Imaging features of the ileocecal valve may be correlated with disease activity in patients with Crohn's disease

To summarize the imaging signs of the ileocecal valve (ICV) in Crohn's disease (CD) patients, explore the relationship of these signs with disease activity, and evaluate the correlation between ICV radiological and endoscopic findings. This retrospective study included 93 patients who simultaneously underwent endoscopic and radiological examinations; patients were divided into Group 1 (G1, Simple Endoscopic Score for Crohn's Disease [SES-CD] ≥3, n = 55) and Group 2 (SES-CD <3, n = 38). The shape (categorized as the labial, papillary, fatty infiltration, or deformed/indiscernible type), height, and enhancement pattern of ICV were recorded. In two groups, the papillary and deformed/indiscernible types were the main ICV shapes on computed tomography enterography (CTE) (baseline: G1, 40% vs. 49.1%; G2, 50% vs. 34.2%). The deformed/indiscernible type of ICV and the ICV with both hyperenhancement at baseline and follow-up had the shortest disease-free survival. The former was a risk factor for persistent disease activity (HR = 7.223; 95% CI, 1.179–44.262; p = 0.03). The hyperenhancement of ICV tended to coexist with more common radiologic terminal ileal inflammation and more widespread endoscopic intestinal lesions. There was a positive correlation between endoscopy and CTE for assessing ileocecal valve shape (Kendall's tau b = 0.572, p < 0.0001). 78.6% (22/28) of the deformed/indiscernible type on endoscopy appeared as the deformed/indiscernible type on CTE. The deformed/indiscernible shape and persistent hyperenhancement of ICV on CTE may prompt CD disease activity. The assessment of the deformed/indiscernible type of ICV was broadly similar in endoscopy and CTE.