Value of dual energy computed tomography with material decomposition algorithm in assessing intestinal creeping fat in Crohn’s disease

BACKGROUND While next-generation dual-energy computed tomography (DECT) has demonstrated utility for fat quantification in various clinical applications, its potential to characterize intestinal creeping fat (CrF) and to correlate these imaging finding with specific molecular pathways in Crohn’s disease (CD) remains poorly studied. AIM To assess the value of DECT with the material decomposition (MMD) algorithm in quantifying CrF in patients with CD, and to explore the impact of CrF on intestinal inflammation, fibrosis, adipogenesis, and expression of mucosal barrier-related genes. METHODS Patients with active or quiescent CD and healthy controls were included for clinical, endoscopic, and DECT imaging assessments. The MMD algorithm was used to quantify CrF. Inflammatory and fibrotic changes were scored histologically. Expression of tumor necrosis factor-α, transforming growth factor-β, peroxisome proliferator-activated receptor gamma 2, and occludin was measured by immunohistochemistry and quantitative real-time polymerase chain reaction. RESULTS DECT provided high-quality images and allowed quantification of CrF. CrF volume was significantly higher in active CD patients than in healthy controls (104.67 ± 26.51 vs 17.24 ± 5.16, P < 0.05). In quiescent CD, CrF volume decreased compared with active CD (32.69 ± 11.42 vs 104.67 ± 26.51, P < 0.05) but remained above control levels (P < 0.05). These changes correlated strongly with clinical and pathological indicators, including CDAI (r = 0.927), endoscopic score (r = 0.904), histologic inflammation score (r = 0.917), and fibrosis score (r = 0.932). Furthermore, CrF volume was positively correlated with peroxisome proliferator-activated receptor gamma 2 expression (r = 0.917) and negatively correlated with occludin expression (r = -0.926). CONCLUSION DECT with the MMD algorithm can effectively quantify intestinal CrF in CD. The quantified CrF correlates well with clinical, endoscopic, histopathological, and molecular indicators of disease activity and intestinal barrier dysfunction. This approach may serve as a useful noninvasive tool for assessing CD.