BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significan...BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.展开更多
Magnetic resonance enterography(MRE)is a non-invasive,radiation-free imaging modality that facilitates the assessment of transmural Crohn’s disease activity.It offers advantages over ileo-colonoscopy,which is limited...Magnetic resonance enterography(MRE)is a non-invasive,radiation-free imaging modality that facilitates the assessment of transmural Crohn’s disease activity.It offers advantages over ileo-colonoscopy,which is limited to mucosal-level evaluation,cannot routinely assess small bowel segments proximal to the terminal ileum,and is unable to detect extra-luminal complications.Despite these ad-vantages,the lack of standardised criteria for defining and appraising radiologic disease activity on MRE has contributed to variability in interpretation and clinical application.In response,multiple MRE-based scoring systems have been developed to quantify radiological Crohn’s disease activity in both luminal and post-operative settings.Radiological disease activity scores specific to luminal Crohn’s disease include the magnetic resonance index of activity(MaRIA),simplified MaRIA,Nancy score,London score,Crohn’s disease magnetic reso-nance imaging(MRI)index,Clermont score,paediatric inflammatory Crohn’s MRE index,MRE global score,MRE index,and modified Clermont score.The MR score and the MRI in Crohn’s disease to predict postoperative recurrence index have been specifically developed to evaluate post-operative disease recurrence in Crohn’s disease.Nevertheless,heterogeneity in scoring parameters,variability in computational complexity,and a lack of consensus regarding optimal score selection,have impeded widespread clinical adoption of radiological disease activity scores.This narrative review aims to summarise the key imaging features of luminal Crohn’s disease,explore their integration into existing MRE scoring indices,and critically compare the structure,strengths,and clinical applicability of each.Furthermore,MRI scores specific to post-operative Crohn’s disease evaluation,and the assessment of cumulative bowel wall damage using the Lemann index will also be discussed.展开更多
AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroe...AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroenterostomy with Braun anastomosis(n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic ret-rograde cholangiopancreatography(ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triplelumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.RESULTS: For the patients with Billroth Ⅱ gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients(85%) and there was therapeutic success in 16 patients(80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth Ⅱ gastroenterostomy, there was failure in accessing the papilla in 15 patients(13.8%). ERCP was unsuccessful because of tumor infiltration(6 patients), a long afferent loop(9 patients), and cannulation failure(4 patients). The papilla was successfully accessed in 94 patients(86.2%), and there was therapeutic success in 90 patients(82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth Ⅱ gastroenterostomy and Braun anastomosis.展开更多
AIM:To analyze the clinical and imaging features of the small intestinal lipomas and to evaluate the diagnostic value of multi-slice computed tomography(CT) enterography.METHODS:Fourteen cases(one had two intestinal l...AIM:To analyze the clinical and imaging features of the small intestinal lipomas and to evaluate the diagnostic value of multi-slice computed tomography(CT) enterography.METHODS:Fourteen cases(one had two intestinal lesions) of surgically confirmed lipomas of the small intestine were retrospectively analyzed.The location,size,clinical and radiological aspects were discussed.RESULTS:Twelve patients presented with abdominal pain,of whom three complained of paroxysmal colic.Melena or bloody stools was mentioned in five cases.One lesion was detected incidentally during routine physical examination.One lesion was found unexpectedly during the preoperational evaluation for cholecystitis.Examination of the abdomen revealed palpable masses in four cases.Precontrast CT scan showed round or oval well-defined hypo-intense intraluminal masses with the attenuation ranging from-130 HU to-60 HU.On contrast enhancement CT scan,no striking enhancement was seen.CONCLUSION:The small intestinal lipomas are rare and difficult to diagnose merely based on clinical manifestations,while the characteristic features at small intestinal CT enterography can help establish reliable prospective diagnoses.展开更多
AIM: To assess the feasibility and usefulness of multi-detector CT enterography with orally administered iso-osmotic mannitol as negative contrast in demonstrating small bowel disease.METHODS: Thirteen volunteers and ...AIM: To assess the feasibility and usefulness of multi-detector CT enterography with orally administered iso-osmotic mannitol as negative contrast in demonstrating small bowel disease.METHODS: Thirteen volunteers and 38 patients with various kinds of small bowel disease were examined. We administered about 1 500 mL iso-osmotic mannitol as negative contrast agent and then proceeded with helical CT scanning on a Siemens Sensation 16 scanner. All volunteers and patients were interviewed about their tolerance of the procedure. Two radiologists postprocessed imaging data with MPR, thin MIP, VRT and INSPACE when necessary and then interpreted the scans,and adequacy of luminal distention was evaluated on a four-point scale. Demonstration of features of various kinds of small bowel disease was analyzed.RESULTS: The taste of iso-osmotic mannitol is good (slightly sweet) and acceptable by all. Small bowel distention was excellent and moderate in most volunteers and patients. CT features of many kinds of diseases such as tumors, Crohn's disease,and small bowel obstruction,etc. were clearly displayed.CONCLUSION: Multi-detector CT enterography with iso-osmotic mannitol as negative contrast to distend the small bowel is a simple, rapid, noninvasive and effective method of evaluating small bowel disease.展开更多
This case reports an application of conventional duodenoscope in a post pancreaticoduodenectomy patient with the help of retrieval balloon assisted enterography.The 56-year-old woman had pancreaticoduodenectomy with C...This case reports an application of conventional duodenoscope in a post pancreaticoduodenectomy patient with the help of retrieval balloon assisted enterography.The 56-year-old woman had pancreaticoduodenectomy with Child reconstruction 9 mo ago because of pancreatic adenocarcinoma and now there are recurrent enlarged lymph nodes in the anastomotic stoma of hepaticojejunostomy.Considering the patient's late-stage cancer,a plastic stent was then successfully placed there to drainage.The main challenge in this case was the extremely long afferent loop and blind cannulation through the anastomotic stoma of hepaticojejunostomy.Retrieval balloon assisted enterography is very helpful for duodenoscope going through the reconstructed intestinal tract and for the cannulation.After two weeks,the patient remained free of painful symptoms and free of fever.Liver function improved well.Four months after the placement of stent,the patient died of cachexia without jaundice,fever and abdominal pain according to her daughter's statement.展开更多
Primary adult hypertrophic pyloric stenosis is a rare but important cause of gastric outlet obstruction that may be misdiagnosed as idiopathic gastroparesis.Clinically,patients present with early satiety,abdominal ful...Primary adult hypertrophic pyloric stenosis is a rare but important cause of gastric outlet obstruction that may be misdiagnosed as idiopathic gastroparesis.Clinically,patients present with early satiety,abdominal fullness,nausea,epigastric discomfort and eructation.Permanent gastric retention of a video capsule endoscope is diagnostic in differentiating between the two diseases,in the absence of an organic gastric outlet obstruction.This case presents the longest video capsule retention in the medical literature to date.It is also the first case report of adult hypertrophic pyloric stenosis diagnosed with video capsule endoscopy or a computed tomography scan.Finally,an unusual"plugging"of the gastric outlet with free floating capsule has an augmented effect on disease physiology and on patient’s symptoms.展开更多
Although the introduction of double-balloon enteroscopy has greatly improved the diagnostic rate, definite diagnosis of Meckel's diverticulum far from the ileocecal valve is still impossible in most cases. We expl...Although the introduction of double-balloon enteroscopy has greatly improved the diagnostic rate, definite diagnosis of Meckel's diverticulum far from the ileocecal valve is still impossible in most cases. We explored the role of magnetic resonance (MR) enterography in detecting bleeding from Meckel's diverticulum that can not be confirmed via double-balloon enteroscopy. This study describes a case of male patient with bleeding from Meckel's diverticulum diagnosed with MR enterography of the small intestine. No bleeding lesion was found via colonoscopy, anal enteroscopy, or oral colonoscopy. MR enterography of the small intestine revealed an occupying lesion of 3.0 cm in the lower segment of the ileum. The patient was transferred to the Department of Abdominal Surgery of our hospital for surgical treatment. During surgery, a mass of 3 cm × 2 cm was found 150 cm from the ileocecal valve, in conjunction with congestion and edema of the corresponding mesangium. Intraoperative diagnosis was small bowel diverticulum with bleeding. The patient underwent partial resection of the small intestine. Postopera-tive pathology showed Meckel's diverticulum containing pancreatic tissues. He was cured and discharged 7 d after operation. We conclude that MR enterography of the small intestine has greatly improved the diagnosis rate of Meckel's diverticulum, particularly in those patients with the disease which can not be confirmed via double-balloon enteroscopy.展开更多
Crohn's disease (CD) is a chronic autoimmune disorder that affects mainly young people. The clinical management is based on the Crohn's Disease Activity Index and especially on biologic parameters with or with...Crohn's disease (CD) is a chronic autoimmune disorder that affects mainly young people. The clinical management is based on the Crohn's Disease Activity Index and especially on biologic parameters with or without additional endoscopic and imaging procedures, such as barium and computed tomography examinations. Recently, magnetic resonance (MR) imaging has been a promising diagnostic radiologic technique with lack of ionizing radiation, enabling superior tissue contrast resolution due to new pulse-sequence developments. Therefore, MR enterography has the potential to become the modality of choice for imaging the small bowel in CD patients.展开更多
BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) a...BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIM To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC. METHODS Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed. RESULTS Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r=0.875, P<0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI>10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn’s disease, those with a positive PCDAI (>10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%;P=0.018). CONCLUSION We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity.展开更多
BACKGROUND Bowel ultrasound and magnetic resonance enterography(MRE)are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications.They assess the degree...BACKGROUND Bowel ultrasound and magnetic resonance enterography(MRE)are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications.They assess the degree of activity,help clinicians to identify patients in need of surgery,and can be used for patient follow-up.AIM To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease(IBD)patients in Egypt.METHODS The study was conducted on 40 patients with IBD.All patients were subjected to clinical assessment,laboratory investigations,bowel ultrasound,MRE,and colonoscopy up to the terminal ileum with biopsies for histopathological examination.RESULTS This study was conducted on 14 patients(35%)with ulcerative colitis and 26 patients(65%)with Crohn's disease;34(85%)of these patients had active disease.Bowel ultrasound detected different bowel lesions with the following accuracies:ileum(85%),large bowel(70%),fistula(95%),stricture and proximal dilatation(95%)and abscesses(100%).Also,it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.CONCLUSION In comparison to MRE,bowel ultrasound is a useful,non-invasive,and feasible bedside imaging tool for the detection of inflammation,detection of complications,and follow-up of IBD patients when performed by the attending physician.展开更多
Crohn's disease(CD) is a chronic inflammatory disease of the gastrointestinal tract, with unpredictable clinical course by phases of relapses alternating with other of quiescence. The etiology is multifactorial an...Crohn's disease(CD) is a chronic inflammatory disease of the gastrointestinal tract, with unpredictable clinical course by phases of relapses alternating with other of quiescence. The etiology is multifactorial and is still not completely known; globally the westernization of lifestyle is causing an increasing incidence of CD, with peak age of 20-30 years. The diagnostic workup begins with the evaluation of the clinical history, physical examination and laboratory tests. However, the clinical assessment is subjected interobserver variability and, occasionally, the symptoms of acute and chronic inflammation may be indistinguishable. In this regards, the role of magnetic resonance(MR) enterography is crucial to determine the extension, the disease activity and the presence of any complications without ionizing radiations, making this method very suitable for young population affected by CD. The purpose of this review article is to illustrate the MR enterography technique and the most relevant imaging findings of CD, allowing the detection of small bowel involvement and the assessment of disease activity.展开更多
BACKGROUND Recently,a technique has been developed to use magnetic resonance enterography(MRE)for the evaluation of small bowel motility.The hypothesis was that assessment of the motility index(MI)should reflect diffe...BACKGROUND Recently,a technique has been developed to use magnetic resonance enterography(MRE)for the evaluation of small bowel motility.The hypothesis was that assessment of the motility index(MI)should reflect differences in motility between clinical conditions.AIM To aim of the present observational,cross-sectional study was to evaluate the use of the MI in daily clinical practice.METHODS All consecutive patients aged 18-70 years who were referred for MRE at the Department of Radiology during a 2-year period were asked to participate.Healthy volunteers were included as controls.MRE was prepared and conducted in accordance with clinical routines.On the day of examination,all the participants had to complete the visual analog scale for irritable bowel syndrome(IBS)and IBS-symptom severity scale.Maps of MI were calculated from dynamic MR images.ANOVA was used to evaluate differences in MI between groups,classified as healthy,Crohn’s disease,ulcerative colitis,IBS,other assorted disorders and dysmotility.Logistic and linear regression were applied to the MI values.All medical records were scrutinized for medical history.RESULTS In all,224 examinations were included(inclusion prevalence 76.3%),with 22 controls and 202 patients.There was a significant difference in the MI of the jejunum(P=0.021)and terminal ileum(P=0.007)between the different groups.The MI was inversely associated with the mural thickness of the terminal ileum in men(P<0.001)and women(P=0.063)after adjustments,and tended to be lower in men than in women(P=0.056).Subjectively observed reduction of motility on MRI was accomplished by reduced MI of terminal ileum in men(P<0.001)and women(P=0.030).In women,diarrhea was inversely associated with the MI of the jejunum(P=0.029),and constipation was positively associated with the MI of the terminal ileum(P=0.039).CONCLUSION Although MIs differ across diseases,a lower MI of the terminal ileum is mainly associated with male sex and an increased mural thickness.Symptoms are weakly associated with the MI.展开更多
Crohn’s disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past ...Crohn’s disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.展开更多
Objective:To investigate the role of magnetic resonance enterography (MRE) in valuating infliximab's (IFX)curative effect in active small bowel Crohn's Disease (CD).Methods:27 patients diagnosed as active CD w...Objective:To investigate the role of magnetic resonance enterography (MRE) in valuating infliximab's (IFX)curative effect in active small bowel Crohn's Disease (CD).Methods:27 patients diagnosed as active CD were treated with IFX. Before and after the treatment, the patients were scanned with 3.0 T MRE after small intestinal preparation. The imaging characteristic was analyzed and the relevance analysis between the imaging performance and the clinical score were investigated.Results: (1) Before IFX treatment, MRE could clearly detect the intestinal wall and extra luminal lesion in active CD, including intestinal wall multiple segmental thickening and abnormal enhancement, irregular signaling, comb sign, and intestinal stricture or dilation;(2) After IFX treatment, MRE show that intestinal wall thinning and the dilated bowel lumen were improved, and the comb sign disappeared;(3) During artery phase, the signal of the intestinal lesion was improved from high signal or equal signal before the IFX treatment to equal signal or low signal after treatment (P<0.05). During vein phase, there was no significant change of lesion signal before and after treatment (P>0.05).4. the changes of imaging performance were consistant with that of the clinical score (P>0.05). Conclusions: MRE possesses clinical value in evaluating the IFX curative effect in active small bowel CD.展开更多
BACKGROUND Crohn's disease(CD)is a type of inflammatory bowel disease,with chronic and progressive characteristics.Infliximab(IFX)can rapidly relieve CD-related symptoms and promote mucosal healing.However,some pa...BACKGROUND Crohn's disease(CD)is a type of inflammatory bowel disease,with chronic and progressive characteristics.Infliximab(IFX)can rapidly relieve CD-related symptoms and promote mucosal healing.However,some patients may occur secondary loss of response(SLOR)during the maintenance treatment,leading to the recurrence or progression of CD.The current IFX efficacy prediction models for CD have limited applicability to SLOR.Radiomics,as a non-invasive te-chnique,is expected to serve as a more accurate tool for predicting the risk of SLOR.AIM To develop a radiomics-based model via integrative analysis of intestinal wall and creeping fat to predict SLOR in CD.METHODS We retrospectively analyzed clinical and imaging data from 220 CD patients in two centers.Univariate and multivariate analyses were used to screen out clinically independent predictors of SLOR.Radiomics features of the intestinal wall and creeping fat were extracted and fused together for analysis.Univariate and least absolute shrinkage and selection operator analyses were used to select the most valuable radiomics features to calculate Radscore and develop radiomics predictive model.A combined predictive model was developed based on the Radscore and clinically independent predictors through multivariate logistic regression analysis.Area under the receiver operating characteristic curve(AUC),calibration curve and the decision curve analysis were used to verify model performance.RESULTS White blood cell count,disease duration and Harvey-Bradshaw Index were identified as clinically independent predictors of SLOR to develop the clinical model.Fifteen most valuable radiomics features were selected to develop the radiomics model.Compared with the clinical and radiomics models,the combined model achieved the best prediction performance,with AUCs were 0.871(95%CI:0.814-0.929)in the training cohort and 0.854(95%CI:0.759-0.949)in the validation cohort.CONCLUSION The combined model that integrates intestinal wall and creeping fat analysis is valuable for predicting the SLOR of IFX in CD.展开更多
BACKGROUND Visceral adipose tissue(VAT)plays a role in the pathogenesis of Crohn's disease(CD)and is associated with treatment outcomes following infliximab(IFX)therapy.We developed and validated the first delta-r...BACKGROUND Visceral adipose tissue(VAT)plays a role in the pathogenesis of Crohn's disease(CD)and is associated with treatment outcomes following infliximab(IFX)therapy.We developed and validated the first delta-radiomics model to quantify VAT heterogeneity as a predictive biomarker for IFX response in patients with CD.AIM To develop a longitudinal computed tomography(CT)-based delta-radiomics model of VAT for predicting secondary loss of response(SLR)in patients with CD.METHODS This retrospective study included 161 patients with CD who achieved clinical remission following IFX induction therapy between 2015 and 2023.All patients underwent CT enterography before IFX initiation and after completing induction therapy.VAT volume was delineated by two radiologists in consensus.Radiomics features were extracted from pre-treatment and post-induction CT images,and delta-radiomics features were calculated as follows:Delta features=Feature-post-Feature-pre.A radiomics model was constructed using logistic regression.Model performance was assessed using discrimination,calibration,and decision curve analyses.RESULTS Nine significant delta-radiomics features were used to develop the delta-radiomics model,yielding an area under the receiver operating characteristic curve(AUC)of 0.816(95%CI:0.737-0.896)in the training cohort and 0.750(95%CI:0.605-0.895)in the validation cohort.Multivariable logistic regression identified platelet count,Montreal behavior classification,and the VAT/subcutaneous adipose tissue volume ratio prior to treatment as independent risk factors for SLR.The combined model integrating clinical predictors and delta-radiomics features achieved superior predictive performance,with an AUC of 0.853(95%CI:0.786-0.921)in the training cohort and 0.812(95%CI:0.677-0.948)in the validation cohort.CONCLUSION We developed a predictive model based on longitudinal changes in VAT,demonstrating significant potential for identifying patients with CD at high risk of SLR to IFX therapy.展开更多
Background and aims:The differential diagnosis between Crohn’s disease(CD)and ischemic colitis(ISC)is important as their clinical management is different.ISC can easily be misdiagnosed as CD,especially in elderly pop...Background and aims:The differential diagnosis between Crohn’s disease(CD)and ischemic colitis(ISC)is important as their clinical management is different.ISC can easily be misdiagnosed as CD,especially in elderly populations.The distinctive radiographic features of the two disease entities have not been investigated.The aim of this study is to assess the utility of computed tomographic enterography(CTE)in the differential diagnosis between CD and ISC.Methods:Patients with confirmed CD and ISC were identified through an electronic medical record search of the Cleveland Clinic Foundation.Patients who had undergone CTE,with or without concurrent colonoscopy and histopathological specimens,were included in this study.CTE images were blindly re-reviewed by an expert gastrointestinal radiologist.The sensitivities,specificities,accuracies and positive and negative predictive values for each of the CTE findings in differentiating CD from ISC were estimated.Kappa coefficients(j)were calculated tomeasure diagnosis agreement between CTE and the reference standard.Results:A total of 34 eligible patients were included in this study with 17 having CD and 17 having ISC.In differentiating CD from ISC,the presence ofmucosal hyperenhancement and absence of the“target sign”on CTE showed a sensitivity of 100% each for CD,while the two radiographic features yielded a low specificity of 35.3%and 76.5%,respectively.The presence of stricture had a lower sensitivity of 64.7% for the detection of CD but had a high specificity of 100%.In distinguishing CD fromISC,the accuracy of presence ofmucosal hyperenhancement,stricture and absence of target sign were 67.7%,82.4% and 88.2%,respectively.The combination of the presence ofmucosal hyperenhancement and the absence of the target sign achieved an accuracy of 100%for distinguishing CD from ISC.There was a good correlation between CTE and the reference standard for distinguishing CD fromISC(k=0.882).Conclusions:CTE appeared to be clinically useful in distinguishing CD from ISC.展开更多
Differentiating Crohn's disease(CD) and intestinal tuberculosis(ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammato...Differentiating Crohn's disease(CD) and intestinal tuberculosis(ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical(diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic(longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic(caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic(positive stain/culture for acid fast-bacillus in ITB), radiologic(long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus(AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However,these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy(ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.展开更多
基金Supported by Natural Science Foundation of Anhui Medical University,No.2023xkj130.
文摘BACKGROUND Mucosal healing(MH)is the major therapeutic target for Crohn's disease(CD).As the most commonly involved intestinal segment,small bowel(SB)assessment is crucial for CD patients.Yet,it poses a significant challenge due to its limited accessibility through conventional endoscopic methods.AIM To establish a noninvasive radiomic model based on computed tomography enterography(CTE)for MH assessment in SBCD patients.METHODS Seventy-three patients diagnosed with SBCD were included and divided into a training cohort(n=55)and a test cohort(n=18).Radiomic features were obtained from CTE images to establish a radiomic model.Patient demographics were analysed to establish a clinical model.A radiomic-clinical nomogram was constructed by combining significant clinical and radiomic features.The diagnostic efficacy and clinical benefit were evaluated via receiver operating characteristic(ROC)curve analysis and decision curve analysis(DCA),respectively.RESULTS Of the 73 patients enrolled,25 patients achieved MH.The radiomic-clinical nomogram had an area under the ROC curve of 0.961(95%confidence interval:0.886-1.000)in the training cohort and 0.958(0.877-1.000)in the test cohort and provided superior clinical benefit to either the clinical or radiomic models alone,as demonstrated by DCA.CONCLUSION These results indicate that the CTE-based radiomic-clinical nomogram is a promising imaging biomarker for MH and serves as a potential noninvasive alternative to enteroscopy for MH assessment in SBCD patients.
文摘Magnetic resonance enterography(MRE)is a non-invasive,radiation-free imaging modality that facilitates the assessment of transmural Crohn’s disease activity.It offers advantages over ileo-colonoscopy,which is limited to mucosal-level evaluation,cannot routinely assess small bowel segments proximal to the terminal ileum,and is unable to detect extra-luminal complications.Despite these ad-vantages,the lack of standardised criteria for defining and appraising radiologic disease activity on MRE has contributed to variability in interpretation and clinical application.In response,multiple MRE-based scoring systems have been developed to quantify radiological Crohn’s disease activity in both luminal and post-operative settings.Radiological disease activity scores specific to luminal Crohn’s disease include the magnetic resonance index of activity(MaRIA),simplified MaRIA,Nancy score,London score,Crohn’s disease magnetic reso-nance imaging(MRI)index,Clermont score,paediatric inflammatory Crohn’s MRE index,MRE global score,MRE index,and modified Clermont score.The MR score and the MRI in Crohn’s disease to predict postoperative recurrence index have been specifically developed to evaluate post-operative disease recurrence in Crohn’s disease.Nevertheless,heterogeneity in scoring parameters,variability in computational complexity,and a lack of consensus regarding optimal score selection,have impeded widespread clinical adoption of radiological disease activity scores.This narrative review aims to summarise the key imaging features of luminal Crohn’s disease,explore their integration into existing MRE scoring indices,and critically compare the structure,strengths,and clinical applicability of each.Furthermore,MRI scores specific to post-operative Crohn’s disease evaluation,and the assessment of cumulative bowel wall damage using the Lemann index will also be discussed.
基金Supported by Leading Talent program of Shanghai,Sailing program of Shanghai science and technology commission NO.14YF1403000
文摘AIM: To describe an optimal route to the Braun anastomosis including the use of retrieval-balloon-assisted enterography.METHODS: Patients who received a Billroth Ⅱ gastroenterostomy(n = 109) and a Billroth Ⅱ gastroenterostomy with Braun anastomosis(n = 20) between January 2009 and May 2013 were analyzed in this study. Endoscopic ret-rograde cholangiopancreatography(ERCP) was performed under fluoroscopic control using a total length of 120 cm oblique-viewing duodenoscope with a 3.7-mm diameter working channel. For this procedure, we used a triplelumen retrieval balloon catheter in which a 0.035-inch guidewire could be inserted into the "open-channel" guidewire lumen while the balloon could be simultaneously injected and inflated through the other 2 lumens.RESULTS: For the patients with Billroth Ⅱ gastroenterostomy and Braun anastomosis, successful access to the papilla was gained in 17 patients(85%) and there was therapeutic success in 16 patients(80%). One patient had afferent loop perforation, but postoperative bleeding did not occur. For Billroth Ⅱ gastroenterostomy, there was failure in accessing the papilla in 15 patients(13.8%). ERCP was unsuccessful because of tumor infiltration(6 patients), a long afferent loop(9 patients), and cannulation failure(4 patients). The papilla was successfully accessed in 94 patients(86.2%), and there was therapeutic success in 90 patients(82.6%). Afferent loop perforation did not occur in any of these patients. One patient had hemorrhage 2 h after ERCP, which was successfully managed with conservative treatment.CONCLUSION: Retrieval-balloon-assisted enterography along an optimal route may improve the ERCP success rate after Billroth Ⅱ gastroenterostomy and Braun anastomosis.
文摘AIM:To analyze the clinical and imaging features of the small intestinal lipomas and to evaluate the diagnostic value of multi-slice computed tomography(CT) enterography.METHODS:Fourteen cases(one had two intestinal lesions) of surgically confirmed lipomas of the small intestine were retrospectively analyzed.The location,size,clinical and radiological aspects were discussed.RESULTS:Twelve patients presented with abdominal pain,of whom three complained of paroxysmal colic.Melena or bloody stools was mentioned in five cases.One lesion was detected incidentally during routine physical examination.One lesion was found unexpectedly during the preoperational evaluation for cholecystitis.Examination of the abdomen revealed palpable masses in four cases.Precontrast CT scan showed round or oval well-defined hypo-intense intraluminal masses with the attenuation ranging from-130 HU to-60 HU.On contrast enhancement CT scan,no striking enhancement was seen.CONCLUSION:The small intestinal lipomas are rare and difficult to diagnose merely based on clinical manifestations,while the characteristic features at small intestinal CT enterography can help establish reliable prospective diagnoses.
文摘AIM: To assess the feasibility and usefulness of multi-detector CT enterography with orally administered iso-osmotic mannitol as negative contrast in demonstrating small bowel disease.METHODS: Thirteen volunteers and 38 patients with various kinds of small bowel disease were examined. We administered about 1 500 mL iso-osmotic mannitol as negative contrast agent and then proceeded with helical CT scanning on a Siemens Sensation 16 scanner. All volunteers and patients were interviewed about their tolerance of the procedure. Two radiologists postprocessed imaging data with MPR, thin MIP, VRT and INSPACE when necessary and then interpreted the scans,and adequacy of luminal distention was evaluated on a four-point scale. Demonstration of features of various kinds of small bowel disease was analyzed.RESULTS: The taste of iso-osmotic mannitol is good (slightly sweet) and acceptable by all. Small bowel distention was excellent and moderate in most volunteers and patients. CT features of many kinds of diseases such as tumors, Crohn's disease,and small bowel obstruction,etc. were clearly displayed.CONCLUSION: Multi-detector CT enterography with iso-osmotic mannitol as negative contrast to distend the small bowel is a simple, rapid, noninvasive and effective method of evaluating small bowel disease.
文摘This case reports an application of conventional duodenoscope in a post pancreaticoduodenectomy patient with the help of retrieval balloon assisted enterography.The 56-year-old woman had pancreaticoduodenectomy with Child reconstruction 9 mo ago because of pancreatic adenocarcinoma and now there are recurrent enlarged lymph nodes in the anastomotic stoma of hepaticojejunostomy.Considering the patient's late-stage cancer,a plastic stent was then successfully placed there to drainage.The main challenge in this case was the extremely long afferent loop and blind cannulation through the anastomotic stoma of hepaticojejunostomy.Retrieval balloon assisted enterography is very helpful for duodenoscope going through the reconstructed intestinal tract and for the cannulation.After two weeks,the patient remained free of painful symptoms and free of fever.Liver function improved well.Four months after the placement of stent,the patient died of cachexia without jaundice,fever and abdominal pain according to her daughter's statement.
文摘Primary adult hypertrophic pyloric stenosis is a rare but important cause of gastric outlet obstruction that may be misdiagnosed as idiopathic gastroparesis.Clinically,patients present with early satiety,abdominal fullness,nausea,epigastric discomfort and eructation.Permanent gastric retention of a video capsule endoscope is diagnostic in differentiating between the two diseases,in the absence of an organic gastric outlet obstruction.This case presents the longest video capsule retention in the medical literature to date.It is also the first case report of adult hypertrophic pyloric stenosis diagnosed with video capsule endoscopy or a computed tomography scan.Finally,an unusual"plugging"of the gastric outlet with free floating capsule has an augmented effect on disease physiology and on patient’s symptoms.
文摘Although the introduction of double-balloon enteroscopy has greatly improved the diagnostic rate, definite diagnosis of Meckel's diverticulum far from the ileocecal valve is still impossible in most cases. We explored the role of magnetic resonance (MR) enterography in detecting bleeding from Meckel's diverticulum that can not be confirmed via double-balloon enteroscopy. This study describes a case of male patient with bleeding from Meckel's diverticulum diagnosed with MR enterography of the small intestine. No bleeding lesion was found via colonoscopy, anal enteroscopy, or oral colonoscopy. MR enterography of the small intestine revealed an occupying lesion of 3.0 cm in the lower segment of the ileum. The patient was transferred to the Department of Abdominal Surgery of our hospital for surgical treatment. During surgery, a mass of 3 cm × 2 cm was found 150 cm from the ileocecal valve, in conjunction with congestion and edema of the corresponding mesangium. Intraoperative diagnosis was small bowel diverticulum with bleeding. The patient underwent partial resection of the small intestine. Postopera-tive pathology showed Meckel's diverticulum containing pancreatic tissues. He was cured and discharged 7 d after operation. We conclude that MR enterography of the small intestine has greatly improved the diagnosis rate of Meckel's diverticulum, particularly in those patients with the disease which can not be confirmed via double-balloon enteroscopy.
文摘Crohn's disease (CD) is a chronic autoimmune disorder that affects mainly young people. The clinical management is based on the Crohn's Disease Activity Index and especially on biologic parameters with or without additional endoscopic and imaging procedures, such as barium and computed tomography examinations. Recently, magnetic resonance (MR) imaging has been a promising diagnostic radiologic technique with lack of ionizing radiation, enabling superior tissue contrast resolution due to new pulse-sequence developments. Therefore, MR enterography has the potential to become the modality of choice for imaging the small bowel in CD patients.
基金Supported by the donation of wireless Small bowel capsule and patency capsules from Giving imaging,Ltd Medtronic company with the funding agreement from Given investigator-initiated study No.13-12
文摘BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIM To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC. METHODS Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed. RESULTS Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r=0.875, P<0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI>10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn’s disease, those with a positive PCDAI (>10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%;P=0.018). CONCLUSION We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity.
文摘BACKGROUND Bowel ultrasound and magnetic resonance enterography(MRE)are decisive medical imaging modalities for diagnosing and locating bowel lesions with its extramural extent and complications.They assess the degree of activity,help clinicians to identify patients in need of surgery,and can be used for patient follow-up.AIM To compare the role of MRE and bowel ultrasound in diagnosis and follow-up of inflammatory bowel disease(IBD)patients in Egypt.METHODS The study was conducted on 40 patients with IBD.All patients were subjected to clinical assessment,laboratory investigations,bowel ultrasound,MRE,and colonoscopy up to the terminal ileum with biopsies for histopathological examination.RESULTS This study was conducted on 14 patients(35%)with ulcerative colitis and 26 patients(65%)with Crohn's disease;34(85%)of these patients had active disease.Bowel ultrasound detected different bowel lesions with the following accuracies:ileum(85%),large bowel(70%),fistula(95%),stricture and proximal dilatation(95%)and abscesses(100%).Also,it showed that statistically significance of bowel ultrasound in differentiation between remission and activity of IBD in comparison to MRE and colonoscopy.CONCLUSION In comparison to MRE,bowel ultrasound is a useful,non-invasive,and feasible bedside imaging tool for the detection of inflammation,detection of complications,and follow-up of IBD patients when performed by the attending physician.
文摘Crohn's disease(CD) is a chronic inflammatory disease of the gastrointestinal tract, with unpredictable clinical course by phases of relapses alternating with other of quiescence. The etiology is multifactorial and is still not completely known; globally the westernization of lifestyle is causing an increasing incidence of CD, with peak age of 20-30 years. The diagnostic workup begins with the evaluation of the clinical history, physical examination and laboratory tests. However, the clinical assessment is subjected interobserver variability and, occasionally, the symptoms of acute and chronic inflammation may be indistinguishable. In this regards, the role of magnetic resonance(MR) enterography is crucial to determine the extension, the disease activity and the presence of any complications without ionizing radiations, making this method very suitable for young population affected by CD. The purpose of this review article is to illustrate the MR enterography technique and the most relevant imaging findings of CD, allowing the detection of small bowel involvement and the assessment of disease activity.
基金Supported by Funding from the Department of Radiology,Marmara University School of Medicine
文摘AIM: To highlight magnetic resonance enterography (MRE) for diagnosis of patients with refractory iron deficiency anemia and normal endoscopy results.
基金the Development Foundation of Region Skåne,No.REGSKANE-619091the Foundation of Skåne University Hospital,No.2017-008and the Dir Albert Påhlsson’s Foundation,No.2019.
文摘BACKGROUND Recently,a technique has been developed to use magnetic resonance enterography(MRE)for the evaluation of small bowel motility.The hypothesis was that assessment of the motility index(MI)should reflect differences in motility between clinical conditions.AIM To aim of the present observational,cross-sectional study was to evaluate the use of the MI in daily clinical practice.METHODS All consecutive patients aged 18-70 years who were referred for MRE at the Department of Radiology during a 2-year period were asked to participate.Healthy volunteers were included as controls.MRE was prepared and conducted in accordance with clinical routines.On the day of examination,all the participants had to complete the visual analog scale for irritable bowel syndrome(IBS)and IBS-symptom severity scale.Maps of MI were calculated from dynamic MR images.ANOVA was used to evaluate differences in MI between groups,classified as healthy,Crohn’s disease,ulcerative colitis,IBS,other assorted disorders and dysmotility.Logistic and linear regression were applied to the MI values.All medical records were scrutinized for medical history.RESULTS In all,224 examinations were included(inclusion prevalence 76.3%),with 22 controls and 202 patients.There was a significant difference in the MI of the jejunum(P=0.021)and terminal ileum(P=0.007)between the different groups.The MI was inversely associated with the mural thickness of the terminal ileum in men(P<0.001)and women(P=0.063)after adjustments,and tended to be lower in men than in women(P=0.056).Subjectively observed reduction of motility on MRI was accomplished by reduced MI of terminal ileum in men(P<0.001)and women(P=0.030).In women,diarrhea was inversely associated with the MI of the jejunum(P=0.029),and constipation was positively associated with the MI of the terminal ileum(P=0.039).CONCLUSION Although MIs differ across diseases,a lower MI of the terminal ileum is mainly associated with male sex and an increased mural thickness.Symptoms are weakly associated with the MI.
文摘Crohn’s disease affects more than 500000 individuals in the United States, and about 25% of cases are diagnosed during the pediatric period. Imaging of the bowel has undergone dramatic changes in the past two decades. The endoscopy with biopsy is generally considered the diagnostic reference standard, this combination can evaluates only the mucosa, not inflammation or fibrosis in the mucosa. Actually, the only modalities that can visualize submucosal tissues throughout the small bowel are the computed tomography (CT) enterography (CTE) with the magnetic resonance enterography (MRE). CT generally is highly utilized, but there is growing concern over ionizing radiation and cancer risk; it is a very important aspect to keep in consideration in pediatric patients. In contrast to CTE, MRE does not subject patients to ionizing radiation and can be used to detect detailed morphologic information and functional data of bowel disease, to monitor the effects of medical therapy more accurately, to detect residual active disease even in patients showing apparent clinical resolution and to guide treatment more accurately.
基金National Natural Science Foundation of China.Project No:81860102.
文摘Objective:To investigate the role of magnetic resonance enterography (MRE) in valuating infliximab's (IFX)curative effect in active small bowel Crohn's Disease (CD).Methods:27 patients diagnosed as active CD were treated with IFX. Before and after the treatment, the patients were scanned with 3.0 T MRE after small intestinal preparation. The imaging characteristic was analyzed and the relevance analysis between the imaging performance and the clinical score were investigated.Results: (1) Before IFX treatment, MRE could clearly detect the intestinal wall and extra luminal lesion in active CD, including intestinal wall multiple segmental thickening and abnormal enhancement, irregular signaling, comb sign, and intestinal stricture or dilation;(2) After IFX treatment, MRE show that intestinal wall thinning and the dilated bowel lumen were improved, and the comb sign disappeared;(3) During artery phase, the signal of the intestinal lesion was improved from high signal or equal signal before the IFX treatment to equal signal or low signal after treatment (P<0.05). During vein phase, there was no significant change of lesion signal before and after treatment (P>0.05).4. the changes of imaging performance were consistant with that of the clinical score (P>0.05). Conclusions: MRE possesses clinical value in evaluating the IFX curative effect in active small bowel CD.
基金Supported by Natural Science Foundation of Anhui Province,China,No.2308085MH241.
文摘BACKGROUND Crohn's disease(CD)is a type of inflammatory bowel disease,with chronic and progressive characteristics.Infliximab(IFX)can rapidly relieve CD-related symptoms and promote mucosal healing.However,some patients may occur secondary loss of response(SLOR)during the maintenance treatment,leading to the recurrence or progression of CD.The current IFX efficacy prediction models for CD have limited applicability to SLOR.Radiomics,as a non-invasive te-chnique,is expected to serve as a more accurate tool for predicting the risk of SLOR.AIM To develop a radiomics-based model via integrative analysis of intestinal wall and creeping fat to predict SLOR in CD.METHODS We retrospectively analyzed clinical and imaging data from 220 CD patients in two centers.Univariate and multivariate analyses were used to screen out clinically independent predictors of SLOR.Radiomics features of the intestinal wall and creeping fat were extracted and fused together for analysis.Univariate and least absolute shrinkage and selection operator analyses were used to select the most valuable radiomics features to calculate Radscore and develop radiomics predictive model.A combined predictive model was developed based on the Radscore and clinically independent predictors through multivariate logistic regression analysis.Area under the receiver operating characteristic curve(AUC),calibration curve and the decision curve analysis were used to verify model performance.RESULTS White blood cell count,disease duration and Harvey-Bradshaw Index were identified as clinically independent predictors of SLOR to develop the clinical model.Fifteen most valuable radiomics features were selected to develop the radiomics model.Compared with the clinical and radiomics models,the combined model achieved the best prediction performance,with AUCs were 0.871(95%CI:0.814-0.929)in the training cohort and 0.854(95%CI:0.759-0.949)in the validation cohort.CONCLUSION The combined model that integrates intestinal wall and creeping fat analysis is valuable for predicting the SLOR of IFX in CD.
基金Supported by the National Natural Science Foundation of China,No.82372072 and No.82071986.
文摘BACKGROUND Visceral adipose tissue(VAT)plays a role in the pathogenesis of Crohn's disease(CD)and is associated with treatment outcomes following infliximab(IFX)therapy.We developed and validated the first delta-radiomics model to quantify VAT heterogeneity as a predictive biomarker for IFX response in patients with CD.AIM To develop a longitudinal computed tomography(CT)-based delta-radiomics model of VAT for predicting secondary loss of response(SLR)in patients with CD.METHODS This retrospective study included 161 patients with CD who achieved clinical remission following IFX induction therapy between 2015 and 2023.All patients underwent CT enterography before IFX initiation and after completing induction therapy.VAT volume was delineated by two radiologists in consensus.Radiomics features were extracted from pre-treatment and post-induction CT images,and delta-radiomics features were calculated as follows:Delta features=Feature-post-Feature-pre.A radiomics model was constructed using logistic regression.Model performance was assessed using discrimination,calibration,and decision curve analyses.RESULTS Nine significant delta-radiomics features were used to develop the delta-radiomics model,yielding an area under the receiver operating characteristic curve(AUC)of 0.816(95%CI:0.737-0.896)in the training cohort and 0.750(95%CI:0.605-0.895)in the validation cohort.Multivariable logistic regression identified platelet count,Montreal behavior classification,and the VAT/subcutaneous adipose tissue volume ratio prior to treatment as independent risk factors for SLR.The combined model integrating clinical predictors and delta-radiomics features achieved superior predictive performance,with an AUC of 0.853(95%CI:0.786-0.921)in the training cohort and 0.812(95%CI:0.677-0.948)in the validation cohort.CONCLUSION We developed a predictive model based on longitudinal changes in VAT,demonstrating significant potential for identifying patients with CD at high risk of SLR to IFX therapy.
文摘Background and aims:The differential diagnosis between Crohn’s disease(CD)and ischemic colitis(ISC)is important as their clinical management is different.ISC can easily be misdiagnosed as CD,especially in elderly populations.The distinctive radiographic features of the two disease entities have not been investigated.The aim of this study is to assess the utility of computed tomographic enterography(CTE)in the differential diagnosis between CD and ISC.Methods:Patients with confirmed CD and ISC were identified through an electronic medical record search of the Cleveland Clinic Foundation.Patients who had undergone CTE,with or without concurrent colonoscopy and histopathological specimens,were included in this study.CTE images were blindly re-reviewed by an expert gastrointestinal radiologist.The sensitivities,specificities,accuracies and positive and negative predictive values for each of the CTE findings in differentiating CD from ISC were estimated.Kappa coefficients(j)were calculated tomeasure diagnosis agreement between CTE and the reference standard.Results:A total of 34 eligible patients were included in this study with 17 having CD and 17 having ISC.In differentiating CD from ISC,the presence ofmucosal hyperenhancement and absence of the“target sign”on CTE showed a sensitivity of 100% each for CD,while the two radiographic features yielded a low specificity of 35.3%and 76.5%,respectively.The presence of stricture had a lower sensitivity of 64.7% for the detection of CD but had a high specificity of 100%.In distinguishing CD fromISC,the accuracy of presence ofmucosal hyperenhancement,stricture and absence of target sign were 67.7%,82.4% and 88.2%,respectively.The combination of the presence ofmucosal hyperenhancement and the absence of the target sign achieved an accuracy of 100%for distinguishing CD from ISC.There was a good correlation between CTE and the reference standard for distinguishing CD fromISC(k=0.882).Conclusions:CTE appeared to be clinically useful in distinguishing CD from ISC.
文摘Differentiating Crohn's disease(CD) and intestinal tuberculosis(ITB) has remained a dilemma for most of the clinicians in the developing world, which are endemic for ITB, and where the disease burden of inflammatory bowel disease is on the rise. Although, there are certain clinical(diarrhea/hematochezia/perianal disease common in CD; fever/night sweats common in ITB), endoscopic(longitudinal/aphthous ulcers common in CD; transverse ulcers/patulous ileocaecal valve common in ITB), histologic(caseating/confluent/large granuloma common in ITB; microgranuloma common in CD), microbiologic(positive stain/culture for acid fast-bacillus in ITB), radiologic(long segment involvement/comb sign/skip lesions common in CD; necrotic lymph node/contiguous ileocaecal involvement common in ITB), and serologic differences between CD and ITB, the only exclusive features are caseation necrosis on biopsy, positive smear for acid-fast bacillus(AFB) and/or AFB culture, and necrotic lymph node on cross-sectional imaging in ITB. However,these exclusive features are limited by poor sensitivity, and this has led to the development of multiple multi-parametric predictive models. These models are also limited by complex formulae, small sample size and lack of validation across other populations. Several new parameters have come up including the latest Bayesian meta-analysis, enumeration of peripheral blood T-regulatory cells, and updated computed tomography based predictive score. However, therapeutic anti-tubercular therapy(ATT) trial, and subsequent clinical and endoscopic response to ATT is still required in a significant proportion of patients to establish the diagnosis. Therapeutic ATT trial is associated with a delay in the diagnosis of CD, and there is a need for better modalities for improved differentiation and reduction in the need for ATT trial.
