Monochromatic energy computed tomography image for active intestinal hemorrhage:A model investigation

AIM: To investigate the value of computed tomography(CT) spectral imaging in the evaluation of intestinal hemorrhage.METHODS: Seven blood flow rates were simulated in vitro.Energy spectral CT and mixed-energy CT scanswere performed for each rate(0.5,0.4,0.3,0.2,0.1,0.05 and 0.025 m L/min).The detection rates and the contrast-to-noise ratios(CNRs) of the contrast agent extravasation regions were compared between the two scanning methods in the arterial phase(AP) and the portal venous phase(PVP).Comparisons of the CNR values between the PVP and the AP were made for each energy level and carried out using a completely random t test.A χ2 test was used to compare the detection rates obtained from the two scanning methods.RESULTS: The total detection rates for energy spectral CT and mixed-energy CT in the AP were 88.57%(31/35) and 65.71%(23/35),respectively,and the difference was significant(χ2 = 5.185,P = 0.023); the total detection rates in the PVP were 100.00%(35/35) and 91.4%(32/35),respectively,and the difference was not significant(χ2 = 1.393,P = 0.238).In the AP,the CNR of the contrast agent extravasation regions was 3.58 ± 2.09 on the mixed-energy CT images,but the CNRs were 8.78 ± 7.21 and 8.83 ± 6.75 at 50 and 60 keV,respectively,on the single-energy CT images,which were significantly different(3.58 ± 2.09 vs 8.78 ± 7.21,P = 0.031; 3.58 ± 2.09 vs 8.83 ± 6.75,P = 0.029).In the PVP,the differences between the CNRs at 40,50 and 60 keV different monochromatic energy levels and the polychromatic energy images were significant(19.35 ± 10.89 vs 11.68 ± 6.38,P = 0.010; 20.82 ± 11.26 vs 11.68 ± 6.38,P = 0.001; 20.63 ± 10.07 vs 11.68 ± 6.38,P = 0.001).The CNRs at the different energy levels in the AP and the PVP were significantly different(t =-2.415,-2.380,-2.575,-2.762,-2.945,-3.157,-3.996 and-3.189).CONCLUSION: Monochromatic energy imaging spectral CT is superior to polychromatic energy images for the detection of intestinal hemorrhage,and the detection was easier in the PVP compared with the AP.