Background: This retrospective study aimed to investigate the usefulness of the optimized kiloelectron volt (keV) for virtual monoenergetic imaging (VMI) combined with iodine map in dual-energy computed tomography enterography (DECTE) in the diagnosis of Crohn’s disease (CD). Methods: Seventy-two patients (mean age: 41.89 ± 17.28 years) with negative computed tomography enterography (CTE) were enrolled for investigating the optimized VMI keV in DECTE by comparing subjective and objective parameters of VMIs that were reconstructed from 40 to 90 keV. Moreover, 68 patients (38.27 ± 15.10 years; 35 normal and 33 CD) were included for evaluating the diagnostic efficacy of DECTE iodine map at the optimized VMI energy level and routine CTE for CD and active CD. Statistical analysis for all data was conducted. Results: Objective and subjective imaging evaluations showed the best results at 60 keV for VMIs. The CT values of the normal group, active subgroup, and CD group during the small intestinal phase at routine 120 kVp or 60 keV VMI had significant differences. The diagnostic efficacy of an iodine map was the best when NIC = 4% or fat value = 45.8% for CD, whereas NIC < 0.35 or the fat value < 0.38 for active CD. The combined routine CTE and optimized VMI improved the diagnostic efficacy (P < 0.001). Conclusions: VMI at 60 keV provided the best imaging quality on DECTE. NIC and fat value provided important basis for active CD evaluation. Routine CTE combined with VMI at 60 keV improved the diagnostic efficiency for CD.

Background: Occupational stress and job satisfaction significantly impact the well-being and performance of healthcare professionals, including radiologists. Understanding the complex interplay between these factors through network analysis can provide valuable insights into intervention strategies to enhance workplace satisfaction and productivity.Method: In this study, a convenience sampling method was used to recruit 312 radiologists for participation. Data on socio-demographic characteristics, job satisfaction measured by the Minnesota job satisfaction questionnaire revised short version (MJSQ-RSV), and occupational stress assessed using the occupational stress scale. Network analysis was employed to analyze the data in this study.Results: The network analysis revealed intricate patterns of associations between occupational stress and job satisfaction symptoms among radiologists. Organizational management and occupational interests emerged as crucial nodes in the network, indicating strong relationships within these domains. Additionally, intrinsic satisfaction was identified as a central symptom with high connectivity in the network structure. The stability analysis demonstrated robustness in the network edges and centrality metrics, supporting the reliability of the findings.Conclusion: This study sheds light on the complex relationships between occupational stress and job satisfaction in radiologists, offering valuable insights for targeted interventions and support strategies to promote well-being and job satisfaction in healthcare settings.

Background: This study was aimed to explore the clinical application of dual-energy computed tomography (DECT) monoenergetic plus (mono+) imaging to evaluate anatomical variations in the inferior mesenteric artery (IMA). Methods: The clinical and imaging data of 212 patients who had undergone total abdominal DECT were retrospectively analyzed. The post-processing mono+ technique was used to obtain 40-keV single-level images in the arterial phase. Three-dimensional reconstruction was performed to evaluate the relationship between the IMA root position and the spinal level, IMA length, and IMA branch type, as well as the position of the left colic artery (LCA) and inferior mesenteric vein (IMV) at the IMA root level. Results: The IMA root was located at the L3 level in 78.3% of cases and at the L2/L3 level in 3.3%. The highest vertebral level of IMA origin was L2 (4.2%), and the lowest was L4 (7.1%). The distance from the IMA root to the level of the sacral promontory was 99.58 ± 13.07 mm, which increased with the elevation of the IMA root at the spinal level. Of the patients, 53.8% demonstrated Type I IMA, 23.1% Type II, 20.7% Type III, and 2.4% Type IV. The length of the IMA varied from 13.6 to 66.0 mm. 77.3% of the IMAs belonged to Type A, the adjacent type, and 22.7% to Type B, the distant type. Conclusion: DECT mono+ can preoperatively evaluate the anatomical characteristics of the IMA and the positional relationship between the LCA and IMV at the IMA root level, which would help clinicians plan individualized surgery for patients.

BACKGROUND Accurate preoperative T staging is essential for determining optimal treatment strategies in colorectal cancer (CRC). Low-keV virtual monoenergetic images (VMIs) have been shown to enhance lesion conspicuity. This study aimed to assess the diagnostic value of dual-layer spectral computed tomography (CT)-derived VMIs, in combination with multiplanar reformation (MPR) and evaluation of peritumoral fat stranding (PFS), for improving the accuracy of T staging in CRC. AIM To assess the diagnostic performance of dual-layer spectral CT (DLSCT) VMIs, particularly at low energy levels, and their integration with personalized MPR for preoperative T staging of CRC. METHODS In this retrospective study, 157 patients with pathologically confirmed CRC (mean age: 63.5 ± 12.1 years) underwent DLSCT within 1 week before surgery. VMIs ranging from 40 keV to 70 keV (at 10 keV intervals) and conventional polyenergetic images (PEIs) were reconstructed. Objective image quality parameters, including image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR), were quantified, alongside subjective image quality scores using a 5-point Likert scale. Interobserver agreement was evaluated using κ statistics. Taking histopathology as the reference standard, the diagnostic accuracy of T staging (T1-2 vs T3-4) was compared across PEIs and VMIs, both with and without MPR and PFS. RESULTS Low-keV VMIs (40-70 keV) demonstrated significantly higher SNR and CNR than PEIs (all P < 0.001). Notably, 40-keV VMIs achieved noise levels comparable to PEIs (8.17 ± 3.63 vs 8.53 ± 2.90; P = 0.673). Subjective image quality peaked at 40-50 keV VMIs (Likert scores 4.85-4.88 vs 3.97 for PEIs; P < 0.001), supported by excellent interobserver agreement (κ = 0.812-0.913). The combination of 40-50 keV VMIs with MPR yielded the highest T staging accuracy (94.27%) compared to axial PEIs (70.7%), with a sensitivity and specificity of 83.87% and 96.83%, respectively (Youden index = 0.81; P < 0.05). While PFS enhanced staging accuracy on PEIs (up to 77.07% with MPR), it provided no significant additional benefit for VMIs. CONCLUSION DLSCT VMIs at 40-50 keV significantly enhanced image quality and improved preoperative T staging accuracy of CRC when combined with MPR. These findings underscored the clinical value of low-keV spectral imaging in tailoring individualized treatment strategies.

Objectives: An investigation of the effects of different types of the inferior mesenteric artery (IMA) on laparoscopic left colic artery (LCA) radical resection of rectal cancer was conducted. Methods: Clinical data were collected from 92 patients who underwent laparoscopic radical resection of rectal cancer with preservation of the LCA at Nantong University’s Second Affiliated Hospital. All patients underwent full-abdominal dual-energy CT enhancement examination before surgery and 3D post-processing reconstruction of the IMA. Two radiologists with >3 years of experience in abdominal radiology jointly conducted the examination. A total of three types of IMA were identified among the patients: IMA type I (the LCA arising independently from the IMA), type II (LCA and sigmoid colon artery [SA] branching from a common trunk from IMA), and type III (LCA, SA, and superior rectal artery [SRA] branching from the IMA at the same point). The baseline data, pathological results, and intra-operative and post-operative indicators of the groups were analyzed. Results: The proportions of type I, type II, and type III IMA were 58.70% (54/92), 18.48% (17/92), and 22.82% (21/92), respectively. IMA typing was consistent with the preoperative CT evaluation results. The intra-operative blood loss of type III IMA patients [median (interquartile spacing), M (P25, P75): 52.00 (39.50, 68.50) ml] was higher than that of type I and II IMA patients [35.00 (24.00, 42.00) and 32.00 (25.50, 39.50) ml, respectively] (P0.05). Conclusions: Among rectal cancer patients undergoing laparoscopic LCA preservation, type III IMA patients had more intraoperative bleeding and a higher incidence of postoperative anastomotic fistula. However, this did not increase the risk of overall postoperative complications.

BACKGROUND Irreversible transmural intestinal necrosis (ITIN) is associated with high mortality rates in patients with acute occlusive mesenteric ischemia (AOMI). Currently, there are not many studies on the use of dual energy computed tomography (DECT) for evaluating ITIN. AIM To evaluate the diagnostic value of DECT for ITIN in AOMI. METHODS The cases and computed tomography (CT) images of 102 patients with clinically diagnosed AOMI (including 48 ITIN) from January 2012 to January 2022 were retrospectively collected. The CT scans included both multidetector CT and DECT. The raw data from DECT portal-venous phase were reconstructed into 120 kVp mixed energy image, 50 keV virtual monoenergetic imaging, and iodine map. Two radiologists independently completed the subjective visual assessment of CT signs related to AOMI. Objective parameters, including the attenuation of the normal and lesion intestinal wall segment (CT50 keV lesion, CT50 keV normal/lesion) and iodine concentrations (IClesion and ICnormal/lesion), were quantified. Furthermore, multivariate logistic regression, receiver operating characteristic curves, and area under the curve (AUC) values were used to evaluate the subjective and objective indicators in predicting ITIN. RESULTS Regarding subjective signs, logistic regression analysis revealed reduced or absent bowel wall enhancement [odds ratio (OR) = 5.576, 95% confidence interval (CI): 1.547-20.093], bowel dilation (OR = 11.613, 95%CI: 3.790-35.586), and parenchymatous organ infarction (OR = 4.727, 95%CI: 1.536-14.551) were independent risk factors for the ITIN. CT subjective signs had a high diagnostic efficacy for ITIN (AUC = 0.853). The two DECT objective parameters also exhibited excellent diagnostic value for ITIN, with an AUC of 0.79, a cut-off value of CT50 keV normal/lesion = 2.81, and an AUC of 0.777 with a cut-off value of ICnormal/lesion = 2.39. The Delong test showed that there was no significant difference in the efficacy of subjective CT signs and objective DECT parameters (P > 0.05). Importantly, we observed that ICnormal/lesion combined with subjective signs (bowel dilation and parenchymatous organ infarction) had the highest predictive performance (AUC = 0.894), sensitivity (100%), and specificity (70.83%), which was statistically different from the AUC of CT subjective signs (P = 0.017). CONCLUSION ICnormal/lesion (DECT-based features) combined with CT subjective signs (bowel dilatation and parenchymatous organ infarction) showed favorable predictive performance for ITIN in AOMI, which may help clinicians develop timely treatment strategies.