Abstract
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 technique, 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.