Establishing a machine learning model based on dual-energy CT enterography to evaluate Crohn’s disease activity

Abstract Objectives The simplified endoscopic score of Crohn’s disease (SES-CD) is the gold standard for quantitatively evaluating Crohn’s disease (CD) activity but is invasive. This study aimed to develop and validate a machine learning (ML) model based on dual-energy CT enterography (DECTE) to noninvasively evaluate CD activity. Methods We evaluated the activity in 202 bowel segments of 46 CD patients according to the SES-CD score and divided the segments randomly into training set and testing set at a ratio of 7:3. Least absolute shrinkage and selection operator (LASSO) was used for feature selection, and three models based on significant parameters were established based on logistic regression. Model performance was evaluated using receiver operating characteristic (ROC), calibration, and clinical decision curves. Results There were 110 active and 92 inactive bowel segments. In univariate analysis, the slope of spectral curve in the venous phases (λ HU -V) has the best diagnostic performance, with an area under the ROC curve (AUC) of 0.81 and an optimal threshold of 1.975. In the testing set, the AUC of the three models established by the 7 variables to differentiate CD activity was 0.81–0.87 (DeLong test p value was 0.071–0.766, p > 0.05), and the combined model had the highest AUC of 0.87 (95% confidence interval (CI): 0.779–0.959). Conclusions The ML model based the DECTE can feasibly evaluate CD activity, and DECTE parameters provide a quantitative analysis basis for evaluating specific bowel activities in CD patients. Critical relevance statement The machine learning model based on dual-energy computed tomography enterography can be used for evaluating Crohn’s disease activity noninvasively and quantitatively. Key Points Dual-energy CT parameters are related to Crohn’s disease activity. Three machine learning models effectively evaluated Crohn’s disease activity. Combined models based on conventional and dual-energy CT have the best performance. Graphical Abstract