Objective <p>It was hypothesized that virtual touch tissue imaging and quantification (VTIQ) is more accurate in quantifying intestinal stiffness compared to conventional B-mode ultrasound for detecting Crohn’s disease (CD) stenosis. We aimed to explore the diagnostic value of multimodal ultrasound in intestinal stenosis of CD.</p> Materials and methods <p>A retrospective analysis of CD patients (May 2020 to October 2024) was conducted. Risk factors associated with intestinal stenosis in CD were identified using univariate and multivariate logistic regression analysis. The area under the curve (AUC) of the receiver operating characteristic (ROC) of combined indices was compared with individual indices to assess their predictive ability for intestinal stenosis in CD.</p> Results <p>Sixty-three patients were included. Univariate and multivariate logistic regression analysis identified shear wave velocity (OR = 3.943, <i>p</i> = 0.008), Young’s modulus value (OR = 1.079, <i>p</i> = 0.046), and intestinal bowel ultrasound stenosis assessment score (IBUS-SAS; OR = 1.033, <i>p</i> = 0.015) as significant risk factors. The AUC for IBUS-SAS was 0.671, for shear wave velocity was 0.838, and for Young’s modulus value was 0.788. The combined model yielded an AUC of 0.878. Compared to the gold standard (Simplified Endoscopy for Crohn’s Disease, SES-CD), the ultrasound-based approach showed 100% specificity and 71% sensitivity for stenosis detection.</p> Conclusion <p>IBUS-SAS, shear wave velocity, and Young’s modulus were independent risk factors for CD intestinal stenosis, with shear wave velocity being the most accurate (AUC = 0.838), supporting our hypothesis. These findings warrant validation in large, high-quality studies.</p> Critical relevance statement <p>This study examines the potential of VTIQ ultrasound to assess intestinal stiffness in CD, offering a non-invasive, radiation-free approach that may enhance diagnostic capabilities and contribute to clinical radiology practice.</p> Key Points <p><UnorderedList Mark="Bullet"> <ItemContent> <p>VTIQ non-invasively assesses intestinal stiffness in CD.</p> </ItemContent> <ItemContent> <p>Shear wave velocity, Young’s modulus, and IBUS-SAS predict stenosis.</p> </ItemContent> <ItemContent> <p>Integrated indices improve diagnostic accuracy.</p> </ItemContent> <ItemContent> <p>VTIQ shows promise for safe, non-invasive diagnosis.</p> </ItemContent> <ItemContent> <p>Requires large-scale, multicenter studies for confirmation.</p> </ItemContent> </UnorderedList></p> Graphical Abstract <p></p>