Original Investigation|Articles in Press

A Novel Radiomics Model Integrating Luminal and Mesenteric Features to Predict Mucosal Activity and Surgery Risk in Crohn's Disease Patients: A Multicenter Study


      To investigate the feasibility of integrating radiomics and morphological features based on computed tomography enterography (CTE) for developing a noninvasive grading model for mucosal activity and surgery risk of Crohn's disease (CD) patients.


      A total of 167 patients from three centers were enrolled. Radiomics and image morphological features were extracted to quantify segmental and global simple endoscopic score for Crohn's disease (SES-CD). An image-fusion-based support vector machine (SVM) classifier was used for grading SES-CD and identifying moderate-to-severe SES-CD. The performance of the predictive model was assessed using the area under the receiver operating characteristic curve (AUC). A multiparametric model was developed to predict surgical progression in CD patients by combining sum-image scores and clinical data.


      The AUC values of the multicategorical segmental SES-CD fusion radiomic model based on a combination of luminal and mesenteric radiomics were 0.828 and 0.709 in training and validation cohorts. The image fusion model integrating the fusion radiomics and morphological features could accurately distinguish bowel segments with moderate-to-severe SES-CD in both the training cohort (AUC = 0.847, 95% confidence interval (CI): 0.784–0.902) and the validation cohort (AUC = 0.896, 95% CI: 0.812–0.960). A predictive nomogram for interval surgery was developed based on multivariable cox analysis.


      This study demonstrated the feasibility of integrating lumen and mesentery radiomic features to develop a promising noninvasive grading model for mucosal activity of CD. In combination with clinical data, the fusion-image score may yield an accurate prognostic model for time to surgery.

      Key words


      AIC (akaike information criterion), ALB (albumin level), AUC (area under the receiver operating characteristic curve), CD (Crohn's disease), CI (confidence interval), CIR (cecal intubation rate), CRP (C-reactive protein), CTE (computed tomography enterography), Hb (hemoglobin), HR (hazard ratio), IBD (inflammatory bowel disease), ICC (intraclass correlation coefficients), LASSO (least absolute shrinkage and selection operator), LR (logistic regression), MH (mucosal healing), PLT (platelet count), RF (random forest), ROC (receiver operating characteristic), SES-CD (simple endoscopic score for Crohn's disease), SFFS (sequential forward floating selection), SFS (Surgery-free survival), SVM (support vector machine), TH (transmural healing: VOIs, volumes of interest), WBC (white blood cell), XGBoost (eXtreme Gradient Boosting)
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        • Lwenberg M
        • Vermeire S
        • Mostafavi N
        • et al.
        Vedolizumab induces endoscopic and histologic remission in patients with Crohn's disease[J].
        Gastroenterology. 2019; 157: 997-1006
        • Minordi LM
        • Bevere A
        • Papa A
        • et al.
        CT and MRI evaluations in Crohn's complications: a guide for the radiologist.
        Acad Radiol. 2022; 29: 1206-1227
        • Torres J
        • Bonovas S
        • Doherty G
        • et al.
        ECCO guidelines on therapeutics in Crohn's disease: medical treatment.
        J Crohns Colitis. 2020; 14: 4-22
        • Peyrin-Biroulet L
        • Sandborn W
        • Sands BE
        • et al.
        Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to target.
        Am J Gastroenterol. 2015; 110 (1324-13)
        • Longobardi T
        • Bernstein CN
        Health care resource utilization in inflammatory bowel disease.
        Clin Gastroenterol Hepatol. 2006; 4: 731-743
        • Fernandes SR
        • Rodrigues RV
        • Bernardo S
        • et al.
        Transmural healing is associated with improved long-term outcomes of patients with Crohn's disease.
        Inflamm Bowel Dis. 2017; 23: 1403-1409
        • Chavoshi M
        • Mirshahvalad SA
        • Kasaeian A
        • et al.
        Diagnostic accuracy of magnetic resonance enterography in the evaluation of colonic abnormalities in Crohn's disease: a systematic review and meta-analysis.
        Acad Radiol. 2021; 28 (Suppl): S192-S202
        • Cipriano LE
        • Levesque BG
        • Zaric GS
        • et al.
        Cost-effectiveness of imaging strategies to reduce radiation-induced cancer risk in Crohn's disease.
        Inflamm Bowel Dis. 2012; 18: 1240-1248
        • Samuel S
        • Bruining DH
        • Loftus EV
        • et al.
        Skipping of distal terminal ileum in Crohn's disease.
        Gastroenterology. 2011; 140: 2
        • Kundrotas LW
        • Clement DJ
        • Kubik CM
        • et al.
        A prospective evaluation of successful terminal ileum intubation during routine colonoscopy.
        Gastrointest Endosc. 1994; 40: 544-546
        • Fiorino G
        • Morin M
        • Bonovas S
        • et al.
        Prevalence of bowel damage assessed by cross-sectional imaging in early Crohn's Disease and its impact on disease outcome.
        J Crohns Colitis. 2017; 11: 274-280
        • Jeuring SFG
        • Van Den Heuvel TRA
        • Liu LYL
        • et al.
        Improvements in the long-term outcome of Crohn's disease over the past two decades and the relation to changes in medical management: results from the population-based IBDSL Cohort.
        Am J Gastroenterol. 2017; 112: 325-336
        • Ng SC
        • Leung WK
        • Shi HY
        • et al.
        Epidemiology of inflammatory bowel disease from 1981 to 2014: results from a territory-wide population-based registry in Hong Kong.
        Inflamm Bowel Dis. 2016; 22: 1954-1960
        • Liu W
        • Zhou W
        • Xiang J
        • et al.
        Lémann index at diagnosis predicts the risk of early surgery in Crohn's disease.
        Dis Colon Rectum. 2018; 61: 207-213
        • Wang K
        • Huang L
        • Huang W
        • et al.
        Predictive value of CT enterography index for postoperative intra-abdominal septic complications in patients with Crohn's disease: implications for surgical decision-making.
        Dis Colon Rectum. 2021; 64: 964-976
        • Yang J
        • Wu Q
        • Xu L
        • et al.
        Integrating tumor and nodal radiomics to predict lymph node metastasis in gastric cancer.
        Radiother Oncol. 2020; 150: 89-96
        • Dong D
        • Tang L
        • Li ZY
        • et al.
        Development and validation of an individualized nomogram to identify occult peritoneal metastasis in patients with advanced gastric cancer.
        Ann Oncol. 2019; 30: 431-438
        • Zhu C
        • Yu Y
        • Wang S
        • et al.
        A novel clinical radiomics nomogram to identify crohn's disease from intestinal tuberculosis.
        J Inflamm Res. 2021; 14: 6511-6521
        • Li H
        • Mo Y
        • Huang C
        • et al.
        An MSCT-based radiomics nomogram combined with clinical factors can identify Crohn's disease and ulcerative colitis.
        Ann Transl Med. 2021; 9: 572
        • Chen Y
        • Li H
        • Feng J
        • et al.
        A novel radiomics nomogram for the prediction of secondary loss of response to infliximab in Crohn's disease.
        J Inflamm Res. 2021; 14: 2731-2740
        • Coffey CJ
        • Kiernan MG
        • Sahebally SM
        • et al.
        Inclusion of the mesentery in ileocolic resection for Crohn's disease is associated with reduced surgical recurrence.
        J Crohns Colitis. 2018; 12: 1139-1150
        • Li XH
        • Feng ST
        • Cao QH
        • et al.
        Degree of creeping fat assessed by computed tomography enterography is associated with intestinal fibrotic stricture in patients with Crohn's disease: a potentially novel mesenteric creeping fat index.
        J Crohns Colitis. 2021; 15: 1161-1173
        • Sakurai T
        • Katsuno T
        • Saito K
        • et al.
        Mesenteric findings of CT enterography are well correlated with the endoscopic severity of Crohn's disease.
        Eur J Radiol. 2017; 89: 242-248
        • Yuan L
        • Wu TT
        • Chandan V
        • et al.
        Clinicopathological significance of lymphocytic colitis/collagenous colitis in inflammatory bowel disease.
        Hum Pathol. 2020; 96: 87-95
        • Daperno M
        • D'Haens G
        • Van Assche G
        • et al.
        Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD.
        Gastrointest Endosc. 2004; 60: 505-512
        • Zwanenburg A
        • Vallières M
        • Abdalah MA
        • et al.
        The image biomarker standardization initiative: standardized quantitative radiomics for high-throughput image-based phenotyping.
        Radiology. 2020; 295: 328-338
        • Pudil P
        • Novovicova J
        • Kittler J
        Floating search methods in feature-selection.
        Pattern Recogn Lett. 1994; 15: 1119-1125
        • Baert F
        • Moortgat L
        • Van Assche G
        • et al.
        Mucosal healing predicts sustained clinical remission in patients with early-stage Crohn's disease.
        Gastroenterology. 2010; 138: 463-e11
        • Meral M
        • Bengi G
        • Kayahan H
        • et al.
        Is ileocecal valve intubation essential for routine colonoscopic examination?.
        Eur J Gastroenterol Hepatol. 2018; 30: 432-437
        • Bodily KD
        • Fletcher JG
        • Solem CA
        • et al.
        Crohn disease: mural attenuation and thickness at contrast-enhanced CT Enterography–correlation with endoscopic and histologic findings of inflammation.
        Radiology. 2006; 238: 505-516
        • Vogel J
        • da Luz Moreira A
        • Baker M
        • et al.
        CT enterography for Crohn's disease: accurate preoperative diagnostic imaging.
        Dis Colon Rectum. 2007; 50: 1761-1769
        • Lafeuille P
        • Hordonneau C
        • Vignette J
        • et al.
        Transmural healing and MRI healing are associated with lower risk of bowel damage progression than endoscopic mucosal healing in Crohn's disease.
        Aliment Pharmacol Ther. 2021; 53: 577-586
        • Hsu W
        • Sohn JH
        Using radiomics for risk stratification: where we need to go.
        Radiology. 2022; 302: 435-437
        • Xu L
        • Yang P
        • Liang W
        • et al.
        A radiomics approach based on support vector machine using MR images for preoperative lymph node status evaluation in intrahepatic cholangiocarcinoma.
        Theranostics. 2019; 9: 5374-5385
        • Liu R
        • Qiao S
        • Shen W
        • et al.
        Disturbance of fatty acid desaturation mediated by FADS2 in mesenteric adipocytes contributes to chronic inflammation of Crohn's disease.
        J Crohns Colitis. 2020; 14: 1581-1599
        • Shen W
        • Cao L
        • Li Y
        • et al.
        Visceral fat is associated with mucosal healing of infliximab treatment in Crohn's disease.
        Dis Colon Rectum. 2018; 61: 706-712
        • Zhou Z
        • Xiong Z
        • Cheng R
        • et al.
        Volumetric visceral fat machine learning phenotype on CT for differential diagnosis of inflammatory bowel disease.
        Eur Radiol. 2023; 33: 1862-1872
        • Meng J
        • Mao Y
        • Zhou J
        • et al.
        Mesenteric abnormalities play an important role in grading intestinal fibrosis in patients with Crohn's disease: a computed tomography and clinical marker-based nomogram.
        Therap Adv Gastroenterol. 2022; 1517562848221122504
        • Zhu C
        • Hu J
        • Wang X
        • et al.
        A novel clinical radiomics nomogram at baseline to predict mucosal healing in Crohn's disease patients treated with infliximab.
        Eur Radiol. 2022; 32: 6628-6636
        • Scharrer S
        • Lissner D
        • Primas C
        • et al.
        Passive smoking increases the risk for intestinal surgeries in patients with Crohn's disease.
        Inflamm Bowel Dis. 2021; 27: 379-385
        • Chirra P
        • Sharma A
        • Bera K
        • et al.
        Integrating radiomics with clinicoradiological scoring can predict high-risk patients who need surgery in Crohn’s disease: a pilot study.
        Inflamm Bowel Dis. 2023; 29: 349-358