Imaging monitoring contributes to the “treat-to-target” strategy in the management of Crohn’s disease

Crohn's disease (CD) manifests as a chronic inflammatory condition of the gastrointestinal tract, featuring progressive and destructive full-thickness intestinal lesions that frequently result in irreversible structural damage. In recent decades, the treatment target for patients with CD has evolved from controlling symptoms to achieving sustained deep remission. While ileocolonoscopy remains the reference standard for the diagnosis and assessment of mucosal healing, cross-sectional imaging techniques, including magnetic resonance enterography, computed tomography enterography, and bowel ultrasound, provide comprehensive visualization of the small bowel, enabling evaluation of transmural inflammation and extraintestinal manifestations. Compared with endoscopic mucosal healing alone, transmural healing, assessed <i>via</i> these imaging modalities, is associated with superior long-term outcomes and has emerged as a pivotal treatment target in CD. Additionally, radiomics analysis based on cross-sectional imaging data offers a promising approach for capturing hidden biological signatures of disease phenotypes. This approach can be used to enhance diagnostic performance, monitor disease activity, and predict prognosis, ultimately facilitating more personalized medicine for CD patients.