Crohn's disease related strictures in cross-sectional imaging: More than meets the eye?

United European Gastroenterol J. 2022 Dec;10(10):1167-1178.doi: 10.1002/ueg2.12326. Epub 2022 Nov 3.


Joseph Sleiman 1Prathyush Chirra 2Namita S Gandhi 3Mark E Baker 4Cathy Lu 5Ilyssa O Gordon 6Satish E Viswanath 2Florian Rieder 7 8Stenosis Therapy and Anti-Fibrotic Research (STAR) Consortium


Author information

1Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.

2Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA.

3Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.

4Imaging Institute, Digestive Diseases and Surgery Institute and Cancer Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

5Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.

6Department of Pathology, Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

7Department of Gastroenterology, Hepatology & Nutrition, Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

8Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.


Strictures in Crohn's disease (CD) are a hallmark of long-standing intestinal damage, brought about by inflammatory and non-inflammatory pathways. Understanding the complex pathophysiology related to inflammatory infiltrates, extracellular matrix deposition, as well as muscular hyperplasia is crucial to produce high-quality scoring indices for assessing CD strictures. In addition, cross-sectional imaging modalities are the primary tool for diagnosis and follow-up of strictures, especially with the initiation of anti-fibrotic therapy clinical trials. This in turn requires such modalities to both diagnose strictures with high accuracy, as well as be able to delineate the impact of each histomorphologic component on the individual stricture. We discuss the current knowledge on cross-sectional imaging modalities used for stricturing CD, with an emphasis on histomorphologic correlates, novel imaging parameters which may improve segregation between inflammatory, muscular, and fibrotic stricture components, as well as a future outlook on the role of artificial intelligence in this field of gastroenterology.


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