Abstract
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, p < 0.00001) and hospitalization (HR = 1.34, 95% CI: 1.18-1.53, p < 0.0001). Similarly, stricturing lesions were associated with an elevated risk of surgery (HR = 1.65, 95% CI: 1.39-1.96, p < 0.00001). Achieving TH was linked to lower risks of surgery (HR = 0.55, 95% CI: 0.44-0.68, p < 0.00001), hospitalization (HR = 0.54, 95% CI: 0.45-0.64, p < 0.00001), and treatment escalation (HR = 0.51, 95% CI: 0.46-0.57, p < 0.00001). Notably, TH achieved significantly greater risk reduction than MH alone, as evidenced by two direct comparative studies of these two treatment targets (HR = 0.28 and 0.26, respectively). 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.