Ma Yuping, Zhu Luanxin, Cui Bota, Zhang Faming, Li Haige, Zhu Jianguo
Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University, No. 121, Jiangjiayuan Road, Nan Jing, 210011, P.R. China.
School of Stomatology, Xuzhou Medical University, Xu Zhou, P.R. China.
BMC Med Imaging. 2025 Jan 27;25(1):27. doi: 10.1186/s12880-025-01560-0.
This study aims to develop and validate nomograms that utilize morphological and radiomics features derived from computed tomography enterography (CTE) to evaluate inflammatory activity in patients with ileocolonic Crohn's disease (CD).
A total of 54 CD patients (237 bowel segments) with clinically confirmed CD were retrospectively analyzed. The Simple Endoscopic Score for Crohn's Disease (SES-CD) was used as a reference standard to quantify the degree of mucosal inflammation and assess disease severity. We extracted morphological and radiomics features in the training cohort to create a morphological model (M-score) and a radiomics model (Rad-score). A combined nomogram was generated by integrating the M-score and Rad-score. The predictive performance of each model was evaluated using receiver operating characteristic (ROC) curve analysis. Additionally, calibration curve and decision curve analysis (DCA) were employed to assess the accuracy and clinical applicability of the nomogram in the testing cohort.
The area under the ROC curve (AUC) for the nomogram, which included stenosis, comb sign, and Rad-score, was 0.834 [95% confidence interval (CI): 0.728-0.940] for distinguishing between active and remissive disease. Furthermore, the nomogram created using comb sign and Rad-score achieved a satisfactory AUC of 0.781 (95% CI: 0.611-0.951) in differentiating mild activity from moderate-to-severe activity. The calibration curve and DCA confirmed both nomograms' accuracy and clinical utility.
Nomograms that combined CTE-based radiomics and morphological features could serve as valuable tools for assessing inflammatory activity, thereby supporting clinical decision-making in managing CD.
本研究旨在开发并验证利用计算机断层扫描小肠造影（CTE）得出的形态学和影像组学特征来评估回结肠克罗恩病（CD）患者炎症活动度的列线图。
对54例临床确诊为CD的患者（237个肠段）进行回顾性分析。采用克罗恩病简易内镜评分（SES-CD）作为参考标准来量化黏膜炎症程度并评估疾病严重程度。我们在训练队列中提取形态学和影像组学特征，以创建形态学模型（M评分）和影像组学模型（Rad评分）。通过整合M评分和Rad评分生成联合列线图。使用受试者操作特征（ROC）曲线分析评估每个模型的预测性能。此外，采用校准曲线和决策曲线分析（DCA）来评估列线图在测试队列中的准确性和临床适用性。
包含狭窄、梳征和Rad评分的列线图在区分活动期和缓解期疾病时，ROC曲线下面积（AUC）为0.834[95%置信区间（CI）：0.728 - 0.940]。此外，使用梳征和Rad评分创建的列线图在区分轻度活动与中重度活动时，AUC达到了令人满意的0.781（95%CI：0.611 - 0.951）。校准曲线和DCA证实了两个列线图的准确性和临床实用性。
结合基于CTE的影像组学和形态学特征的列线图可作为评估炎症活动度的有价值工具，从而为CD管理中的临床决策提供支持。
