Magnetic Resonance Enterography Predicts Long-Term Outcomes in Crohn's Disease: A Systematic Review and Meta-Analysis.

Background and Aims: Crohn's disease (CD) is characterized by chronic transmural inflammation, which often leads to bowel damage. While mucosal healing (MH) is an established treatment target, transmural healing (TH) has emerged as a more comprehensive goal. Magnetic resonance enterography (MRE) provides excellent soft-tissue resolution for assessing TH. This meta-analysis evaluates the prognostic value of MRE in predicting surgery, hospitalization, and treatment escalation in adults with CD. Methods: A total of 16 studies involving adult CD patients with ≥ 12 months of follow-up (with a mean duration of 4.42 ± 3.90 years) were included if they incorporated pre- and posttreatment MRE, reported baseline MRE phenotypes (e.g., penetrating/stenosing lesions), and documented posttreatment TH. Hazard ratios (HRs) were used to compare associations between baseline MRE features, TH achievement, and long-term outcomes. Results: Baseline MRE-defined penetrating lesions were associated with increased risks of surgery (HR = 1.62, 95% CI: 1.37-1.91, Conclusion: MRE-identified penetrating/stenosing lesions at baseline predict higher risks of surgery and hospitalization. Conversely, TH achievement was associated with a marked reduction in adverse outcomes. Incorporating MRE into CD management facilitates early identification of high-risk patients for timely treatment intensification, thereby supporting personalized therapeutic strategies.