title: Diagnostic accuracy of computed tomography using lower doses of radiation for patients with Crohn's disease.
abstract: OBJECTIVE
  Magnetic resonance and ultrasonography have increasing roles in the initial diagnosis of Crohn's disease, but computed tomography (CT) with positive oral contrast agents is most frequently used to identify those with acute extramural complications. However, CT involves exposure of patients to radiation. We prospectively compared the diagnostic accuracy of low-dose CT (at a dose comparable to that used to obtain an abdominal radiograph) with conventional-dose CT in patients with active Crohn's disease.
  
  
  METHODS
  Low and conventional dose CT of the abdomen and pelvis were acquired from 50 patients with Crohn's disease, referred from an inflammatory bowel disease service (20 male; median age, 34 years). Acute complications of Crohn's disease were suspected. Iterative reconstruction was performed on all CT datasets to facilitate dose reduction. Three radiologists reviewed the low-dose CT images before the conventional-dose CT images.
  
  
  RESULTS
  The median effective dose (interquartile range) of radiation for the low-dose CT was reduced by 72% from that of conventional CT: from 3.5 mSv (3-5.08 mSv) to 0.98 mSv (0.77-1.42 mSv) (P < .001). As expected, the quality indexes of the low-dose images were inferior to those of the conventional-dose images, but no clinically significant diagnostic findings were missed with low-dose imaging. Follow-up CT examinations were recommended for 5 patients; 1 had a cervical tumor, 1 had a pancreatic lesion, and 3 had intra-abdominal abscess. In each case, the image obtained by low-dose CT was considered sufficient for diagnosis.
  
  
  CONCLUSIONS
  Although low-dose CT images are of lower quality than images obtained with conventional doses of radiation, no clinically significant diagnostic findings were missed from low-dose CT images of patients with Crohn's disease. The low-dose CT was obtained at a median effective dose equivalent to 1.4 abdominal radiographs.
authors.affiliation: Departments of Medicine and Radiology, Cork University Hospital and Alimentary Pharmabiotic Centre, University College Cork, National University of Ireland, Cork, Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: Craig
authors.forename: Siobhan
authors.initials: S
authors.lastname: O'Neill
authors.forename: Fiona
authors.initials: F
authors.lastname: O'Neill
authors.forename: Patrick
authors.initials: P
authors.lastname: McLaughlin
authors.forename: Annemarie
authors.initials: A
authors.lastname: McGarrigle
authors.forename: Sebastian
authors.initials: S
authors.lastname: McWilliams
authors.forename: Owen
authors.initials: O
authors.lastname: O'Connor
authors.forename: Alan
authors.initials: A
authors.lastname: Desmond
authors.forename: Elizabeth Kenny
authors.initials: EK
authors.lastname: Walsh
authors.forename: Max
authors.initials: M
authors.lastname: Ryan
authors.forename: Michael
authors.initials: M
authors.lastname: Maher
authors.forename: Fergus
authors.initials: F
authors.lastname: Shanahan
mesh_terms: D000328:Adult; D003424:Crohn Disease / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging; D011446:Prospective Studies; D011860:Radiography, Abdominal / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*