Parameters of body composition and creeping fat are associated with activity of Crohn's disease

Association between sacroiliac joint forms and subchondral changes in patients with Crohn's disease

AIM

To assess the relationship between anatomical variants of sacroiliac joint (SIJ) and subchondral changes detected in magnetic resonance enterography (MRE) in patients with Crohn's disease (CD).

METHODS

This was a retrospective study of 60 CD patients, who were divided into two groups: with (n = 16) and without SIJ (n = 44) involvement, depending on the presence of inflammatory (bone marrow edema) and structural changes (sclerosis and erosions) in MRE. Anatomical variants of SIJ were assessed in CT of the abdomen and/or pelvis, distinguishing typical form with convex iliac surface and atypical forms. Univariate and multivariate analyses were performed to reveal an association between joint changes and forms.

RESULTS

Our study included 60 patients (38 males; mean age 38.72 years ± 13.33). Patients with SIJ changes were older (p = .044). No significant differences in CD localization and behavior were found. The most common SIJ lesions were structural changes (in 75% of patients); the main atypical form was the iliosacral complex. The univariate and multivariate analyses showed a significant association of atypical forms with total subchondral changes (odds ratio [OR]: 3.429, 95% confidence interval [CI] 1.043-11.268; p = .042; OR: 5.066, 95% CI: 1.273-20.167; p = .021, respectively), and with structural changes (OR: 4.185, 95% CI: 1.155-15.160; p = .029; OR: 5.986, 95% CI: 1.293-27.700; p = .022, respectively).

CONCLUSION

Atypical forms of SIJ are a risk factor for the occurrence of structural joint changes in CD patients. An association between bone marrow edema and atypical forms was not found.

Creeping Fat in Crohn's Disease-Surgical, Histological, and Radiological Approaches

During the course of Crohn's disease, the response of mesenteric adipose tissue to the production of inflammatory mediators and bacterial invasion through the intestinal mucosa results in the formation of creeping fat. Creeping fat describes the arresting finger-like projections that surround the inflamed bowel. In this review, the microscopic and macroscopic features of creeping fat and histological evidence for the importance of this tissue are discussed. Moreover, the most recent insights into the radiological assessment of creeping fat in patients with Crohn's disease are reported. Advances in imaging techniques have revolutionized the possibility of visualization and quantification of adipose tissue depots with excellent accuracy. Visceral fat has been significantly correlated with various Crohn's-disease-related outcomes. Despite the difficulties in distinguishing physiologic perienteric fat from creeping fat, the growing interest in fat-wrapping in Crohn's disease has rejuvenated radiologic research. With regard to the noninvasive fat-wrapping assessment, a novel CT enterography-based mesenteric creeping fat index has been developed for the mitigation of the confounding effect of normal retroperitoneal and perienteric adipose tissue. Research on machine learning algorithms and computational radiomics in conjunction with mechanistic studies may be the key for the elucidation of the complex role of creeping fat in Crohn's disease.

Imaging-based assessment of body composition in patients with Crohn's disease: a systematic review

BACKGROUND AND AIMS

Body composition changes in patients with Crohn's disease (CD) have received increasing attention in recent years. This review aims to describe the changes in body composition in patients with CD on imaging and to analyze and summarize the prognostic value of body composition.

METHODS

We systematically searched Web of Science, PubMed, Embase, Cochrane Library, and Medline via OVID for literature published before November 2022, and two researchers independently evaluated the quality of the retrieved literature.

RESULTS

A total of 39 publications (32 cohort studies and 7 cross-sectional studies) involving 4219 patients with CD were retrieved. Imaging methods for body composition assessment, including dual-energy X-ray absorptiometry (DXA), computed tomography (CT) and magnetic resonance imaging (MRI), were included in this review. The study found that patients with CD typically have more visceral adipose tissue and less skeletal muscle mass, and the prevalence of sarcopenia and visceral obesity was significantly different in different studies (sarcopenia: 16-100%; visceral obesity: 5.3-30.5%). Available studies suggest that changes in the body composition of CD patients are significantly related to inflammatory status, disease behavior, poor outcomes, and drug efficacy.

CONCLUSION

Altered body composition can be a significant predictor of poor outcomes for CD patients. Therefore, the body composition of CD patients may serve as a potential therapeutic target to help optimize disease management strategies in clinical practice.