81) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Reason for consultation</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Abdominal pain and/or diarrhea \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (88) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anemia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Perianal fistula \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Digestive hemorrhage \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Affected bowel segment</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ileum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (100) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Jejunum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 (12) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Caecum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 (9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pancolonic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rectum \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737446.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">These values express mean values.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics of patients with Crohn's disease included in the study.</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">The concentrations are expressed as means<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>standard deviations.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Iodine density (mg/ml) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Fat fraction (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Healthy segment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.8<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.41 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">32.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>6.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Pathological segment \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>0.89 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">23.7<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>9.3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1737447.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The average concentrations of iodine density were higher in the pathological segments, and the average concentrations of fat fraction were higher in the healthy segments (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.05).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Inflammatory bowel disease imaging: current practice and future directions" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. 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Original Report
Value of dual-energy CT enterography in the analysis of pathological bowel segments in patients with Crohn's disease
Valor de la enterografía por tomografía computarizada con doble energía en el análisis de segmentos intestinales patológicos en pacientes con enfermedad de Crohn
A.M. Villanueva Campos
, G. Tardáguila de la Fuente, E. Utrera Pérez, C. Jurado Basildo, D. Mera Fernández, C. Martínez Rodríguez
Autor para correspondencia
Servicio de Radiología, Hospital Povisa, Vigo, Spain