| Background and ObjectiveCrohn’s disease(CD)is a chronic non-specific inflammatory bowel disease(IBD)of the digestive tract.The course of the disease is characterized by relapse and remission.It is a lifelong disease.CD usually occurs in the terminal ileum and ascending colon.Colonoscopy is often used to evaluate CD lesions.Therefore,This article mainly studies the terminal ileum and colon lesions in patients with ileocolonic CD.The clinical conditions of CD patients are complex and changeable,and the relief of clinical symptoms and the recovery of intestinal lesions are often inconsistent.Clinicians need to adjust the treatment plan in time according to changes in disease activity.Therefore,in the long-term management of CD patients,an accurate assessment of the disease activity of patients with CD can help clinicians formulate treatment plans and evaluate treatment effects.It is helpful to prevent complications and improve prognosis.In recent years,with the rapid economic development,the incidence of CD in our country has continued to increase,and the evaluation of the disease activity of CD patients has also been paid more and more attention.There are many ways to evaluate CD activity.Colonoscopy has been a gold standard test for evaluating CD activity.The widely recognized simplified endoscopic score for Crohn’s disease(SES-CD)has been commonly used.However,endoscopy is an invasive examination.It is not easy to operate when the intestinal cavity is narrow.In severe cases,implementation may incraese the risk of complications such as intestinal perforation and bleeding,and.endoscopy can only observe mucosal lesions,which has limitations.In recent years,computed tomography enterography(CTE)has played an important role in assessing CD activity with non-invasive and high efficiency.However,domestic and foreign studies so far are mostly based on the CTE semi-quantitative scoring method established by CTE signs.This study used classic SES-CD as the scoring standard,and attempted to establish a objectively quantitative CTE scoring method through a multinomial and ordinal logistic regression model.To explore the value of CTE in the quantitative evaluation of CD activity.Materials and methods1.MaterialsFrom November 2018 to April 2020,we retrospectively analyzed 83 patients who were diagnosed with ileocolonic CD through CTE examinations,colonoscopy,histopathology and laboratory examinations in our hospital.Among them,including29 females and 54 males,aged 14 to 68 years old,with an average age of(36.6±12.9)years old.All patients underwent CTE examination and routine colonoscopy,and the time interval should less than 1 week.SES-CD had been the scoring standard,the diseased bowel of CD patients were divided into inactive group(0-2 points),mild active group(3-6 points)and moderate-severe active group(7-12 points).CTE mainly evaluated the patient’s bowel wall performances,including lesion site,bowel-wall thickness,mural stratification enhancement,luminal stenosis,plain CT value,intestinal mucosal venous phase CT value and ΔCT value(intestinal mucosal venous phase CT value-plain CT value).CTE also evaluated the patient’s peri-intestinal performances,including lymph node short diameter,mesenteric fibro-fatty proliferation and comb sign.Then,based on the patient’s CTE result and clinical data,a quantitative CTE scoring method was established.In addition,36 CD patients collected from May 2020 to November 2020 were used as the verification group to test the effectiveness of the scoring method.2.Statistieal methodsSPSS25.0 software was used to perform statistical analysis on the obtained data,P<0.05 indicates that the difference is statistically significant.Firstly,univariate analysis(normally distributed data),Kruskal-Wallis rank sum test(skewed distribution data)and R×C table chi-square test(count data)had been used to compare whether there were statistical differences in CTE signs between the three groups of CD lesions.Secondly,univariate analysis showed that all CTE indicators with statistically significant differences between groups were further analyzed by multinomial and ordinal logistic regression analysis to calculate the quantitative CTE scoring method: regression coefficient*statistically significant CTE indicators.Thirdly,according to the quantitative CTE scoring method,the CTE scores of each diseased bowel segment was calculated.According to the receiver operating characteristic(ROC)curve,the diagnostic accuracy and diagnostic threshold of the quantitative CTE scoring method for CD activity were analyzed.Finally,Spearman(skew distribution data,count data)or Pearson(normally distributed data)were used to compare the correlation between the verification group’s CTE score and SES-CD,and the ROC curve was used to test the diagnostic efficacy of the scoring method.Results1.234 intestinal segments that meets the inclusion criteria in 83 ileocolonic CD patients were evaluated,including 62 in inactive group,99 in mild active group,and73 in moderate-severe active group.2.The results of univariate analysis showed that the CTE signs with statistically significant differences between the three groups were bowel-wall thickness,mural stratification enhancement,luminal stenosis,intestinal mucosal venous phase CT value,ΔCT value,lymph node short diameter,mesenteric fibro-fatty proliferation and comb sign(P<0.05),and there was no significant difference in lesion site and plain CT value(P >0.05).3.Four statistically significant CTE signs and the corresponding regression coefficients were calculated by multivariate ordered logistic regression analysis.Quantitative CTE scoring method=0.737 * bowel-wall thickness+2.252 * mural stratification enhancement+1.153*luminal stenosis+0.106*ΔCT value(simplified CTE quantitative scoring method=0.7 * bowel-wall thickness+2.3 * mural stratification enhancement+1.2 * luminal stenosis+0.1 * Δ CT value,and the simplified method was used for subsequent calculations).4.The analysis of 36 CD patients(105 bowel segments)in the verification group showed that simplified CTE quantitative scoring method was highly correlated with SES-CD(r=0.926,P < 0.001).The bowel-wall thickness,mural stratification enhancement and ΔCT value were all moderately correlated with SES-CD(r values were 0.854,0.712,0.790,P<0.001).Luminal stenosis was mildly correlated with SES-CD(r=0.483,P<0.001)).5.ROC curve of verification group showed that area under curve(AUC)that distinguished the CD inactive group from mild active group was 0.955,the sensitivity and specificity respectively were 90.9% and 92.9%,and the Youden index was 0.838;The AUC to distinguish mild active group from moderate-severe active group was0.895,the sensitivity and specificity respectively were 90.9% and 86.4%,and the Youden index was 0.773.Conclusions1.The four CTE signs of bowel-wall thickness,mural stratification enhancement,luminal stenosis and ΔCT value can independently predict CD disease activity.Among them,mural stratification enhancement and luminal stenosis were the most effective indicators for judging CD activity.2.The quantitative CTE scoring method has high value in evaluating the disease activity of CD patients,and provides a non-invasive method for clinical evaluation of CD activity,which is helpful for clinical formulation of individualized treatment plans and accurate evaluation of curative effects. |
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