Predictive Value of Dual Energy Computed Tomography Enterography Derived Iodine Density Measurements for Surgical vs. Medical Management in Crohn’s Disease: A Cross-Sectional Imaging Study

Abstract

Background:
Determining whether patients with Crohn’s disease (CD) will respond to medical therapy or require surgery remains a key clinical challenge. Dual-energy computed tomography (DECT) allows for iodine density quantification, which may serve as a non-invasive imaging biomarker of disease activity and treatment response.

Objective:
To assess the predictive value of iodine density, derived from DECT enterography, in distinguishing CD patients requiring surgical intervention from those managed conservatively with medical therapy.

Methods:
In this cross-sectional analytical study, 130 patients with confirmed CD were recruited from multiple participating health centers ,in Al Ahsa , Saudi Arabia. All patients underwent DECT imaging. Quantitative iodine density was measured in affected bowel segments, and clinical management pathway (surgical vs. medical) was recorded. Additional variables included age, BMI, disease duration, Montreal classification, medication use, and inflammatory markers. Statistical analyses included independent-sample t-tests, ROC analysis, and logistic regression.

Results:
Mean iodine density was significantly higher in the medical group (3.34 ± 0.44 mg/mL) than in the surgical group (1.92 ± 0.51 mg/mL, p < 0.001). An iodine density threshold of 2.5 mg/mL yielded 82% sensitivity and 78% specificity for predicting surgical need. Iodine density was an independent predictor of surgery (OR = 0.38, p = 0.001), along with perianal disease.

Conclusion:
Iodine density is a valuable, non-invasive predictor of treatment direction in Crohn’s disease, offering potential to optimize early clinical decision-making and improve patient outcomes.