Development and Validation of a Novel Computed-Tomography Enterography Radiomic Approach for Characterization of Intestinal Fibrosis in Crohn's Disease

Xuehua Li, Dong Liang, Jixin Meng, Jie Zhou, Zhao Chen, Siyun Huang, Baolan Lu, Yun Qiu, Mark E. Baker, Ziyin Ye, Qinghua Cao, Mingyu Wang, Chenglang Yuan, Zhihui Chen, Shengyu Feng, Yuxuan Zhang, Marietta Iacucci, Subrata Ghosh, Florian Rieder, Canhui SunMinhu Chen, Ziping Li, Ren Mao, Bingsheng Huang, Shi Ting Feng

Research output: Contribution to journalArticlepeer-review

45 Scopus citations

Abstract

Background & Aims: No reliable method for evaluating intestinal fibrosis in Crohn's disease (CD) exists; therefore, we developed a computed-tomography enterography (CTE)–based radiomic model (RM) for characterizing intestinal fibrosis in CD. Methods: This retrospective multicenter study included 167 CD patients with 212 bowel lesions (training, 98 lesions; test, 114 lesions) who underwent preoperative CTE and bowel resection at 1 of the 3 tertiary referral centers from January 2014 through June 2020. Bowel fibrosis was histologically classified as none–mild or moderate–severe. In the training cohort, 1454 radiomic features were extracted from venous-phase CTE and a machine learning–based RM was developed based on the reproducible features using logistic regression. The RM was validated in an independent external test cohort recruited from 3 centers. The diagnostic performance of RM was compared with 2 radiologists’ visual interpretation of CTE using receiver operating characteristic (ROC) curve analysis. Results: In the training cohort, the area under the ROC curve (AUC) of RM for distinguishing moderate–severe from none–mild intestinal fibrosis was 0.888 (95% confidence interval [CI], 0.818–0.957). In the test cohort, the RM showed robust performance across 3 centers with an AUC of 0.816 (95% CI, 0.706–0.926), 0.724 (95% CI, 0.526–0.923), and 0.750 (95% CI, 0.560–0.940), respectively. Moreover, the RM was more accurate than visual interpretations by either radiologist (radiologist 1, AUC = 0.554; radiologist 2, AUC = 0.598; both, P <.001) in the test cohort. Decision curve analysis showed that the RM provided a better net benefit to predicting intestinal fibrosis than the radiologists. Conclusions: A CTE-based RM allows for accurate characterization of intestinal fibrosis in CD.

Original languageEnglish (US)
Pages (from-to)2303-2316.e11
JournalGastroenterology
Volume160
Issue number7
DOIs
StatePublished - Jun 2021
Externally publishedYes

Keywords

  • Computed Tomography Enterography
  • Crohn's Disease
  • Fibrosis
  • Radiomics

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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