Predicting mucosal healing in Crohn's disease: development of a deep-learning model based on intestinal ultrasound images.

Abstract

Objective: Predicting treatment response in Crohn's disease (CD) is essential for making an optimal therapeutic regimen, but relevant models are lacking. This study aimed to develop a deep learning model based on baseline intestinal ultrasound (IUS) images and clinical information to predict mucosal healing.

Methods: Consecutive CD patients who underwent pretreatment IUS were retrospectively recruited at a tertiary hospital. A total of 1548 IUS images of longitudinal diseased bowel segments were collected and divided into a training cohort and a test cohort. A convolutional neural network model was developed to predict mucosal healing after one year of standardized treatment. The model's efficacy was validated using the five-fold internal cross-validation and further tested in the test cohort.

Results: A total of 190 patients (68.9% men, mean age 32.3 ± 14.1 years) were enrolled, consisting of 1038 IUS images of mucosal healing and 510 images of no mucosal healing. The mean area under the curve in the test cohort was 0.73 (95% CI: 0.68-0.78), with the mean sensitivity of 68.1% (95% CI: 60.5-77.4%), specificity of 69.5% (95% CI: 60.1-77.2%), positive prediction value of 80.0% (95% CI: 74.5-84.9%), negative prediction value of 54.8% (95% CI: 48.0-63.7%). Heat maps showing the deep-learning decision-making process revealed that information from the bowel wall, serous surface, and surrounding mesentery was mainly considered by the model.

Conclusions: We developed a deep learning model based on IUS images to predict mucosal healing in CD with notable accuracy. Further validation and improvement of this model with more multi-center, real-world data are needed.

Critical relevance statement: Predicting treatment response in CD is essential to making an optimal therapeutic regimen. In this study, a deep-learning model using pretreatment ultrasound images and clinical information was generated to predict mucosal healing with an AUC of 0.73.

Key points: Response to medication treatment is highly variable among patients with CD. High-resolution IUS images of the intestinal wall may hide significant characteristics for treatment response. A deep-learning model capable of predicting treatment response was generated using pretreatment IUS images.