Dual-energy computed tomography quantification of creeping fat in Crohn's disease: A new radiologic biomarker for transmural disease monitoring.

Accurate, noninvasive assessment of disease activity remains one of the central challenges in the management of Crohn's disease (CD). The study by Dong et al in World Journal of Radiology represents a meaningful advance in this effort, demonstrating that dual-energy computed tomography with the material decomposition algorithm can reliably quantify intestinal creeping fat (CrF), a pathological hallmark of CD, and that this measurement correlates robustly with clinical, endoscopic, histological, and molecular indicators of disease activity. Notably, CrF volume tracked not only inflammatory burden and fibrosis, but also the expression of peroxisome proliferator-activated receptor gamma 2 and occludin, implicating CrF in both adipogenesis and intestinal barrier dysfunction. Crucially, CrF remained elevated during clinical remission, underscoring its potential as a more sensitive marker of subclinical disease persistence than conventional activity indices alone. As the field continues to seek non-invasive surrogates for mucosal healing and histological remission, dual-energy computed tomography-based CrF quantification emerges as a promising, clinically accessible tool. With further validation in larger, multicenter cohorts, this approach could meaningfully reshape how we monitor disease activity, evaluate treatment response, and predict disease course in CD.