Objective To investigate the value of hyperechoic mesenteric fat (HMF) detected by preoperative intestinal ultrasound (IUS) in predicting early postoperative recurrence (EPR) in patients with Crohn’s disease (CD). Materials and methods This retrospective study included 124 CD patients who underwent I-stage intestinal resection. Based on 1-year postoperative recurrence, patients were stratified into EPR (n = 59) and non-EPR (n = 65) groups. Clinical parameters (such as smoking history, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), immunosuppressive therapy) and IUS parameters (such as bowel wall thickness (BWT), HMF, abscess/fistula) were compared. Univariate and multivariate logistic regression identified EPR predictors. Results EPR occurred in 59 patients (47.6%) during the 1-year follow-up. Significant differences (p < 0.05) were observed between EPR and non-EPR groups for clinical factors (smoking history, elevated preoperative CRP/ESR, postoperative immunosuppression) and IUS parameters (HMF, BWT, and abscess/fistula). HMF demonstrated superior discriminative capacity for EPR prediction (area under the curve (AUC) = 0.808, 95% confidence interval (CI): 0.728–0.873) vs BWT (AUC = 0.618, p < 0.05) and abscess/fistula (AUC = 0.599, p < 0.05). Univariate analysis identified CRP, ESR, colonic disease, immunosuppression, HMF, abscess/fistula, and BWT as candidate predictors (p < 0.05), with multivariate analysis confirming HMF as an independent predictor (adjusted odds ratio (OR) = 18.810, 95% CI: 6.459–54.775; p < 0.001). Conclusions Preoperative IUS-detected HMF may serve as a valuable predictor for assessing EPR risk in patients with CD. Critical relevance statement Preoperative IUS identification of HMF provides a practical, non-invasive biomarker that enables radiologists to critically improve risk stratification for EPR in CD. Key Points <UnorderedList Mark="Bullet"> <ItemContent> EPR poses a significant clinical challenge in the management of CD. </ItemContent> <ItemContent> HMF detected on preoperative IUS is a strong, independent predictor for EPR, with superior predictive performance compared to other established IUS parameters. </ItemContent> <ItemContent> Assessing HMF provides a valuable, non-invasive imaging biomarker for preoperative risk stratification. </ItemContent> </UnorderedList> Graphical Abstract

Hyperechoic mesenteric fat on preoperative intestinal ultrasound predicts early postoperative recurrence in Crohn’s disease

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2026年4月16日

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Zhuohua Liang,
Shuting Chen,
Wenjie Cheng,
Si Qin,
Xiaofang Hong,
Xueting Guan,
Jie Zhou,
Guangjian Liu

摘要

Objective

To investigate the value of hyperechoic mesenteric fat (HMF) detected by preoperative intestinal ultrasound (IUS) in predicting early postoperative recurrence (EPR) in patients with Crohn’s disease (CD).

Materials and methods

This retrospective study included 124 CD patients who underwent I-stage intestinal resection. Based on 1-year postoperative recurrence, patients were stratified into EPR (n = 59) and non-EPR (n = 65) groups. Clinical parameters (such as smoking history, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), immunosuppressive therapy) and IUS parameters (such as bowel wall thickness (BWT), HMF, abscess/fistula) were compared. Univariate and multivariate logistic regression identified EPR predictors.

Results

EPR occurred in 59 patients (47.6%) during the 1-year follow-up. Significant differences (p < 0.05) were observed between EPR and non-EPR groups for clinical factors (smoking history, elevated preoperative CRP/ESR, postoperative immunosuppression) and IUS parameters (HMF, BWT, and abscess/fistula). HMF demonstrated superior discriminative capacity for EPR prediction (area under the curve (AUC) = 0.808, 95% confidence interval (CI): 0.728–0.873) vs BWT (AUC = 0.618, p < 0.05) and abscess/fistula (AUC = 0.599, p < 0.05). Univariate analysis identified CRP, ESR, colonic disease, immunosuppression, HMF, abscess/fistula, and BWT as candidate predictors (p < 0.05), with multivariate analysis confirming HMF as an independent predictor (adjusted odds ratio (OR) = 18.810, 95% CI: 6.459–54.775; p < 0.001).

Conclusions

Preoperative IUS-detected HMF may serve as a valuable predictor for assessing EPR risk in patients with CD.

Critical relevance statement

Preoperative IUS identification of HMF provides a practical, non-invasive biomarker that enables radiologists to critically improve risk stratification for EPR in CD.

Key Points

EPR poses a significant clinical challenge in the management of CD.

HMF detected on preoperative IUS is a strong, independent predictor for EPR, with superior predictive performance compared to other established IUS parameters.

Assessing HMF provides a valuable, non-invasive imaging biomarker for preoperative risk stratification.

Graphical Abstract