To investigate the diagnostic value of texture analysis (TA) for differentiating between colorectal cancer (CRC), colonic lesions caused by inflammatory bowel disease (IBD), and normal thickened colon wall (NTC) on computed tomography (CT) and assess which scanning phase has the highest differential diagnostic value. In all, 107 patients with CRC, 113 IBD patients with colonic lesions, and 96 participants with NTC were retrospectively enrolled. All subjects underwent multiphase CT examination, including pre-contrast phase (PCP), arterial phase (AP), and portal venous phase (PVP) scans. Based on these images, classification by TA and visual classification by radiologists were performed to discriminate among the three tissue types. The performance of TA and visual classification was compared. Precise TA classification results (error, 2.03-12.48%) were acquired by nonlinear discriminant analysis for CRC, IBD and NTC, regardless of phase or feature selection. PVP images showed a better ability to discriminate the three tissues by comprising the three scanning phases. TA showed significantly better performance in discriminating CRC, IBD and NTC than visual classification for residents, but there was no significant difference in classification between TA and experienced radiologists. TA could provide useful quantitative information for the differentiation of CRC, IBD and NTC on CT, particularly in PVP images. Colorectal cancer (CRC) is one of the most commonly diagnosed and deadly cancers worldwide 1. The risk of CRC is increased in patients with inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), compared with that of sporadic CRC, especially in IBD patients with long-term colitis, strictures, fistulae, and right-sided colonic disease 2. Although the incidence of CRC in IBD patients accounts for only 1-2% of all CRC cases, a recent population-based study showed that CRC accounted for 10-15% of all IBD-related deaths 3. Therefore, CRC screening and early detection in IBD patients may reduce the morbidity and mortality rates of CRC in patients with IBD 4. Regular monitoring by endoscopy may allow the early detection of CRC. However, endoscopy usually involves sedation and has associated risks, including perforation and bleeding, especially in patients with active IBD 5. Compared with colonoscopy, computed tomography (CT) is a promising method for CRC screening due to the lower rate of test-related complications, the ability to assess the patient for perforating complications of IBD, and the ability to determine the extent and severity of CRC and IBD 6. On CT images, patterns of wall thickening are helpful for differential diagnosis, with heterogeneous and asymmetrical focal thickening indicating malignancies and homogeneous and symmetrical regular thickening suggesting benign or well-differentiated tumours 2. For experienced gastrointestinal radiologists, it is not very difficult to distinguish CRC from IBD, but for less experienced radiologists or residents, there are still som...