Harvey-Bradshaw index with CT/MR enterography combo can predict near-term surgery risk in crohn's disease

A new study found that computed tomography enterography (CTE) and magnetic resonance enterography (MRE) imaging findings in combination with the Harvey-Bradshaw index (HBI) can certainly predict the necessity of near-term surgery in patients with small bowel Crohn's disease. The study results were published in the journal Inflammatory Bowel Diseases. 

Crohn's disease is a chronic inflammatory disorder of the gastrointestinal tract. The inflammation affects bowel movements. Intestinal stricturing and aberrant small bowel motility are common complications in Crohn's leading to significant morbidity. Hence researchers from the U.S.A conducted a study to determine if patient symptoms and computed tomography enterography (CTE) and magnetic resonance enterography (MRE) imaging findings can be used to predict the near-term risk of surgery in patients with small bowel Crohn's disease (CD). 

Retrospectively, CD patients with small bowel strictures who underwent serial CTE or MRE were identified. Strictures were characterized by proximal small bowel dilation, luminal narrowing, and thickening of the bowel wall. Harvey-Bradshaw index (HBI) was recorded. Using baseline CTE or MRE, stricture observations and measurements were done and compared with prior and subsequent scans. Participants were divided into two groups those who had surgery within 2 years and those who did not. LASSO regression models were trained and validation was done using 5-fold cross-validation. 

Results

• Eighty-five patients with a mean age of 43.7 ± 15.3 years at baseline scan were enrolled, the majority of them were male [57.6%]) and there were 137 small bowel strictures.
• From baseline CTE or MRE, surgery was done in 26 patients within 2 years.
• Development of stricture on the baseline exam was associated with near-term surgery, in univariate analysis of patients with prior exams (P = .006).
• A mathematical model using baseline features predicting surgery within 2 years included the following: 

• A sensitivity of 67% and specificity of 73% were demonstrated by this model (area under the curve, 0.62). 

Thus, surgery requirement within 2 years could be predicted by a combination of CTE or MRE imaging findings with HBI. 

Further reading: Inoue A, Bartlett DJ, Shahraki N, et al. Predicting Risk of Surgery in Patients With Small Bowel Crohn's Disease Strictures Using Computed Tomography and Magnetic Resonance Enterography. Inflamm Bowel Dis. 2022;28(11):1677-1686. doi:10.1093/ibd/izab332