Predicting progression in mild CD

December 2, 2025

Issue 23

Clinical Question

Which cross-sectional radiographic features predict disease progression in mild Crohn’s disease patients?

Editor’s Bottom Line

While including the introduction of effective therapy as a surrogate marker for disease progression in this analysis is problematic, its results do emphasize the predictive value of specific findings on cross-sectional imaging. Clinicians should integrate all available radiologic, endoscopic and biomarker tools to estimate individual risk in patients with Crohn’s disease.

Reference

Bachour SP, Srinivas-Rao S, Baskaran NU, et al. Cross-Sectional Imaging Features Associated With Disease Progression in Crohn’s Disease. Inflamm Bowel Dis. Epub ahead of print Sept 30, 2025; https://academic.oup.com/ibdjournal

Synopsis

This multi-institutional retrospective cohort evaluated whether radiologic features on cross-sectional imaging predict disease progression in patients with mild Crohn’s disease (CD). The study included 177 adult patients without prior immunomodulator or biologic use, prior surgery, or CD-related hospitalization who underwent abdominal CT (81%) or MRI prior to 2018. Patients were a mean 45 years of age, 53% were female and 62% had imaging within two years of diagnosis. Patients with an abscess or stricturing disease on index imaging were excluded.

Two radiologists reviewed imaging and extracted 37 features related to intestinal, mesenteric and extra-luminal complications. The primary outcome was composite disease progression, defined as initiation of immunomodulator or biologic therapy, surgical resection, or CD-related hospitalization occurring 30 days or more after imaging.

After a median follow-up of 3.4 years, 45.8% of patients experienced disease progression. The median time-to-progression was 145 days.

More specifically, 39 patients initiated immunomodulator treatment, 72 began treatment with a biologic, 37 required hospitalization and 17 underwent surgical resection.

On multivariable logistic regression, small bowel wall thickening >5 mm on the index imaging was most strongly associated with progression (adjusted Odds Ratio [aOR] 8.59; 95% Confidence Interval [CI]: 2.37–34.3; p<0.001). Small bowel wall thickness less than 3 mm was used as the comparator.

Distal colonic inflammation (aOR 3.95; 95% CI: 1.20–13.84; p=0.03) and segmental mural hyperenhancement (aOR 2.44; 95% CI: 1.01–6.13; p=0.04) were also independently associated with progression. Increased time from diagnosis to imaging and older age were protective variables.

Using Cox regression analysis, segmental mural hyperenhancement (adjusted Hazard Ratio [aHR]: 1.92), engorged vasa recta (aHR: 2.47) and cecal inflammation (aHR: 1.65) were associated with decreased time to progression.

The likelihood of progression increased with the number of high-risk features. Specifically, the rate of progression during follow-up was 13.7% among patients with no features, 42.6% among those with one feature, 74.4% for patients with two high-risk features and 90.9% for those with three features (p<0.001).

With regard to the risk of hospitalization, engorged vasa recta and segmental mural hyperenhancement were predictors, while increased age was protective

Details

Study Design: Retrospective cohort
Funding: National Institutes of Health, the Leona M. and Harry B. Helmsley Charitable Trust and the Chleck Family Foundation
Allocation: Not applicable
Setting: Multicenter
Level of Evidence: 2b