Prospective Comparison of Standard-Versus Low-Radiation-Dose CT Enterography for the Quantitative Assessment of Crohn Disease

OBJECTIVE. CT enterography (CTE) is sensitive and specific for active inflammatory changes of Crohn disease (CD), but its use has been limited by exposure to ionizing radiation. The objective of this study is to show the noninferiority of a model-based iterative reconstruction (MBIR) technique using lower radiation doses compared with standard-dose CTE in the assessment of CD. SUBJECTS AND METHODS. Patients referred to a hospital radiology department for CTE for the evaluation of CD underwent both a standard examination (used to generate filtered back-projection and adaptive statistical iterative reconstruction [ASIR] images) and low-dose MBIR CTE performed in a random sequence on the same day. Images were reviewed by two radiologists for signs of small-bowel CD. Radiologic findings obtained using ASIR and clinical assessments of disease activity served as the reference standard for comparison with low-dose CTE findings. RESULTS. A total of 163 patients, 92 (56.4%) of whom had active disease, underwent CTE. MBIR was found to be noninferior to the two standard-dose techniques, with no significant differences noted between the three types of images when compared with the clinical reference standard. As compared with the radiologic standard of ASIR, the very-low-dose scans had a high degree of accuracy, with sensitivity ranging from 0.85 to 0.94 and specificity ranging from 0.84 to 0.97 depending on the reader. A significant reduction in radiation exposure was noted with MBIR (mean [+/- SD] reduction, 3.30 +/- 3.17 mSv) versus standard-dose imaging (7.16 +/- 4.61 mSv; p < 0.001). CONCLUSION. Low-dose CTE using MBIR is sensitive and specific for the detection of active inflammatory changes of CD while utilizing radiation doses substantially lower than those associated with standard techniques.