Li S, Zhu C, Tong L, Zheng XM, Rong C, Gao YK, Yuan DC, Wu XW. Correlation between radiomic features of Crohn's disease and secondary loss of response to infliximab. World J Gastroenterol 2025; 31(27): 109459 [DOI: 10.3748/wjg.v31.i27.109459]
Corresponding Author of This Article
Xing-Wang Wu, MD, PhD, Professor, Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230031, Anhui Province, China. duobi2004@126.com
Research Domain of This Article
Imaging Science & Photographic Technology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Shuai Li, Li Tong, Xiao-Min Zheng, Chang Rong, Yan-Kun Gao, Xing-Wang Wu, Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230031, Anhui Province, China
Chao Zhu, Department of Radiology, Yijishan Hospital of Wanan Medical University, Wuhu 241000, Anhui Province, China
Dong-Cun Yuan, Department of Radiology, Anhui Woman and Children's Medical Center, Hefei 230031, Anhui Province, China
Co-first authors: Shuai Li and Chao Zhu.
Author contributions: Li S, Zhu C, Tong L, Gao YK, Yuan DC and Wu XW designed the study; Li S, Zhu C, Rong C, and Zheng XM performed the study; Li S and Zhu C contribute equally to this study as co-first authors.
Supported by Natural Science Foundation of Anhui Province, China, No. 2308085MH241.
Institutional review board statement: The previous study was approved by the ethics committee of the First Affiliated Hospital of Anhui Medical University (approval No. PJ 2024-11-68). This study was a secondary analysis of retrospective data and was a retrospective study using de-identified data. Therefore, consent and research ethics committee approval was not required.
Informed consent statement: This study did not involve human subjects or living animals. Signed Informed Consent Form(s) or Documents are not applicable.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data can be provided as needed.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xing-Wang Wu, MD, PhD, Professor, Department of Radiology, The First Affiliated Hospital of Anhui Medical University, No. 218 Jixi Road, Hefei 230031, Anhui Province, China. duobi2004@126.com
Received: May 12, 2025 Revised: May 31, 2025 Accepted: July 1, 2025 Published online: July 21, 2025 Processing time: 70 Days and 19.7 Hours
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.
Core Tip: This study is the first to present the integrative analysis of intestinal wall and creeping fat in the prediction of secondary loss of response (SLOR) to infliximab in Crohn's disease (CD). This model can accurately identify patients with high risk of SLOR in CD, providing reliable pre-treatment references for clinicians and thereby assisting in treatment decisions.
