From the Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195 (F.R.); Department of Gastroenterology, Hepatology, and Nutrition, Digestive Diseases and Surgery Institute and Program for Global Translational Inflammatory Bowel Diseases Research, Cleveland Clinic, Cleveland, Ohio (F.R., M.P., J.N., R.O.); Departments of Medicine and Community Health Sciences, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada (C.M.); Alimentiv, London, Ontario, Canada (C.M., J.H., Z.W., L.G., L.M.S., J. Rémillard, G.Z., B.G.F., V.J.); Department of Gastroenterology, University of Ljubljana, University Medical Centre Ljubljana, Ljubljana, Slovenia (J.H.); Department of Radiology, Mayo Clinic, Rochester, Minn (J.G.F.); Section of Abdominal Imaging, Imaging Institute, Digestive Diseases and Surgery Institute and Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio (M.E.B.); Department of Radiology, University of California San Diego, San Diego, Calif (C.S.S.); Department of Radiology, IBD Unit, Hospital Clínic de Barcelona, Barcelona, Spain (N.C., J. Rimola); Pediatric and Adult Cardiothoracic and Vascular, Oncohematologic and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy (N.C.); Centre for Medical Imaging, University College London, London, England (S.A.T.); Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minn (D.H.B.); and Departments of Medicine and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada (B.G.F., V.J.).
Radiology. 2024 Aug;312(2):e233038. doi: 10.1148/radiol.233038.
Background Standardized methods to measure and describe Crohn disease strictures at CT enterography are needed to guide clinical decision making and for use in therapeutic studies. Purpose To assess the reliability of CT enterography features to describe Crohn disease strictures and their correlation with stricture severity. Materials and Methods A retrospective study was conducted in 43 adult patients with symptomatic terminal ileal Crohn disease strictures who underwent standard-of-care CT enterography at a tertiary care center at the Cleveland Clinic between January 2008 and August 2016. After training on standardized definitions, four abdominal radiologists blinded to all patient information assessed imaging features (seven continuous measurements and nine observations) of the most distal ileal stricture in two separate sessions (separated by ≥2 weeks) in random order. Features with an interrater intraclass correlation coefficient (ICC) of 0.41 or greater (ie, moderate reliability or better) were considered reliable. Univariable and multivariable linear regression analysis identified reliable features associated with a visual analog scale of overall stricture severity. Significant reliable features were assessed as components of a CT enterography-based model to quantitate stricture severity. Results Examinations in 43 patients (mean age, 52 years ± 16 [SD]; 23 female) were evaluated. Five continuous measurements and six observations demonstrated at least moderate interrater reliability (interrater ICC range, 0.42 [95% CI: 0.25, 0.57] to 0.80 [95% CI: 0.67, 0.88]). Of these, 10 were univariably associated with stricture severity, and three continuous measurements-stricture length (interrater ICC, 0.64 [95% CI: 0.42, 0.81]), maximal associated small bowel dilation (interrater ICC, 0.80 [95% CI: 0.67, 0.88]), and maximal stricture wall thickness (interrater ICC, 0.50 [95% CI: 0.34, 0.62])-were independently associated ( value range, <.001 to .003) with stricture severity in a multivariable model. These three measurements were used to derive a well-calibrated (optimism-adjusted calibration slope = 1.00) quantitative model of stricture severity. Conclusion Standardized CT enterography measurements and observations can reliably describe terminal ileal Crohn disease strictures. Stricture length, maximal associated small bowel dilation, and maximal stricture wall thickness are correlated with stricture severity. © RSNA, 2024 See also the article by Rieder et al in this issue. See also the editorial by Galgano and Summerlin in this issue.
背景 需要标准化的方法来测量和描述 CT 肠造影术的克罗恩病狭窄，以指导临床决策并用于治疗研究。目的 评估 CT 肠造影术特征描述克罗恩病狭窄及其与狭窄严重程度的相关性的可靠性。材料与方法 在克利夫兰诊所的一家三级保健中心，对 2008 年 1 月至 2016 年 8 月间因症状性末端回肠克罗恩病狭窄而接受标准护理 CT 肠造影术的 43 例成人患者进行了一项回顾性研究。在接受了标准化定义的培训后，4 名腹部放射科医生在两次单独的会议（间隔至少 2 周）中以随机顺序对最远端回肠狭窄的最远端回肠狭窄进行了七个连续测量和九个观察（盲于所有患者信息）。具有组内相关系数（ICC）为 0.41 或更高（即中度可靠性或更高）的特征被认为是可靠的。单变量和多变量线性回归分析确定了与整体狭窄严重程度的视觉模拟量表相关的可靠特征。显著可靠的特征被评估为基于 CT 肠造影术的定量狭窄严重程度模型的组成部分。结果 对 43 例患者（平均年龄，52 岁±16[标准差]；23 例女性）的检查进行了评估。五个连续测量和六个观察显示出至少中度的组内可靠性（组内 ICC 范围，0.42[95%CI：0.25，0.57]至 0.80[95%CI：0.67，0.88]）。其中，10 个特征与狭窄严重程度相关，3 个连续测量——狭窄长度（组内 ICC，0.64[95%CI：0.42，0.81]）、最大相关小肠扩张（组内 ICC，0.80[95%CI：0.67，0.88]）和最大狭窄壁厚度（组内 ICC，0.50[95%CI：0.34，0.62]）——在多变量模型中与狭窄严重程度独立相关（ 值范围，<.001 至<.003）。这三个测量值用于推导出一个校准良好的（经乐观调整的校准斜率=1.00）狭窄严重程度定量模型。结论 标准化 CT 肠造影术测量和观察可可靠地描述末端回肠克罗恩病狭窄。狭窄长度、最大相关小肠扩张和最大狭窄壁厚度与狭窄严重程度相关。
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