Computed tomography enterography for crohn’s disease: correlation between the imaging findings and histopathologic scoring system

Ma, Liang; Shen, Xing; Chen, Yijing; Zhang, Qi; Li, Bo; Zhang, Wei

doi:10.1007/s00261-021-03112-w

“…Literature reports that strictures can also distinguish CD activity [ 28 ], and our research confirms these results. Previous studies have shown that lymph node enlargement (length ≥ 1 cm) can be considered a sign of the active stage of CD, but it is more prominent in severely active intestinal segments [ 27 , 29 ]. We found that there was statistical significance in the size of regional lymph nodes between active and inactive intestinal segments, which could be reactive hyperplasia of mesentery lymph nodes caused by CD activity.…”

Section: Discussionmentioning

confidence: 99%

Establishing a machine learning model based on dual-energy CT enterography to evaluate Crohn’s disease activity

Li,

Xie,

Tang

et al. 2024

Insights Imaging

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Objectives The simplified endoscopic score of Crohn’s disease (SES-CD) is the gold standard for quantitatively evaluating Crohn’s disease (CD) activity but is invasive. This study aimed to develop and validate a machine learning (ML) model based on dual-energy CT enterography (DECTE) to noninvasively evaluate CD activity. Methods We evaluated the activity in 202 bowel segments of 46 CD patients according to the SES-CD score and divided the segments randomly into training set and testing set at a ratio of 7:3. Least absolute shrinkage and selection operator (LASSO) was used for feature selection, and three models based on significant parameters were established based on logistic regression. Model performance was evaluated using receiver operating characteristic (ROC), calibration, and clinical decision curves. Results There were 110 active and 92 inactive bowel segments. In univariate analysis, the slope of spectral curve in the venous phases (λHU-V) has the best diagnostic performance, with an area under the ROC curve (AUC) of 0.81 and an optimal threshold of 1.975. In the testing set, the AUC of the three models established by the 7 variables to differentiate CD activity was 0.81–0.87 (DeLong test p value was 0.071–0.766, p > 0.05), and the combined model had the highest AUC of 0.87 (95% confidence interval (CI): 0.779–0.959). Conclusions The ML model based the DECTE can feasibly evaluate CD activity, and DECTE parameters provide a quantitative analysis basis for evaluating specific bowel activities in CD patients. Critical relevance statement The machine learning model based on dual-energy computed tomography enterography can be used for evaluating Crohn’s disease activity noninvasively and quantitatively. Key Points Dual-energy CT parameters are related to Crohn’s disease activity. Three machine learning models effectively evaluated Crohn’s disease activity. Combined models based on conventional and dual-energy CT have the best performance. Graphical Abstract

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“…In fact, pure fibrotic lesions in CD are rare, and inflammation and fibrosis often coexist [27]. The establishment of the CTE scoring system provides an objective tool for disease assessment [39]. The CTE score represents an accumulation of intestinal CT findings.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Cohort Study of Shear-Wave Elastography and Computed Tomography Enterography in Crohn’s Disease

Zhang

¹

,

Xiao

²

,

Liu

³

et al. 2023

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Distinguishing between inflammatory and fibrotic lesions drastically influences treatment decision-making regarding Crohn’s disease. However, it is challenging to distinguish these two phenotypes before surgery. This study investigates the diagnostic yield of shear-wave elastography and computed tomography enterography to distinguish intestinal phenotypes in Crohn’s disease. Thirty-seven patients (mean age, 29.51 ± 11.52; 31 men) were evaluated with average value of shear-wave elastography (Emean) and computed tomography enterography (CTE) scores. The results demonstrated that a positive correlation between the Emean and fibrosis (Spearman’s r = 0.653, p = 0.000). The cut-off value for fibrotic lesions was 21.30 KPa (AUC: 0.877, sensitivity: 88.90%, specificity: 89.50%, 95% CI:0.755~0.999, p = 0.000). The CTE score showed a positive correlation with inflammation (Spearman’s r = 0.479, p = 0.003), and a 4.5-point grading system was the optimal cut-off value for inflammatory lesions (AUC: 0.766, sensitivity: 73.70%, specificity: 77.80%, 95% CI: 0.596~0.936, p = 0.006). Combining these two metrics improved the diagnostic performance and specificity (AUC: 0.918, specificity: 94.70%, 95% CI: 0.806~1.000, p = 0.000). In conclusion, shear-wave elastography can be used to help detect fibrotic lesions and the computed tomography enterography score emerged as a feasible predictor of inflammatory lesions. The combination of these two imaging techniques is proposed to distinguish intestinal predominant phenotypes.

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“…Each variable was scored from 0 to 3 in each segment. The SES-CD was defined as follows: inactive (0-2), mild activity (3)(4)(5)(6), moderate activity (7)(8)(9)(10)(11)(12)(13)(14)(15)(16), and severe activity (>16). CD patients with moderate and severe activity were allocated to the moderatesevere group.…”

Section: Methodsmentioning

confidence: 99%

“…Endoscopy is considered the gold standard for the assessment of CD activity. Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are the current standard for assessing the small bowel and complications in CD and have been proposed as alternative procedures to endoscopy in the evaluation of CD activity [4,5]. As that endoscopy, CTE, and MRE are invasive, time-consuming, and expensive procedures and unappealing to patients, noninvasive tools for assessment and monitoring CD activity are strongly needed.…”

Section: Introductionmentioning

confidence: 99%

Intestinal Ultrasound Combined with Blood Inflammatory Markers Is a More Efficient Tool in Evaluating Severity of Crohn’s Disease: A Pilot Study

Fang,

Liu,

Qian

et al. 2023

Gastroenterology Research and Practice

1

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Background and Aims. Intestinal ultrasound (IUS) is considered a nonirradiating, noninvasive, well-tolerated, and valuable tool for objectively assessing Crohn’s disease (CD) activity. However, there is no widely accepted intestinal ultrasound scoring system. This study is aimed at evaluating the efficacy of IUS key parameters, the International Bowel Ultrasound Activity Score (IBUS-SAS), and IBUS-SAS combined with blood inflammatory markers in assessing CD activity. Methods. 40 CD patients were reviewed in this retrospective study and were divided into the moderate-severe group ( n = 25 ) and nonmoderate-severe group ( n = 15 ) based on a simplified endoscopic score of Crohn’s disease (SES-CD). Double-balloon enteroscopy/colonoscopy were reviewed by three gastroenterologists. A transabdominal ultrasound was performed by two ultrasound specialists. Blood inflammatory markers were measured from morning samples. Results. In evaluating moderate to severe CD patients, (1) IBUS-SAS had a good predictive effect with an area-under-the-curve (AUC) of 0.855 ( P < 0.001 ); (2) IUS key parameters (including BWT, CDS, BWS, and I-fat) yielded good predictive effects with AUC of 0.811, 0.731, 0.724, and 0.747, respectively ( P < 0.001 ); (3) blood inflammatory markers (including ESR, CRP, PLR, MLR, and NLR) also had good predictive effects with AUC of 0.771, 0.837, 0.728, 0.743, and 0.775, respectively ( P < 0.001 ); (4) IBUS-SAS combined with ESR and CRP exerted the best predictive effect with the highest AUC of 0.912 (95% CI: 0.823-1.000), and the sensitivity and specificity were 88.0% and 80.0%, respectively ( P < 0.001 ). Conclusion. IBUS-SAS combined with ESR and CRP is a more efficient tool than IBUS-SAS alone or inflammatory markers alone in evaluating CD patients with moderate to severe disease activity.

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Computed tomography enterography for crohn’s disease: correlation between the imaging findings and histopathologic scoring system

Cited by 7 publications

References 20 publications

Establishing a machine learning model based on dual-energy CT enterography to evaluate Crohn’s disease activity

Establishing a machine learning model based on dual-energy CT enterography to evaluate Crohn’s disease activity

Retrospective Cohort Study of Shear-Wave Elastography and Computed Tomography Enterography in Crohn’s Disease

Intestinal Ultrasound Combined with Blood Inflammatory Markers Is a More Efficient Tool in Evaluating Severity of Crohn’s Disease: A Pilot Study

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