A Mesenteric Fat-Derived Radiomic Model to Identify Colonic Fibrosis and Predict Treatment Response to Biologics in Chronic Ulcerative Colitis

BACKGROUND: Evidence suggested the lesion of ulcerative colitis stretches beyond mucosa. The application of radiomics on ulcerative colitis fibrosis is unclear. OBJECTIVE: We aimed to characterize the colonic fibrosis and treatment response to biologics in chronic ulcerative colitis using radiomic features extracted from bowel wall and mesenteric adipose tissue. DESIGN: Retrospective analysis of prospective database. SETTINGS: This study was conducted in a single tertiary center. PATIENTS: A total of 72 patients who underwent proctocolectomy and 47 patients who received biologics induction were included. INTERVENTION: Computed Tomography images were collected and radiomic features were extracted to develop radiomic models using logistic regression. MAIN OUTCOME MEASURES: Main outcome was colonic fibrosis, which was classified into mild and severe based on histological scoring. RESULTS: The area under curve of the bowel wall model to predict severe fibrosis was 0.931 ( p < 0.001) and 0.869 ( p < 0.001) in the training and test cohort, respectively. For mesenteric adipose tissue model, area under curve was 0.947 ( p < 0.001) and 0.837 ( p < 0.001), respectively. The mesenteric adipose tissue model was superior to bowel wall model (area under curve, 0.809, p < 0.001 and 0.722, p = 0.006) in predicting response to biologics in chronic ulcerative colitis. LIMITATIONS: Retrospective single center study. CONCLUSIONS: Two radiomic models derived from bowel wall and mesenteric adipose tissue features readily predicted colonic fibrosis and treatment response of biologics in chronic ulcerative colitis. The mesentery harbors critical information and was essentially involved in fibrogenesis. See Video Abstract .