Background The imaging features of the ileocecal valve (ICV) in Crohn’s disease (CD) patients have been poorly studied; therefore, little is known about their role in the course of CD. This study aimed to summarize the imaging signs of ICV in CD patients, explore their relationship with disease activity, and evaluate the correlation between ICV radiological and endoscopic findings.

Methods This retrospective study included 93 patients who simultaneously underwent endoscopic and radiological examinations; these patients were divided into Group 1 (G1, Simple Endoscopic Score for Crohn’s Disease [SES-CD] ≥3) and Group 2 (G2, SES-CD <3). The ICV, where the terminal ileum projects into the caecum, was located. The shape of the ICV was categorized as the labial, papillary, fatty infiltration, or deformed/indiscernible types. The height and hyperenhancement pattern of the ICV were recorded.

Results The shape of the ICV was significantly different between the two groups (P =0.007) and changed dynamically according to disease activity (according to the SES-CD). A moderate positive correlation in ICV shape was found between the CTE and endoscopy results (Cramer’s V =0.325, P <0.0001). The papillary and deformed/indiscernible types were the main ICV shapes on CTE at baseline (both 47.4% in G1; 52.8% and 22.2% in G2, respectively), and the deformed/indiscernible type not only accompanied a higher SES-CD than the other three types but was also a risk factor affecting CD remission (hazard ratio, 1.342). The fatty infiltration type may be related to remission. Persistent hyperenhancement of the ICV might suggest active CD.

Conclusions The shapes and enhancement patterns of the ICV on CT may help evaluate CD activity and are essential for clinical treatment, especially when endoscopic examination cannot be performed.