Rationale and Objectives
To develop computed tomography enterography (CTE)-based radiomics models to assess
mucosal healing (MH) in patients with Crohn's disease (CD).
Materials and Methods
CTE images were retrospectively collected from 92 confirmed cases of CD at the post-treatment
review. Patients were randomly divided into developing (n = 73) and testing (n = 19) groups. Radiomics features were extracted from the enteric phase images, and
the least absolute shrinkage and selection operator (LASSO) logistic regression was
applied for feature selection using 5-fold cross-validation on the developing group.
The selected features were further identified from the top-ranked features and used
to create improved radiomics models. Machine learning models were constructed to compare
radiomics models with different radiomics features. The area under the ROC curve (AUC)
was calculated to assess the predictive performance for identifying MH in CD.
Results
Among the 92 CD patients included in our study, 36 patients achieved MH. The AUC of
the radiomics model 1, which was based on the 26 selected radiomics features, was
0.976 for evaluating MH in the testing cohort. The AUCs of radiomics models 2 and
4, based on the top 10 and top 5 positive and negative radiomics features, were 0.974
and 0.952 in the testing cohort, respectively. The AUC of the radiomics model 3, built
by removing features with r > 0.5, was 0.956 in the testing cohort. The clinical utility
of the clinical radiomics nomogram was confirmed by the decision curve analysis (DCA).
Conclusion
The CTE-based radiomics models have demonstrated favorable performance in assessing
MH in patients with CD. Radiomics features can be used as a promising imaging biomarker
for MH.
Abbreviations:
AUC (area under the ROC curve), CD (Crohn's disease), CTE (computed tomography enterography), CRP (C-reactive protein), DCA; (decision curve analysis), HBI (Harvey Bradshaw Index), IFX (infliximab), LASSO (least absolute shrinkage and selection operator), MH (mucosal healing), ROI (regions of interest), ROC (receiver operator characteristic), WBC (white blood cell)Key Words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic RadiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Crohn's disease.Nat Rev Dis Primers. 2020; 6: 22https://doi.org/10.1038/s41572-020-0156-2
- Diagnosis and classification of Crohn's disease.Autoimmun Rev. 2014; 13: 467-471https://doi.org/10.1016/j.autrev.2014.01.029
- Infliximab exposure associates with radiologic evidence of healing in patients with Crohn's disease.Clin Gastroenterol Hepatol. 2021; 19: 947-954https://doi.org/10.1016/j.cgh.2020.04.052
- Noninvasive targeted Crohn disease management by combining endoscopic healing index and therapeutic drug monitoring.Crohns Colitis 360. 2021; 3: otab035https://doi.org/10.1093/crocol/otab035
- Results of the 2nd scientific workshop of the ECCO (IV): therapeutic strategies to enhance intestinal healing in inflammatory bowel disease.J Crohns Colitis. 2012; 6: 492-502https://doi.org/10.1016/j.crohns.2011.12.016
- Infliximab trough levels are associated with mucosal healing during maintenance treatment with infliximab in paediatric Crohn's disease.J Crohns Colitis. 2019; 13: 189-197https://doi.org/10.1093/ecco-jcc/jjy155
- Monitoring a combination of calprotectin and infliximab identifies patients with mucosal healing of Crohn's disease.Clin Gastroenterol Hepatol. 2020; 18: 637-646https://doi.org/10.1016/j.cgh.2019.05.029
- Monitoring Crohn's disease activity: endoscopy, fecal markers and computed tomography enterography.Therap Adv Gastroenterol. 2018; 111756284818769075https://doi.org/10.1177/1756284818769075
- Endoscopic, radiologic, and histologic healing with vedolizumab in patients with active Crohn's disease.Gastroenterology. 2019; 157: 1007-1018https://doi.org/10.1053/j.gastro.2019.06.038
- ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease.Gastrointest Endosc. 2006; 63: 558-565https://doi.org/10.1016/j.gie.2006.02.005
- Correlation of CT enteroclysis with surgical pathology in Crohn's disease.Am J Gastroenterol. 2007; 102: 2541-2550https://doi.org/10.1111/j.1572-0241.2007.01537.x
- Associations among mucosal and transmural healing and fecal level of calprotectin in children with Crohn's disease.Clin Gastroenterol Hepatol. 2018; 16: 1089-1097https://doi.org/10.1016/j.cgh.2018.01.024
- Mesenteric findings of CT enterography are well correlated with the endoscopic severity of Crohn's disease.Eur J Radiol. 2017; 89: 242-248https://doi.org/10.1016/j.ejrad.2016.10.022
- A novel clinical radiomics nomogram to identify Crohn's disease from intestinal tuberculosis.J Inflamm Res. 2021; 14: 6511-6521https://doi.org/10.2147/jir.S344563
- A novel clinical radiomics nomogram at baseline to predict mucosal healing in Crohn's disease patients treated with infliximab.Eur Radiol. 2022; 32: 6628-6636https://doi.org/10.1007/s00330-022-08989-9
- ECCO-ESGAR guideline for diagnostic assessment in IBD part 1: initial diagnosis, monitoring of known IBD, detection of complications.J Crohns Colitis. 2019; 13: 144-164https://doi.org/10.1093/ecco-jcc/jjy113
- Association of faecal calprotectin level and combined endoscopic and radiological healing in patients with Crohn's disease receiving anti-tumour necrosis factor therapy.J Crohns Colitis. 2020; 14: 1231-1240https://doi.org/10.1093/ecco-jcc/jjaa042
- Serum oncostatin M at baseline predicts mucosal healing in Crohn's disease patients treated with infliximab.Aliment Pharmacol Ther. 2020; 52: 284-291https://doi.org/10.1111/apt.15870
- Development and validation of a new, simplified endoscopic activity score for Crohn's disease: the SES-CD.Gastrointest Endosc. 2004; 60: 505-512https://doi.org/10.1016/s0016-5107(04)01878-4
- Endoscopic and radiographic assessment of Crohn's disease.Gastroenterol Clin North Am. 2017; 46: 493-513https://doi.org/10.1016/j.gtc.2017.05.005
- STRIDE-II: an update on the selecting therapeutic targets in inflammatory bowel disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD.Gastroenterology. 2021; 160: 1570-1583https://doi.org/10.1053/j.gastro.2020.12.031
- CT and MRI evaluations in Crohn's complications: a guide for the radiologist.Acad Radiol. 2022; 29: 1206-1227https://doi.org/10.1016/j.acra.2021.07.025
- Endoscopic mucosal healing predicts favorable clinical outcomes in inflammatory bowel disease: a meta-analysis.Inflamm Bowel Dis. 2016; 22: 1859-1869https://doi.org/10.1097/mib.0000000000000816
- Accuracy of fecal calprotectin for the prediction of endoscopic activity in patients with inflammatory bowel disease.Dig Liver Dis. 2018; 50: 353-359https://doi.org/10.1016/j.dld.2017.12.022
- Clinical utility of fecal biomarkers for the diagnosis and management of inflammatory bowel disease.Inflamm Bowel Dis. 2014; 20: 742-756https://doi.org/10.1097/01.Mib.0000442681.85545.31
- Optimizing anti-TNF-α therapy: serum levels of infliximab and adalimumab are associated with mucosal healing in patients with inflammatory bowel diseases.Clin Gastroenterol Hepatol. 2016; 14: 550-557https://doi.org/10.1016/j.cgh.2015.10.025
- Crohn disease: mural attenuation and thickness at contrast-enhanced CT enterography – correlation with endoscopic and histologic findings of inflammation.Radiology. 2006; 238: 505-516https://doi.org/10.1148/radiol.2382041
- Radiomics: the bridge between medical imaging and personalized medicine.Nat Rev Clin Oncol. 2017; 14: 749-762https://doi.org/10.1038/nrclinonc.2017.141
- A deep look into radiomics.Radiol Med. 2021; 126: 1296-1311https://doi.org/10.1007/s11547-021-01389-x
- Texture analysis of magnetic resonance enterography contrast enhancement can detect fibrosis in Crohn disease strictures.J Pediatr Gastroenterol Nutr. 2019; 69: 533-538https://doi.org/10.1097/MPG.0000000000002454
Article info
Publication history
Published online: May 18, 2023
Accepted:
April 18,
2023
Received in revised form:
April 17,
2023
Received:
March 22,
2023
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved All rights reserved.
