Can Baseline MRE Predict Which Crohn’s Strictures Will Resist Medical Therapy?: CGH | September 2026

What Did the Study Find?

This study developed baseline MRE-based scores to predict whether Crohn’s disease strictures would improve on subsequent imaging.

The A-score incorporated bowel-wall thickness >6 mm, ulceration and the comb sign.

The P-score included stricture length >3 cm, prestenotic dilation >3 cm and absence of intramural edema.

Both scores independently predicted persistence of strictures despite medical therapy.

Combining the A- and P-scores achieved excellent discrimination, with an AUC of 0.90.

The combined score outperformed conventional segmental MRI activity indices.

Higher baseline scores were also associated with differences in surgery-free survival.

Why Does It Matter?

Repeated escalation of advanced therapy may offer limited benefit when a stricture is unlikely to reverse. Baseline MRE could help identify these patients earlier.

GastroAGI Takeaway

MRE may increasingly guide more than diagnosis—it could help determine therapeutic strategy. High-risk strictures may warrant earlier surgical discussion and closer imaging follow-up rather than repeated medical escalation. However, the score predicts stricture persistence, not simply fibrosis, and requires broader prospective external validation before routine treatment decisions are based on it.