Toward eliminating missed important findings in fibrostenosing Crohn's disease at CT and MR enterography.

Crohn's disease is a transmural inflammatory bowel disease, which can progress to stricturing and internal penetrating complications. Computed tomography enterography (CTE) and magnetic resonance enterography (MRE) are utilized with endoscopy to detect and stage small bowel Crohn's disease. Small bowel strictures and associated penetrating complications are commonly missed complications of fibrostenosing Crohn's disease at CTE/MRE. This educational review focuses on factors contributing to unreported or overcalled strictures including disease location, postoperative anatomy, erroneous understanding of threshold dilation for stricture diagnosis, and underappreciation for how stricture diagnosis can improve patient care, emphasizing current understanding of Crohn's small bowel strictures using illustrative cases. In addition, we explain emerging consensus for how strictures and their associated obstruction can be consistently measured and described. We also review frequently missed complications of fibrostenosing Crohn's disease such as chronic mesenteric venous occlusion and penetrating complications, including blind-ending sinus tracts, and ileoappendiceal and complex enteroenteric fistulas. Finally, common mimics of fibrostenosing Crohn's disease including NSAID enteropathy, radiation enteritis, and other entities are discussed, highlighting key distinguishing imaging and clinical features. Radiologists must be proactive in identifying strictures to improve patient outcomes and prevent unnecessary delay in surgical intervention or access to targeted biologic therapies.