Computed tomography enterography-based deep learning radiomics to predict stratified healing in patients with Crohn’s disease: a multicenter study

Abstract Objectives This study developed a deep learning radiomics (DLR) model utilizing baseline computed tomography enterography (CTE) to non-invasively predict stratified healing in Crohn’s disease (CD) patients following infliximab (IFX) treatment. Methods The study included 246 CD patients diagnosed at three hospitals. From the first two hospitals, 202 patients were randomly divided into a training cohort ( n = 141) and a testing cohort ( n = 61) in a 7:3 ratio. The remaining 44 patients from the third hospital served as the validation cohort. Radiomics and deep learning features were extracted from both the active lesion wall and mesenteric adipose tissue. The most valuable features were selected using univariate analysis and least absolute shrinkage and selection operator (LASSO) regression. Multivariate logistic regression was then employed to construct the radiomics, deep learning, and DLR models. Model performance was evaluated using receiver operating characteristic (ROC) curves. Results The DLR model achieved an area under the ROC curve (AUC) of 0.948 (95% CI: 0.916–0.980), 0.889 (95% CI: 0.803–0.975), and 0.938 (95% CI: 0.868–1.000) in the training, testing, and validation cohorts, respectively in predicting mucosal healing (MH). Furthermore, the diagnostic performance of DLR model in predicting transmural healing (TH) was 0.856 (95% CI: 0.776–0.935). Conclusions We have developed a DLR model based on the radiomics and deep learning features of baseline CTE to predict stratified healing (MH and TH) in CD patients following IFX treatment with high accuracies in both testing and external cohorts. Critical relevance statement The deep learning radiomics model developed in our study, along with the nomogram, can intuitively, accurately, and non-invasively predict stratified healing at baseline CT enterography. Key Points Early prediction of mucosal and transmural healing in Crohn’s Disease patients is beneficial for treatment planning. This model demonstrated excellent performance in predicting mucosal healing and had a diagnostic performance in predicting transmural healing of 0.856. CT enterography images of active lesion walls and mesenteric adipose tissue exhibit an association with stratified healing in Crohn’s disease patients. Graphical Abstract