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Objectives <p>Approximately 30% of patients with Crohn’s disease (CD) experience primary loss of response (PLR) to ustekinumab. However, studies integrating imaging parameters to predict PLR remain limited. This study aimed to quantify endoluminal and intestinal wall parameters using computed tomography enterography (CTE) and assess their predictive value for PLR to ustekinumab.</p> Materials and methods <p>This multicenter study analyzed 466 intestinal segments from 161 patients with CD between March 2020 and May 2024. A national survey identified 10 CTE parameters for evaluating disease activity and predicting PLR. Logistic regression models were used to assess predictive performance in a validation cohort.</p> Results <p>Ten CTE parameters related to lesion characterization—including length, luminal narrowing, and bowel wall thickness—were defined, with newly introduced metrics, including length, area, effective luminal diameter (EffLD), mean bowel wall thickness, and stenosis. A total of 352 baseline and 114 follow-up segments from 161 patients across six centers were analyzed to assess changes following ustekinumab treatment. Paired analysis across all patients showed significant improvements in eight parameters (<i>p</i> &lt; 0.001); in contrast, unpaired comparisons between PLR and non-PLR groups revealed significant differences in six parameters (<i>p</i> &lt; 0.001), with greater improvements in the non-PLR group. EffLD emerged as an independent predictor of ustekinumab response, with an AUC of 0.858 and an accuracy of 0.780 in the validation cohort.</p> Conclusions <p>Novel endoluminal parameters, particularly EffLD, provide a detailed characterization of intestinal lesions in inflammatory bowel disease and exhibit strong predictive value for PLR in ustekinumab-treated patients with CD.</p> Critical relevance statement <p>This study first applied cardiovascular imaging software to quantify endoluminal CT enterography parameters, establishing effective luminal diameter as a novel, clinically applicable predictor of ustekinumab response in Crohn’s disease.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>Cardiovascular imaging software can facilitate image analysis in Crohn’s disease.</p> </ItemContent> <ItemContent> <p>Endoluminal CT enterography parameters predict primary loss of response in Crohn’s disease.</p> </ItemContent> <ItemContent> <p>Effective luminal diameter independently predicts ustekinumab response.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>

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Novel endoluminal parameters for predicting primary loss of response in Crohn’s disease: a multi-center study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月25日

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  • Ruchen Yao,
  • Changsheng Cai,
  • Jie Liang,
  • Feng Tian,
  • Xiaocang Cao,
  • Yue Li,
  • Yubei Gu,
  • Qi Feng,
  • Jun Shen,
  • Yu Bai,
  • Zhaolian Bian,
  • Qian Cao,
  • Xiaocang Cao,
  • Kang Chao,
  • Jie Chen,
  • Linlin Chen,
  • Min Chen,
  • Yan Chen,
  • Yuanwen Chen,
  • Cong Dai,
  • Xueli Ding,
  • Juan Du,
  • Jianhua Duan,
  • Yihong Fan,
  • Baisui Feng,
  • Jing Feng,
  • Caiping Gao,
  • Hongliang Gao,
  • Quanyi Gao,
  • Wensong Ge,
  • Sizhen Gu,
  • Hong Guo,
  • Lianyi Guo,
  • Hui Hou,
  • Lihong Jia,
  • Qi Jiang,
  • Jinghua Kuai,
  • Jin Li,
  • Qin Li,
  • Wenli Li,
  • Wenqin Li,
  • Yongyu Li,
  • Jie Liang,
  • Wangdi Liao,
  • Jiang Liu,
  • Haimei Lv,
  • Wen Lv,
  • Ren Mao,
  • Qian Ren,
  • Zhen Sun,
  • Jiawen Wang,
  • Lei Yang,
  • Hongjie Zhang,
  • Jianmin Zhao,
  • Changyu Zhou,
  • Lanxiang Zhu

摘要

Objectives

Approximately 30% of patients with Crohn’s disease (CD) experience primary loss of response (PLR) to ustekinumab. However, studies integrating imaging parameters to predict PLR remain limited. This study aimed to quantify endoluminal and intestinal wall parameters using computed tomography enterography (CTE) and assess their predictive value for PLR to ustekinumab.

Materials and methods

This multicenter study analyzed 466 intestinal segments from 161 patients with CD between March 2020 and May 2024. A national survey identified 10 CTE parameters for evaluating disease activity and predicting PLR. Logistic regression models were used to assess predictive performance in a validation cohort.

Results

Ten CTE parameters related to lesion characterization—including length, luminal narrowing, and bowel wall thickness—were defined, with newly introduced metrics, including length, area, effective luminal diameter (EffLD), mean bowel wall thickness, and stenosis. A total of 352 baseline and 114 follow-up segments from 161 patients across six centers were analyzed to assess changes following ustekinumab treatment. Paired analysis across all patients showed significant improvements in eight parameters (p < 0.001); in contrast, unpaired comparisons between PLR and non-PLR groups revealed significant differences in six parameters (p < 0.001), with greater improvements in the non-PLR group. EffLD emerged as an independent predictor of ustekinumab response, with an AUC of 0.858 and an accuracy of 0.780 in the validation cohort.

Conclusions

Novel endoluminal parameters, particularly EffLD, provide a detailed characterization of intestinal lesions in inflammatory bowel disease and exhibit strong predictive value for PLR in ustekinumab-treated patients with CD.

Critical relevance statement

This study first applied cardiovascular imaging software to quantify endoluminal CT enterography parameters, establishing effective luminal diameter as a novel, clinically applicable predictor of ustekinumab response in Crohn’s disease.

Key Points

Cardiovascular imaging software can facilitate image analysis in Crohn’s disease.

Endoluminal CT enterography parameters predict primary loss of response in Crohn’s disease.

Effective luminal diameter independently predicts ustekinumab response.

Graphical Abstract