AI-Assisted MRE for Intestinal Fibrosis in Crohn's Disease

NCT ID: NCT06858553

Last Updated: 2025-08-05

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Total Enrollment

234 participants

Study Classification

OBSERVATIONAL

Study Start Date

2025-06-03

Study Completion Date

2027-02-28

Brief Summary

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Intestinal fibrotic strictures represent a severe complication of Crohn's disease (CD), affecting over half of the patients. Despite the continuous emergence of novel medications, effective treatment options remain scarce. Endoscopy fails to identify the full-thickness fibrosis of the bowel wall, and standardized assessment for cross-sectional imaging has yet to be established. Previous studies have demonstrated that radiomics models based on computed tomography and deep learning models exhibit commendable diagnostic capability. Thus, this project seeks to conduct a prospective multicenter study, with plans to recruit 234 CD patients requiring bowel resection from five medical centers. The aim is to develop and validate a deep learning model based on magnetic resonance enterography (MRE) to accurately characterize intestinal fibrosis.

Detailed Description

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Quality Assurance Plan The registry implements a comprehensive quality assurance (QA) plan to validate data and maintain protocol adherence. This includes routine site monitoring, regular audits, and verification of data consistency. Sites participating in the registry are periodically reviewed for compliance with the established operational standards.

Data Entry and Summary Process Management will enforce access regulations to ensure only authorized personnel can enter or query data. Patient information meeting inclusion criteria will be entered into a Tencent form from the hospital's medical record system. Research assistants will supplement this form with details about intestinal surgical specimens, including condition, quantity, and storage, and summarize all specimens. Researchers will summarize the MRE imaging data for the relevant patients. No one may delete, alter, copy, print, or output confidential data without management's consent.

Verification System During patient enrollment, information collection, and specimen collection, two or more research assistants or researchers will confirm the process. Relevant information will be verified again during specimen collection, labeling, and storage. In the analysis phase, researchers will recheck the accuracy of imaging, patient information, and specimens. Management will conduct a random audit every three months to verify patient inclusion criteria and confirm specimen information accuracy.

Data Dictionary A comprehensive data dictionary is used to define each variable collected within the registry. It includes the source of the variable, coding standards and any relevant normal ranges for clinical measures. This data dictionary serves as a reference to ensure uniformity in data collection and analysis.

Standard Operating Procedures (SOPs) The registry follows established Standard Operating Procedures (SOPs) for various registry functions, including patient recruitment, data collection, management, and analysis. SOPs also cover reporting procedures for adverse events, including guidelines for data reporting and event classification. Change management processes are in place to address any amendments or updates to registry protocols.

Sample Size Assessment A statistical sample size calculation has been performed to ensure that the registry is adequately powered to detect meaningful differences or effects. This calculation takes into account the expected incidence of the event of interest, anticipated variability, and the desired statistical power. The required number of participants or participant years is specified based on the primary and secondary objectives of the study.

Plan for Missing Data The registry has a clear policy for handling missing data, including cases where data may be unavailable, uninterpretable, or missing due to inconsistencies (e.g., out-of-range results). A specific protocol is followed for imputing missing values or excluding incomplete data from analysis, ensuring the final dataset remains reliable and valid for statistical analysis.

Statistical Analysis Methods Automatic recognition and segmentation of intestinal lesions in images, based on multi-parametric MRI data and artificial intelligence models, are used to evaluate intestinal fibrosis and assist in clinical decision-making. Specifically, the process includes: performing VOI annotation to generate 3D VOI; normalizing and resampling MRE images, cropping voxel intensity and applying min-max normalization; decomposing each 3D MRE lesion image into patches, and applying 5-fold data augmentation as input to the network; developing a deep learning segmentation algorithm using the nnU-Net model for automatic recognition of intestinal lesion images, with performance evaluated using the Dice similarity coefficient; constructing a ResNet model to accurately assess different degrees of intestinal fibrosis, with output as a predicted probability between 0 and 1; collecting multi-parametric MRI data prior to model construction and extracting features not affected by intestinal inflammation; excluding relevant features during model development, retaining only those reflecting intestinal fibrosis; after model construction, grouping patients based on inflammation severity and re-evaluating the AI model's recognition capability. Through these steps and the integration of multi-omics data, molecular subtyping and related prognostic analysis of patients are achieved to assist in clinical treatment decision-making.

Conditions

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Crohn Disease (CD)

Study Design

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Observational Model Type

COHORT

Study Time Perspective

CROSS_SECTIONAL

Study Groups

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training group

This group of patients is used in the training phase of the predictive model to fit an appropriate model.

No interventions assigned to this group

validation group

This group of patients is used to validate the trained model to determine whether the model has broad applicability.

No interventions assigned to this group

Eligibility Criteria

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Inclusion Criteria

1. Patients Over 18 years old with a confirmed diagnosis of CD based on the criteria of ECCO guideline.
2. Planning to receive a bowel resection due to stricture in ileum or colon, and availability of histological specimens of resected intestinal walls matched with MRE are expected to be available.
3. Clear boundaries of the target bowel tract enable accurate semi-automatic or fully automatic intestinal segmentation

Exclusion Criteria

1. Cannot undergo MRI examination
2. Difficult to obtain suitable tissue after surgery
3. MRE imaging is of poor quality or contains artifacts
4. The target bowel is located at the anastomosis (ie, anastomotic stricture)
5. Intestinal lesions concurrent with other diseases
Minimum Eligible Age

18 Years

Maximum Eligible Age

75 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Sixth Affiliated Hospital, Sun Yat-sen University

OTHER

Sponsor Role collaborator

Sir Run Run Shaw Hospital

OTHER

Sponsor Role collaborator

Jinling Hospital, China

OTHER

Sponsor Role collaborator

MSD R&D (China) Co., Ltd.

INDUSTRY

Sponsor Role collaborator

Ruijin Hospital

OTHER

Sponsor Role collaborator

Minhu Chen

OTHER

Sponsor Role lead

Responsible Party

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Minhu Chen

Professor

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Minhu Chen

Role: STUDY_CHAIR

First Affiliated Hospital, Sun Yat-Sen University

Locations

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The First Affiliated Hospital,Sun Yat-sen University

Guangzhou, Guangdong, China

Site Status RECRUITING

Sixth Affiliated Hospital of Sun Yat-sen University

Guangzhou, Guangdong, China

Site Status NOT_YET_RECRUITING

Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University

Nanjing, Jiangsu, China

Site Status NOT_YET_RECRUITING

Ruijin Hospital, Shanghai Jiaotong University School of Medicine

Huangpu, Shanghai Municipality, China

Site Status NOT_YET_RECRUITING

Sir Run Run Shaw Hospital, Zhejiang University School of Medicine

Hangzhou, Zhejiang, China

Site Status RECRUITING

Countries

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China

Central Contacts

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Minhu Chen, Professor

Role: CONTACT

+86 13802957089

Ren Mao, Professor

Role: CONTACT

+86 13544476809

Facility Contacts

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Minhu Chen

Role: primary

+86 13802957089

Xiang Gao, Professor

Role: primary

+86 13502405878

Yi Li, Professor

Role: primary

+86 13851843735

Duowu Zou, Professor

Role: primary

+86 13901617608

Qian Cao, Professor

Role: primary

+86 13588706896

References

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Li XH, Feng ST, Cao QH, Coffey JC, Baker ME, Huang L, Fang ZN, Qiu Y, Lu BL, Chen ZH, Li Y, Bettenworth D, Iacucci M, Sun CH, Ghosh S, Rieder F, Chen MH, Li ZP, Mao R. Degree of Creeping Fat Assessed by Computed Tomography Enterography is Associated with Intestinal Fibrotic Stricture in Patients with Crohn's Disease: A Potentially Novel Mesenteric Creeping Fat Index. J Crohns Colitis. 2021 Jul 5;15(7):1161-1173. doi: 10.1093/ecco-jcc/jjab005.

Reference Type BACKGROUND
PMID: 33411893 (View on PubMed)

Li X, Zhang N, Hu C, Lin Y, Li J, Li Z, Cui E, Shi L, Zhuang X, Li J, Lu J, Wang Y, Liu R, Yuan C, Lin H, He J, Ke D, Tang S, Zou Y, He B, Sun C, Chen M, Huang B, Mao R, Feng ST. CT-based radiomics signature of visceral adipose tissue for prediction of disease progression in patients with Crohn's disease: A multicentre cohort study. EClinicalMedicine. 2022 Dec 30;56:101805. doi: 10.1016/j.eclinm.2022.101805. eCollection 2023 Feb.

Reference Type BACKGROUND
PMID: 36618894 (View on PubMed)

Li Z, Chen Z, Zhang R, et, al. Eur J Nucl Med Mol Imaging. 2024 Feb 15.

Reference Type BACKGROUND

Du JF, Lu BL, Huang SY, Mao R, Zhang ZW, Cao QH, Chen ZH, Li SY, Qin QL, Sun CH, Feng ST, Li ZP, Huang L, Li XH. A novel identification system combining diffusion kurtosis imaging with conventional magnetic resonance imaging to assess intestinal strictures in patients with Crohn's disease. Abdom Radiol (NY). 2021 Mar;46(3):936-947. doi: 10.1007/s00261-020-02765-3. Epub 2020 Sep 22.

Reference Type BACKGROUND
PMID: 32964274 (View on PubMed)

Zhang MC, Li XH, Huang SY, Mao R, Fang ZN, Cao QH, Zhang ZW, Yan X, Chen MH, Li ZP, Sun CH, Feng ST. IVIM with fractional perfusion as a novel biomarker for detecting and grading intestinal fibrosis in Crohn's disease. Eur Radiol. 2019 Jun;29(6):3069-3078. doi: 10.1007/s00330-018-5848-6. Epub 2018 Dec 13.

Reference Type BACKGROUND
PMID: 30547200 (View on PubMed)

Huang SY, Li XH, Huang L, Sun CH, Fang ZN, Zhang MC, Lin JJ, Jiang MJ, Mao R, Li ZP, Zhang Z, Feng ST. T2* Mapping to characterize intestinal fibrosis in crohn's disease. J Magn Reson Imaging. 2018 Apr 17. doi: 10.1002/jmri.26022. Online ahead of print.

Reference Type BACKGROUND
PMID: 29663577 (View on PubMed)

Li Z, Lu B, Lin J, He S, Huang L, Wang Y, Meng J, Li Z, Feng ST, Lin S, Mao R, Li XH. A Type I Collagen-Targeted MR Imaging Probe for Staging Fibrosis in Crohn's Disease. Front Mol Biosci. 2021 Nov 11;8:762355. doi: 10.3389/fmolb.2021.762355. eCollection 2021.

Reference Type BACKGROUND
PMID: 34859052 (View on PubMed)

Li XH, Mao R, Huang SY, Fang ZN, Lu BL, Lin JJ, Xiong SS, Chen MH, Li ZP, Sun CH, Feng ST. Ability of DWI to characterize bowel fibrosis depends on the degree of bowel inflammation. Eur Radiol. 2019 May;29(5):2465-2473. doi: 10.1007/s00330-018-5860-x. Epub 2019 Jan 11.

Reference Type BACKGROUND
PMID: 30635756 (View on PubMed)

Chen YJ, Mao R, Li XH, Cao QH, Chen ZH, Liu BX, Chen SL, Chen BL, He Y, Zeng ZR, Ben-Horin S, Rimola J, Rieder F, Xie XY, Chen MH. Real-Time Shear Wave Ultrasound Elastography Differentiates Fibrotic from Inflammatory Strictures in Patients with Crohn's Disease. Inflamm Bowel Dis. 2018 Sep 15;24(10):2183-2190. doi: 10.1093/ibd/izy115.

Reference Type BACKGROUND
PMID: 29718309 (View on PubMed)

Li XH, Mao R, Huang SY, Sun CH, Cao QH, Fang ZN, Zhang ZW, Huang L, Lin JJ, Chen YJ, Rimola J, Rieder F, Chen MH, Feng ST, Li ZP. Characterization of Degree of Intestinal Fibrosis in Patients with Crohn Disease by Using Magnetization Transfer MR Imaging. Radiology. 2018 May;287(2):494-503. doi: 10.1148/radiol.2017171221. Epub 2018 Jan 19.

Reference Type BACKGROUND
PMID: 29357272 (View on PubMed)

Meng J, Luo Z, Chen Z, Zhou J, Chen Z, Lu B, Zhang M, Wang Y, Yuan C, Shen X, Huang Q, Zhang Z, Ye Z, Cao Q, Zhou Z, Xu Y, Mao R, Chen M, Sun C, Li Z, Feng ST, Meng X, Huang B, Li X. Intestinal fibrosis classification in patients with Crohn's disease using CT enterography-based deep learning: comparisons with radiomics and radiologists. Eur Radiol. 2022 Dec;32(12):8692-8705. doi: 10.1007/s00330-022-08842-z. Epub 2022 May 26.

Reference Type BACKGROUND
PMID: 35616733 (View on PubMed)

Li X, Liang D, Meng J, Zhou J, Chen Z, Huang S, Lu B, Qiu Y, Baker ME, Ye Z, Cao Q, Wang M, Yuan C, Chen Z, Feng S, Zhang Y, Iacucci M, Ghosh S, Rieder F, Sun C, Chen M, Li Z, Mao R, Huang B, Feng ST. Development and Validation of a Novel Computed-Tomography Enterography Radiomic Approach for Characterization of Intestinal Fibrosis in Crohn's Disease. Gastroenterology. 2021 Jun;160(7):2303-2316.e11. doi: 10.1053/j.gastro.2021.02.027. Epub 2021 Feb 17.

Reference Type BACKGROUND
PMID: 33609503 (View on PubMed)

Provided Documents

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Document Type: Informed Consent Form

View Document

Other Identifiers

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MISP-102507

Identifier Type: OTHER_GRANT

Identifier Source: secondary_id

No.840[2024]

Identifier Type: -

Identifier Source: org_study_id

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