TY - JOUR
T1 - Mesenteric abnormalities play an important role in grading intestinal fibrosis in patients with Crohn’s disease
T2 - a computed tomography and clinical marker-based nomogram
AU - Meng, Jixin
AU - Mao, Yitao
AU - Zhou, Jie
AU - Chen, Zhao
AU - Huang, Siyun
AU - Wang, Yangdi
AU - Huang, Li
AU - Zhang, Ruonan
AU - Shen, Xiaodi
AU - Lv, Wen
AU - Xiao, Juxiong
AU - Ye, Ziyin
AU - Chen, Zhihui
AU - Mao, Ren
AU - Sun, Canhui
AU - Li, Ziping
AU - Feng, Shi Ting
AU - Lin, Shaochun
AU - Li, Xuehua
N1 - Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by the National Natural Science Foundation of China (grant numbers 82070680, 81870451, and 82072002), Natural Science Foundation of Hunan Province (2022JJ30794) and Changsha Municipal Natural Science Foundation (kq2202126). The funders had no role in the study design, data collection, data analysis, data interpretation, or writing of the report.
Publisher Copyright:
© The Author(s), 2022.
PY - 2022
Y1 - 2022
N2 - Background: While the grading of intestinal fibrosis is closely related to the therapeutic strategy of patients with Crohn’s disease (CD), it has not yet been well resolved. Mesenteric abnormalities are inextricably linked to intestinal fibrosis. Objectives: We aimed to establish an optimal model for assessing intestinal fibrosis using computed tomography enterography (CTE) and clinical markers. Design: A total of 174 patients with CD between January 2014 and June 2020 were included in this retrospective multicentre study. Methods: All patients underwent CTE within 3 months prior to surgery. Intestinal fibrosis was pathologically scored as non-mild or moderate-to-severe. Selected imaging of the intestinal walls and mesentery and/or clinical factors were used to develop the diagnostic models. The area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the discrimination performance of the models. A decision curve analysis was performed to evaluate the clinical usefulness of the models. Results: One-, two-, and three-variable models were identified as possible diagnostic models. Model 1 [mesenteric creeping fat index (MCFI)], Model 2 (mesenteric oedema and MCFI), and Model 3 (mesenteric oedema, MCFI, and disease duration) were established. The AUCs of Model 1 in training and test cohorts 1 and 2 were 0.799, 0.859, and 0.693, respectively; Model 2 was 0.851, 0.833, and 0.757, respectively; and Model 3 was 0.832, 0.821, and 0.850, respectively. We did not observe any significant difference in diagnostic performance between the training and total test cohorts in any model (all p > 0.05). The decision curves showed that Model 3 had the highest net clinical benefit in test cohort 2. The nomogram of this optimal model was constructed by considering the favourable and robust performance of Model 3. Conclusion: A nomogram integrating mesenteric abnormalities on CTE with a clinical marker was optimal for differentiating between non-mild and moderate-to-severe fibrosis in patients with CD.
AB - Background: While the grading of intestinal fibrosis is closely related to the therapeutic strategy of patients with Crohn’s disease (CD), it has not yet been well resolved. Mesenteric abnormalities are inextricably linked to intestinal fibrosis. Objectives: We aimed to establish an optimal model for assessing intestinal fibrosis using computed tomography enterography (CTE) and clinical markers. Design: A total of 174 patients with CD between January 2014 and June 2020 were included in this retrospective multicentre study. Methods: All patients underwent CTE within 3 months prior to surgery. Intestinal fibrosis was pathologically scored as non-mild or moderate-to-severe. Selected imaging of the intestinal walls and mesentery and/or clinical factors were used to develop the diagnostic models. The area under the receiver operating characteristic curve (AUC) analysis was used to evaluate the discrimination performance of the models. A decision curve analysis was performed to evaluate the clinical usefulness of the models. Results: One-, two-, and three-variable models were identified as possible diagnostic models. Model 1 [mesenteric creeping fat index (MCFI)], Model 2 (mesenteric oedema and MCFI), and Model 3 (mesenteric oedema, MCFI, and disease duration) were established. The AUCs of Model 1 in training and test cohorts 1 and 2 were 0.799, 0.859, and 0.693, respectively; Model 2 was 0.851, 0.833, and 0.757, respectively; and Model 3 was 0.832, 0.821, and 0.850, respectively. We did not observe any significant difference in diagnostic performance between the training and total test cohorts in any model (all p > 0.05). The decision curves showed that Model 3 had the highest net clinical benefit in test cohort 2. The nomogram of this optimal model was constructed by considering the favourable and robust performance of Model 3. Conclusion: A nomogram integrating mesenteric abnormalities on CTE with a clinical marker was optimal for differentiating between non-mild and moderate-to-severe fibrosis in patients with CD.
KW - computed tomography enterography
KW - Crohn’s disease
KW - fibrosis
KW - mesentery
KW - nomogram
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U2 - 10.1177/17562848221122504
DO - 10.1177/17562848221122504
M3 - Article
C2 - 36090482
AN - SCOPUS:85139067345
SN - 1756-283X
VL - 15
JO - Therapeutic Advances in Gastroenterology
JF - Therapeutic Advances in Gastroenterology
ER -