Pre-operative visceral adipose tissue radiodensity is a potentially novel prognostic biomarker for early endoscopic post-operative recurrence in Crohn's disease

Phillip Gu; Shishir Dube; Norman Gellada; So Yung Choi; Susan Win; Yoo Jin Lee; Shaohong Yang; Talin Haritunians; Gil Y Melmed; Eric A Vasiliauskas; Niru Bonthala; Gaurav Syal; Andres J Yarur; David Ziring; Shervin Rabizadeh; Phillip Fleshner; Cindy Kallman; Suzanne Devkota; Stephan R Targan; Dalin Li; Dermot Pb McGovern

doi:10.4240/wjgs.v16.i3.740

Pre-operative visceral adipose tissue radiodensity is a potentially novel prognostic biomarker for early endoscopic post-operative recurrence in Crohn's disease

World J Gastrointest Surg. 2024 Mar 27;16(3):740-750. doi: 10.4240/wjgs.v16.i3.740.

Authors

Phillip Gu¹, Shishir Dube², Norman Gellada³, So Yung Choi⁴, Susan Win³, Yoo Jin Lee⁵, Shaohong Yang², Talin Haritunians², Gil Y Melmed², Eric A Vasiliauskas², Niru Bonthala⁶, Gaurav Syal⁷, Andres J Yarur², David Ziring⁸, Shervin Rabizadeh⁸, Phillip Fleshner⁹, Cindy Kallman³, Suzanne Devkota², Stephan R Targan², Dalin Li², Dermot Pb McGovern²

Affiliations

¹ Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States. phillipgu12@gmail.com.
² Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
³ Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
⁴ Department of Biostatistics Shared Resource, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
⁵ Department of Internal Medicine, Keimyung University School of Medicine, Daegu 42601, South Korea.
⁶ Department of Medicine, University of California at Los Angeles, Los Angeles, CA 90095, United States.
⁷ Department of Medicine, University of California at San Diego, San Diego, CA 92093, United States.
⁸ Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.
⁹ Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, United States.

Abstract

Background: Evidence suggests inflammatory mesenteric fat is involved in post-operative recurrence (POR) of Crohn's disease (CD). However, its prognostic value is uncertain, in part, due to difficulties studying it non-invasively.

Aim: To evaluate the prognostic value of pre-operative radiographic mesenteric parameters for early endoscopic POR (ePOR).

Methods: We conducted a retrospective cohort study of CD subjects ≥ 12 years who underwent ileocecal or small bowel resection between 1/1/2007 to 12/31/2021 with computerized tomography abdomen/pelvis ≤ 6 months pre-operatively and underwent ileocolonoscopy ≤ 15 months post-operatively. Visceral adipose tissue (VAT) volume (cm³), ratio of VAT:subcutaneous adipose tissue (SAT) volume, VAT radiodensity, and ratio of VAT:SAT radiodensity were generated semiautomatically. Mesenteric lymphadenopathy (LAD, largest lymph node > 10 mm) and severe vasa recta (VR) engorgement (diameter of the VR supplying diseased bowel ≥ 2 × VR supplying healthy bowel) were derived manually. The primary outcome was early ePOR (Rutgeert's score ≥ i2 on first endoscopy ≤ 15 months post-operatively) and the secondary outcome was ePOR severity (Rutgeert's score i0-4). Regression analyses were performed adjusting for demographic and disease-related characteristics to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI).

Results: Of the 139 subjects included, 45% of subjects developed early ePOR (n = 63). VAT radiodensity (aOR 0.59, 95%CI: 0.38-0.90) and VAT:SAT radiodensity (aOR 8.54, 95%CI: 1.48-49.28) were associated with early ePOR, whereas, VAT volume (aOR 1.23, 95%CI: 0.78-1.95), VAT:SAT volume (aOR 0.80, 95%CI: 0.53-1.20), severe VR engorgement (aOR 1.53, 95%CI: 0.64-3.66), and mesenteric LAD (aOR 1.59, 95%CI: 0.67-3.79) were not. Similar results were observed for severity of ePOR.

Conclusion: VAT radiodensity is potentially a novel non-invasive prognostic imaging marker to help risk stratify CD patients for POR.

Keywords: Computed tomography; Creeping fat; Crohn’s disease; Mesenteric adipose tissue; Surgery; Visceral adipose tissue.