CT enterography for evaluation of disease activity in patients with ileocolonic Crohn's disease

Background CT enterography (CTE) is used routinely for assessment of activity and severity in Crohn's disease (CD), but there are few CTE scoring systems. The aim of this study was to develop a quantitative CTE scoring system for ileocolonic Crohn's disease activity. Methods Forty-nine CD patients with ileocolonic involvement were retrospectively included between March 2015 and May 2018. All patients underwent CTE and ileocolonoscopy. Mural hyperenhancement and mural thickening at CTE were scored quantitatively, while mural stratification, submucosal fat deposition, comb sign, perienteric fat hypertrophy and mesenteric fibrofatty proliferation were qualitative variables. A Tobit regression model was applied for assessing the association between Crohn's disease endoscopic index of severity (CDEIS) and CTE variables. Results A total of 280 intestinal segments were evaluated. Independent predictors for CDEIS were mural thickness (p < 0.001), mural stratification (p < 0.001) and comb sign (p = 0.002). In order to quantify disease activity based on CTE findings in each segment, a simplified CT enterography index of activity (CTEIA) was derived from logistic regression analysis. The formula was as follows: CTEIA (segment) = 2.1 mural thickness(mm) + 9.7 mural stratification + 5.2 comb sign. There was a high and significant correlation coefficient between CDEIS and CTEIA (r = 0.779, p < 0.001) for per-segment analysis. The model for the detection of ulcerative lesions in the colon and terminal ileum achieved an area under the receiver-operating curve of 0.901 using a cut-off point of 6.25. Conclusions CTEIA is a new qualitative tool for evaluation of ileocolonic Crohn's disease, which need to be validated in further studies.

Automated summary

The aim of this study was to develop a quantitative CTE scoring system for evaluation of ileocolonic Crohn's disease. The study found that mural thickness, mural stratification, and comb sign were independent predictors for the endoscopic index of severity in Crohn's disease. A simplified CT enterography index of activity (CTEIA) was derived from logistic regression analysis to quantify disease activity based on CTE findings. CTEIA showed a high and significant correlation with CDEIS. The model achieved good performance in detecting ulcerative lesions in the colon and terminal ileum.