Beyond Mucosal Healing: Quantitative Transmural Phenotyping to Assess Therapeutic Response and Support Precision Treatment in Crohn’s Disease—A Narrative Review
5 affiliations
- 1Department of Medicine, Surgery and Pharmacy, University of Sassari, Viale San Pietro 43, 07100 Sassari, Italy
- 2Gastroenterology and Digestive Endoscopy Unit, Azienda Sanitaria Universitaria Integrata del Trentino (ASUIT), 38122 Trento, Italy
- 3UOC of Radiology, Ospedale Sacro Cuore di Gesù, Fatebenefratelli, 82100 Benevento, Italy
- 4Department of Life Sciences, Health, and Healthcare Professions, Link Campus University, 00100 Rome, Italy
- 5Consiglio Nazionale delle Ricerche (CNR), Institute for Biostructure and Bioimages, 80145 Naples, Italy
Abstract
Crohn’s disease (CD) is a transmural disorder in which mucosal healing may coexist with persistent mural, mesenteric, or penetrating disease. Cross-sectional imaging can therefore extend assessment beyond lesion detection toward quantitative transmural phenotyping, using imaging-derived markers to characterize inflammatory activity, structural and fibrotic burden, extramural involvement, and longitudinal treatment response. This narrative review synthesizes recent evidence on intestinal ultrasound (IUS), including contrast-enhanced ultrasound and elastography, magnetic resonance enterography (MRE), computed tomography enterography (CTE), multienergy CT, radiomics, and artificial intelligence (AI). IUS and MRE currently provide the most clinically mature approaches for serial assessment through bowel wall thickness, vascularity, composite activity indices, and measures of transmural response or healing. Conventional CTE remains important for structural and penetrating complications but is primarily morphologic and semi-quantitative. Multienergy CT introduces material-specific biomarkers, particularly iodine-based measures of inflammatory activity, whereas radiomics and AI remain largely investigational. Across modalities, persistent imaging abnormalities after treatment may provide prognostic information beyond mucosal assessment, but definitions, acquisition protocols, thresholds, and validation strategies remain heterogeneous. Quantitative transmural phenotyping may complement clinical, biochemical, endoscopic, and histological assessment, but standardization, multicenter validation, and prospective imaging-guided trials are required before routine precision-management implementation.
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BibTeX
@article{mereu2026beyond,
title = {{Beyond Mucosal Healing: Quantitative Transmural Phenotyping to Assess Therapeutic Response and Support Precision Treatment in Crohn’s Disease—A Narrative Review}},
author = {Sandro Mereu and Andrea Michielan and Giacomo Sica and Pier Paolo Mainenti and Armando Gabbrielli and Salvatore A. Masala and Mariano Scaglione and Maria Pina Dore and Elettra Merola},
journal = {Journal of Clinical Medicine},
year = {2026},
month = nov,
doi = {10.3390/jcm15218696},
url = {https://www.mdpi.com/2077-0383/15/21/8696},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Beyond Mucosal Healing: Quantitative Transmural Phenotyping to Assess Therapeutic Response and Support Precision Treatment in Crohn’s Disease—A Narrative Review
AU - Sandro Mereu
AU - Andrea Michielan
AU - Giacomo Sica
AU - Pier Paolo Mainenti
AU - Armando Gabbrielli
AU - Salvatore A. Masala
AU - Mariano Scaglione
AU - Maria Pina Dore
AU - Elettra Merola
PY - 2026
DA - 2026/11/07
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218696
UR - https://www.mdpi.com/2077-0383/15/21/8696
AB - Crohn’s disease (CD) is a transmural disorder in which mucosal healing may coexist with persistent mural, mesenteric, or penetrating disease. Cross-sectional imaging can therefore extend assessment beyond lesion detection toward quantitative transmural phenotyping, using imaging-derived markers to characterize inflammatory activity, structural and fibrotic burden, extramural involvement, and longitudinal treatment response. This narrative review synthesizes recent evidence on intestinal ultrasound (IUS), including contrast-enhanced ultrasound and elastography, magnetic resonance enterography (MRE), computed tomography enterography (CTE), multienergy CT, radiomics, and artificial intelligence (AI). IUS and MRE currently provide the most clinically mature approaches for serial assessment through bowel wall thickness, vascularity, composite activity indices, and measures of transmural response or healing. Conventional CTE remains important for structural and penetrating complications but is primarily morphologic and semi-quantitative. Multienergy CT introduces material-specific biomarkers, particularly iodine-based measures of inflammatory activity, whereas radiomics and AI remain largely investigational. Across modalities, persistent imaging abnormalities after treatment may provide prognostic information beyond mucosal assessment, but definitions, acquisition protocols, thresholds, and validation strategies remain heterogeneous. Quantitative transmural phenotyping may complement clinical, biochemical, endoscopic, and histological assessment, but standardization, multicenter validation, and prospective imaging-guided trials are required before routine precision-management implementation.
SN - 2077-0383
ER -