RESUMO
OBJECTIVES: To develop and validate a radiomics nomogram for assessing the response of patients with Crohn's disease (CD) to infliximab. METHODS: Radiomics features of the spleen were extracted from computed tomography enterography (CTE) images of each patient's arterial phase. The feature selection process was performed using the least absolute shrinkage and selection operator (LASSO) algorithm, and a radiomics score (Rad-score) was calculated based on the radiomics signature formula. Subsequently, the radiomic model and the clinical risk factor model were separately established based on the Rad-score and clinically significant features, respectively. The performance of both models was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA) curves, and clinical impact curves (CICs). RESULTS: Among the 175 CD patients, 105 exhibited a clinical response, and 60 exhibited clinical remission after receiving infliximab (IFX) treatment. Our radiomic model, comprising 20 relevant features, demonstrated excellent predictive performance. The radiomic nomogram for predicting clinical response showed good calibration and discrimination in the training cohort (AUC=0.909, 95% CI=0.840-0.978), the validation cohort (AUC=0.954, 95% CI=0.889-1) and the external cohort (AUC=0.902, 95% CI=0.83-0.974). Accordingly, the nomogram was also suitable for predicting clinical remission. Decision curve analysis and clinical impact curves highlighted the clinical utility of our nomogram. CONCLUSIONS: Our radiomics nomogram is a non-invasive predictive tool constructed from radiomic features of the spleen. It also demonstrated good predictive accuracy in evaluating CD patients' response to infliximab treatment. Multicentre validation provided high-level evidence for its clinical application.
