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Computed tomography enterography predicts surgical-free survival in symptomatic stricturing Crohn’s disease

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Abstract

Objectives

The study aimed to predict surgical risks for patients with symptomatic stricturing Crohn’s disease (CD) using computed tomography enterography (CTE) and to assess the association between CTE findings and pathological changes.

Methods

Crohn’s disease patients with symptomatic stricture(s) were included. Exclusion criteria were concomitant penetrating disease, intra-abdominal abscess, previous bowel resection, or asymptomatic. Patients from January 2016 to December 2019 were identified as the primary cohort and those from January 2020 to June 2020 were identified as the validation cohort. Two independent experienced radiologists evaluated CTE variables including mucosal enhancement, mural stratification, wall enhancement, comb sign, lymphadenopathy, thick non-enhancing wall, bowel wall thickness, luminal diameter, and upstream lumen. Receiver operating characteristic, logistic regression, and nomogram were performed to identify the independent predictors of surgical-free survival. Histopathological scores of surgical specimens were also evaluated.

Results

198 patients (primary cohort, 123 with surgery and 75 under non-surgical intervention, and 41 patients (validation cohort) were analyzed. Bowel wall thickness < 5.9 mm, luminal stenosis > 3.35 mm, and upstream lumen < 27.5 mm were predictors of surgical-free survival for symptomatic stricturing CD patients. Logistic analysis showed the three CTE variables were the independent predictors of surgical-free survival (p < 0.001). A nomogram was developed with the concordance indexes of 0.905 and 0.892 in the primary and validation cohorts. Histopathological analysis showed bowel wall muscular hyperplasia/hypertrophy significantly correlated with luminal stenosis (r = − 0.655, p = 0.008) and combined CTE variable (r = − 0.683, p = 0.005).

Conclusions

CTE is highly predictive of disease course and surgical-free survival for patients with symptomatic stricturing CD, suggesting the important role of CTE in decision-making of treatment.

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Abbreviations

AUC:

Area under curve

CTE:

Computed tomography enterography

C-index:

Concordance index

CI:

Confidence interval

CD:

Crohn’s disease

DCA:

Decision curve analysis

HBI:

Harvey–Bradshaw index

IBD:

Inflammatory bowel disease

PMTS:

Possible maximum total score

ROC:

Receiver operating characteristic

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Funding

This study was supported by National Natural Science Foundation of China (Grant 82170573, 81770556, and 81670471).

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Author notes

  1. Ming Duan and Bing Guan have contributed equally to this work as co-authors.

Authors and Affiliations

  1. Department of General Surgery, The Affiliated Jinling Hospital of Nanjing Medical University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China

    Ming Duan & Weiming Zhu

  2. Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China

    Ming Duan, Lei Cao, Weiming Zhu & Yi Li

  3. Department of Pathology, Shanghai 6th People’s Hospital Jinshan Branch, Shanghai, 201599, China

    Bing Guan

  4. Department of Diagnostic Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China

    Changsheng Zhou & Wei Huang

  5. Department of Scientific Research and Training, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, Jiangsu, China

    Qiong Wu

Authors
  1. Ming Duan
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  2. Bing Guan
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  3. Lei Cao
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  7. Weiming Zhu
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Correspondence to Weiming Zhu or Yi Li.

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Duan, M., Guan, B., Cao, L. et al. Computed tomography enterography predicts surgical-free survival in symptomatic stricturing Crohn’s disease. Abdom Radiol 47, 3414–3423 (2022). https://doi.org/10.1007/s00261-022-03588-0

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  • DOI: https://doi.org/10.1007/s00261-022-03588-0

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