Inflammatory bowel diseases · 2026
The Chicago Mesenteric Fat Index: A Novel Metric for Point-of-Care Intestinal Ultrasound Evaluation of Mesenteric Fat Wrapping in Crohn's Disease.
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St-Pierre Joëlle, Kellar Amelia, George Tessa, Miyatani Yusuke, Krugliak Cleveland Noa, Choi Natalie K, Liao Chuanhong, Fear Evan, Fine Zach, Picker Emma, Rubin David T
Аннотация
BACKGROUND: Mesenteric fat (MF) wrapping is a characteristic feature of Crohn's disease (CD). Current assessment methods are limited to binary classification (presence/absence), restricting their utility in assessing disease progression and treatment response. This study aimed to develop and validate a novel semi-quantitative metric for grading MF wrapping using intestinal ultrasound (IUS), and to evaluate its reliability and clinical relevance.
METHODS: This cross-sectional study included 95 ultrasound scans from 63 patients with CD. The novel index described here categorized MF wrapping into 3 categories: none, incomplete, and complete. Images were independently assessed to evaluate inter- and intrarater reliability. Associations between MF wrapping and clinical characteristics, inflammatory markers, and IUS parameters were analyzed.
RESULTS: Interrater reliability for the MF index was moderate (κ = 0.452), while intrarater reliability was substantial (κ = 0.653), similar to binary assessment (κ = 0.572 and κ = 0.674 for inter- and intrarater reliability, respectively). MF wrapping was significantly associated with increased bowel wall thickness (OR, 6.74; P < .001), loss of bowel wall stratification (OR, 22.05; P < .001), hyperemia (OR, 8.09; P = .002), and presence of strictures (OR, 4.30; P = .002). Smoking status and lower serum albumin were significantly associated with increased MF wrapping.
CONCLUSIONS: CMFI represents a proof-of-concept tool for semi-quantitative assessment of MF wrapping on IUS. While reproducible and associated with other disease markers, its incremental clinical utility remains to be established through prospective validation and longitudinal outcome studies.
METHODS: This cross-sectional study included 95 ultrasound scans from 63 patients with CD. The novel index described here categorized MF wrapping into 3 categories: none, incomplete, and complete. Images were independently assessed to evaluate inter- and intrarater reliability. Associations between MF wrapping and clinical characteristics, inflammatory markers, and IUS parameters were analyzed.
RESULTS: Interrater reliability for the MF index was moderate (κ = 0.452), while intrarater reliability was substantial (κ = 0.653), similar to binary assessment (κ = 0.572 and κ = 0.674 for inter- and intrarater reliability, respectively). MF wrapping was significantly associated with increased bowel wall thickness (OR, 6.74; P < .001), loss of bowel wall stratification (OR, 22.05; P < .001), hyperemia (OR, 8.09; P = .002), and presence of strictures (OR, 4.30; P = .002). Smoking status and lower serum albumin were significantly associated with increased MF wrapping.
CONCLUSIONS: CMFI represents a proof-of-concept tool for semi-quantitative assessment of MF wrapping on IUS. While reproducible and associated with other disease markers, its incremental clinical utility remains to be established through prospective validation and longitudinal outcome studies.