Neuroimaging Features of Regional Brain Function in Crohn’s Disease Patients with Anxiety/Depression: A Prospective Case-Control Study

Background Anxiety and depression are common psychiatric comorbidities in Crohn’s disease (CD) patients that significantly worsen disease progression and impair patients’ quality of life. However, the neuroimaging mechanisms underlying the generation of negative emotions in CD patients remain unclear. To investigate alterations in brain function and their correlation with clinical data in CD patients with negative emotional states. Methods This study included 62 patients with Crohn’s disease, comprising 26 cases with anxiety and/or depression symptoms (adCD), 36 cases without anxiety or depression symptoms (nadCD), and 36 healthy controls (HCs) matched for gender, age, and educational attainment. All participants underwent 3.0T T1-weighted imaging scans and resting-state functional magnetic resonance imaging (rs-fMRI) using an echo-planar imaging sequence. Amplitude of low-frequency fluctuations (ALFF) and Regional homogeneity (ReHo) were computed to assess brain activity. The Beck Depression Inventory (BDI), Trait Anxiety Inventory, and Visual Analogue Scale (VAS) were used to assess emotional state and pain level. Group differences in ReHo and ALFF were assessed by ANCOVA and post hoc tests, followed by Spearman correlation of brain activity with clinical data. Results Compared to the nadCD group, the adCD patients exhibited higher ReHo and ALFF in the right insula (INS) and bilateral inferior temporal gyrus (ITG) (all p  < 0.05), while lower ALFF in the right middle temporal gyrus (MTG) ( p  < 0.01). Relative to HCs, CD patients showed altered brain activity in multiple regions, including the INS, ITG, precuneus (PCUN), superior parietal gyrus (SPG), and Opercular part of the Inferior Frontal Gyrus. In adCD patients, BDI scores inversely correlated with right SPG ALFF ( r  = − 0.457, p  = 0.019). Similarly, in nadCD patients, VAS scores positively correlated with left PCUN activity (ReHo: r  = 0.417, p  = 0.011; ALFF: r  = 0.33, p  = 0.049) and right MTG ALFF ( r  = 0.408, p  = 0.014). Furthermore, inflammatory markers showed specific negative correlations with brain activity in nadCD patients. Conclusions CD patients exhibit specific alterations in spontaneous brain activity, with patterns showing marked variation according to emotional state. In adCD patients, brain activity is primarily regulated by the affective system, whereas in nadCD patients, brain function more closely reflects inflammatory and pain burden.