Abstract
ObjectivesTo develop and validate nomograms, derived from morphological features, and computed tomography enterography (CTE) -based radiomics, for evaluating inflammatory activity in patients with ileocolonic Crohn’s disease (CD).
MethodsA total of 54 CD patients (237 bowel segments) with clinically confirmed CD were retrospectively reviewed. The simple endoscopic score for Crohn’s disease (SES-CD) was used as a reference standard to quantify the degree of mucosal inflammation and evaluate the disease severity. Radiomics and image morphological features were extracted in the training cohort, and then a morphological model (M-score) and a radiomics model (Rad-score) were built respectively. A combined nomogram was further generated by incorporating M-score and Rad-score. Predictive values of each model were assessed using receiver operating characteristic (ROC) curve analysis. Calibration curve and decision curve analysis (DCA) were employed to evaluate the accuracy and clinical applicability of the nomogram in the testing cohort.
ResultsThe area under the ROC curve (AUC) of the nomogram, based on the stenosis, comb sign and Rad-score, was 0.834 [95% confidence interval (CI): 0.728–0.940] for distinguishing active from remissive disease. Moreover, the nomogram built using comb sign and Rad-score also achieved satisfied AUC [0.781 (95%CI: 0.611–0.951)] in distinguishing mild activity from moderate-to-severe activity. The calibration curve and DCA confirmed the accuracy and clinical utility of both nomograms.
Conclusions Nomograms constructed by combining CTE-based radiomics and morphological features might be a useful supporting tool for grading inflammatory activity, aiding clinical decision-making for the management of CD.