Preoperative computed tomography enterography-based radiomics signature: A potential predictor of postoperative anastomotic recurrence in patients with Crohn?s disease

Background: More than half of patients with Crohn's disease (CD) require at least one surgery for symptom management; however, approximately half of the patients may experience postoperative anastomotic recurrence (PAR).Objectives: This study aims to develop and validate a preoperative computed tomography enterography (CTE)-based radiomics signature to predict early PAR in CD.Design: A total of 186 patients with CD (training cohort, n = 134; test cohort, n = 52) who underwent preop-erative CTE and surgery between January 2014 and June 2020 were included in this retrospective multi-centre study. Methods: 106 radiomic features were initially extracted from intestinal lesions and peri-intestinal mesenteric fat, respectively; significant radiomic features were selected from them and then used to develop intestinal or mesenteric radiomics signatures, using the least absolute shrinkage and selection operator and a Cox regression model. A radiomics-based nomogram incorporating these signatures with clinical-radiological factors was created for comparison with a model based on clinical-radiological features alone.Results: 68 of 134 patients in training cohort and 16 of 52 patients in test cohort suffered from PAR. The intestinal radiomic signature (hazard ratio [HR]: 2.17; 95% confidence interval [CI]: 1.32-3.58; P = 0.002) and mesenteric radiomic signature (HR: 2.19; 95% CI: 1.14-4.19; P = 0.018) were independent risk factors for PAR in the training cohort as per a multivariate analysis. The radiomics-based nomogram (C-index: 0.710; 95% CI: 0.672-0.748) yielded superior predictive performance than the clinical-radiological model (C-index, 0.607; 95% CI: 0.582-0.632) in the test cohort. Decision curve analysis demonstrated that the radiomics-based nomogram outperformed the clinical-radiological model in terms of clinical usefulness.Conclusions: Preoperative mesenteric and intestinal CTE radiomics signatures are potential non-invasive pre-dictors of PAR in postoperative patients with CD.

Automated summary

This study developed and validated a radiomics signature based on preoperative computed tomography enterography (CTE) to predict early postoperative anastomotic recurrence (PAR) in patients with Crohn's disease (CD). The results showed that both intestinal and mesenteric radiomics signatures were independent risk factors for PAR in CD patients, and the radiomics-based nomogram had superior predictive performance compared to a model based on clinical-radiological features alone.