CT 肠造影定义的肠系膜爬行脂肪指数与克罗恩病患者的早期术后复发相关。

Mesenteric creeping fat index defined by CT enterography is associated with early postoperative recurrence in patients with Crohn's disease.

机构信息

Department of Radiology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China.

Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, People's Republic of China; Department of Gastroenterology, Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.

出版信息

Eur J Radiol. 2023 Nov;168:111144. doi: 10.1016/j.ejrad.2023.111144. Epub 2023 Oct 6.

DOI:10.1016/j.ejrad.2023.111144

PMID:37862926

Abstract

OBJECTIVES

To investigate the value of mesenteric creeping fat index (MCFI) defined by computed-tomography enterography (CTE) in patients with Crohn's Disease (CD) for predicting early postoperative recurrence.

METHODS

A total of 110 patients with CD who underwent CTE and I-stage intestinal resection surgery from December 2013 to December 2018 were enrolled. Two radiologists independently assessed CTE parameters, including MCFI, with scores ranging from 1 to 8; bowel-wall thickening, with a scale of 1 to 3; mural hyperenhancement, mural stratification, submucosal fat deposition, mesenteric fibrofatty proliferation, mesenteric hypervascularity, mesenteric fat stranding, with a scale of 0 to 2; abscess/fistula, enlarged mesenteric lymph node, abdominal and pelvic effusion, with a scale of 0 to 1. Imaging findings associated with early recurrence were assessed using logistic regression analysis.

RESULTS

Within one year follow-up, early postoperative recurrence occurred in 56.4 % (62/110) patients with CD. In univariate analysis, MCFI, bowel-wall thickening, mesenteric hypervascularity, mesenteric fat stranding, abscess/fistula and mesenteric lymphadenopathy were associated with early postoperative recurrence. Among all variables, MCFI (score ≥ 4) contributes the optimal AUC (0.838 [0.758-0.919]), specificity (89.6 %), positive predictive value (90.7 %), accuracy (83.6 %), and risk ratio (OR = 32.42 [10.69-98.33], p < 0.001). In multivariate analysis, only MCFI was an independent predictor of early postoperative recurrence (OR = 25.71 [7.65-86.35], p < 0.001).

CONCLUSION

CTE features are useful in predicting early postoperative recurrence in patients with CD, MCFI may be a valuable tool for clinical monitoring and follow-up.

摘要

目的

探讨 CT 肠造影（CTE）定义的肠系膜爬行脂肪指数（MCFI）在预测克罗恩病（CD）患者术后早期复发中的价值。

方法

本研究纳入了 2013 年 12 月至 2018 年 12 月期间接受 CTE 和 I 期肠切除术的 110 例 CD 患者。两名放射科医生独立评估 CTE 参数，包括 MCFI（评分为 1-8 分）、肠壁增厚（评分为 1-3 分）、壁强化、壁分层、黏膜下脂肪沉积、肠系膜纤维脂肪增生、肠系膜高血管性、肠系膜脂肪条纹，评分为 0-2 分；脓肿/瘘管、肠系膜淋巴结肿大、腹腔和盆腔积液，评分为 0-1 分。采用 logistic 回归分析评估与早期复发相关的影像学表现。

结果

在 1 年的随访期间，110 例 CD 患者中有 56.4%（62/110）发生术后早期复发。单因素分析显示，MCFI、肠壁增厚、肠系膜高血管性、肠系膜脂肪条纹、脓肿/瘘管和肠系膜淋巴结肿大与术后早期复发有关。在所有变量中，MCFI（评分≥4）具有最佳的 AUC（0.838 [0.758-0.919]）、特异性（89.6%）、阳性预测值（90.7%）、准确性（83.6%）和风险比（OR=32.42 [10.69-98.33]，p<0.001）。多因素分析显示，只有 MCFI 是术后早期复发的独立预测因子（OR=25.71 [7.65-86.35]，p<0.001）。