Contrast-enhanced ultrasound patterns in Crohn’s disease: agreement with CT enterography and assessment of disease activity

Objective To characterize contrast-enhanced ultrasound (CEUS) patterns in Crohn’s disease (CD), assess their agreement with CT enterography (CTE), and evaluate their value in activity assessment. Methods In this prospective study, 205 patients with CD underwent intestinal CEUS and CTE between December 2022 and December 2024. CEUS was performed within 30 min after CTE. CD was confirmed by endoscopy and histopathology. Disease activity was classified as active or remission using the Crohn’s Disease Activity Index (CDAI). Agreement between CEUS and CTE enhancement patterns was assessed using kappa statistics, with CTE as the reference standard. Diagnostic performance of CEUS was evaluated by sensitivity, specificity, predictive values, and receiver operating characteristic analysis. Results Of the 205 patients, 133 had active disease and 72 were in remission. On CTE, active CD was mainly associated with stratified or transmural enhancement, whereas remission was associated with absent or mucosal-only enhancement. CEUS showed stratified enhancement in 63.0% of patients with stratified CTE enhancement and transmural enhancement in 73.0% of those with transmural CTE enhancement. In patients with absent or mucosal-only CTE enhancement, CEUS mainly showed mucosal and/or submucosal enhancement (85.9%). Agreement between CEUS and CTE patterns was good (kappa = 0.648; 95% CI:0.544–0.751). The AUC of CEUS for identifying active CD was 0.827 (95% CI: 0.768–0.887). Using stratified or transmural enhancement as a positive finding yielded 75.2% sensitivity, 90.3% specificity, and 80.5% accuracy. Conclusion CEUS patterns correlate with CD activity, show good agreement with CTE, and may serve as a useful noninvasive tool for activity assessment.