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

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.