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Review
. 2025 Jul;316(1):e243123.
doi: 10.1148/radiol.243123.

SAR Consensus Recommendations for Defining Small Bowel Crohn Disease Strictures at CT and MR Enterography

Bari Dane  1 , Jonathan R Dillman  2 , Jeff Fidler  3 , Sudha A Anupindi  4 , Clifton G Fulmer  5 , Ilyssa O Gordon  5 , David H Bruining  6 , Parakkal Deepak  7 , Abdul-Rahman Abualruz  8 , Mahmoud Al-Hawary  9 , Emre Altinmakas  10 , Flavius F Guglielmo  11 , Tracy Jaffe  12 , Jordi Rimola  13 , Dominik Bettenworth  14 , Florian Rieder  15 , Joel G Fletcher #  3 , Mark E Baker #  16
Affiliations
Review

SAR Consensus Recommendations for Defining Small Bowel Crohn Disease Strictures at CT and MR Enterography

Bari Dane et al. Radiology. 2025 Jul.

Abstract

More than half of patients with Crohn disease will develop strictures. Strictures are areas of bowel luminal narrowing composed of a combination of inflammatory cells, muscular hypertrophy, and fibrosis. Most patients with strictures eventually require endoscopic or surgical intervention. This article reviews small bowel Crohn disease stricture histopathology, current imaging definitions and challenges, and stricture management. Current imaging-based stricture definitions use different criteria and do not recognize strictures without upstream dilation nor failed endoscopic passage. This consensus was endorsed by the Society of Abdominal Radiology and developed by the Society of Abdominal Radiology Inflammatory Bowel Disease Disease Focused Panel as well as gastroenterology and pathology experts in Crohn disease strictures. Updated imaging stricture definitions and recommendations are presented. Most importantly, the panel now defines a Crohn disease small bowel stricture using a threshold small bowel dilation of 2.5 cm (rather than 3.0 cm) and incorporates failed endoscopic passage, even when there is no associated bowel dilation at CT or MR enterography. With these updated imaging stricture definitions, it is hoped that patients with Crohn disease may benefit from more timely stricture identification and management.

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Conflict of interest statement

Disclosures of conflicts of interest: B.D. Grant from Helmsley Charitable Trust; speaker honorarium from Siemens Healthineers; support for attending meetings or travel from Siemens Healthineers; member of the Olympus advisory board; co-chair Society of Abdominal Radiology (SAR) Inflammatory Bowel Disease Disease Focused Panel (IBD DFP) and SAR Photon-Counting Detector CT Emerging Technology Commission and chair of the Society for Advanced Body Imaging Scientific Committee. J.R.D. Grants from Philips Healthcare, GE HealthCare, Motilent, Perspectum, Guerbet, and Bracco. J.F. No relevant relationships. S.A.A. Co-chair of the SAR IBD DFP. C.G.F. Grants from the National Institutes of Health and National Cancer Institute. I.O.G. Grants to institution from Morphic Therapeutics, Alimentiv, Pliant Therapeutics, and UCB; patent pending with Case Western Reserve University on radiomics signatures. D.H.B. Consulting fees from Janssen. P.D. Sponsored research agreement with Johnson and Johnson, Pfizer, AbbVie, Arena Pharmaceuticals, Bristol Myers Squibb, CorEvitas, Takeda Pharmaceuticals, Prometheus Biosciences, Teva Pharmaceuticals, Merck, ExeGi Pharma, AGMB, Landos Biopharma, Tr1X, and Boehringer Ingelheim; steering committee membership for Takeda. A.R.A. No relevant relationships. M.A.H. No relevant relationships. E.A. No relevant relationships. F.F.G. No relevant relationships. T.J. No relevant relationships. J.R. Grant from AbbVie; consulting fees from Boehringer Ingelheim, Ferring, Lument, Alimentiv, and Janssen; payment for lectures from Takeda; participation on a data safety monitoring board or advisory board for Janssen and Agomab. D.B. Consulting fees from AbbVie, Alfasigma, Amgen, Arena, Atheneum, BNG Service, Bristol Myers Squibb, CED-Service, Celltrion, Doctorflix, DGVS, Diaplan, Else Kröner-Fresenius Foundation, Falk Foundation, Galapagos, Gastroenterology Today, GSK, Guidepoint, Hexal, Impulze, Ferring, Janssen Cilag, Lilly, Medical Tribune, MedTrix, MSD, Mylan, Onkowissen, Pharmacosmos, Pfizer, Roche, Sandoz, Stada, Streamed Up, Takeda, Tetrameros, Thieme, Tillotts Pharma, UCB, Viatris, and Vifor Pharma; payment for lectures from AbbVie, Alfasigma, Amgen, Arena, Atheneum, BNG Service, Bristol Myers Squibb, CED-Service, Celltrion, Doctorflix, DGVS, Diaplan, Else Kröner-Fresenius Foundation, Falk Foundation, Galapagos, Gastroenterology Today, GSK, Guidepoint, Hexal, Impulze, Ferring, Janssen Cilag, Lilly, Medical Tribune, MedTrix, MSD, Mylan, Onkowissen, Pharmacosmos, Pfizer, Roche, Sandoz, Stada, Streamed Up, Takeda, Tetrameros, Thieme, Tillotts Pharma, UCB, Viatris, and Vifor Pharma; support for meetings and/or travel from AbbVie, Amgen, Bristol Myers Squibb, CED-Service, Celltrion, Falk Foundation, Galapagos, GSK, Hexal, Ferring, Janssen Cilag, Lilly, and Takeda; participation on a data safety monitoring board or advisory board for AbbVie, Amgen, Bristol Myers Squibb, CED-Service, Celltrion, Falk Foundation, Galapagos, GSK, Hexal, Ferring, Janssen Cilag, Lilly, and Takeda. F.R. Consulting fees from Adiso, Adnovate, Agomab, Allergan, AbbVie, Arena, AstraZeneca, Bausch & Lomb, Boehringer Ingelheim, Celgene/BMS, Celltrion, CDISC, Celsius, Cowen, Eugit, Ferring, Galapagos, Galmed, Genentech, Gilead, Gossamer, Granite, Guidepoint, Helmsley, Horizon Therapeutics, Image Analysis Limited, Index Pharma, Landos, Janssen, Koutif, Mestag, Metacrine, Mirum, Mopac, Morphic, Myka Labs, Organovo, Origo, Palisade, Pfizer, Pliant, Prometheus Biosciences, Receptos, Redx, Roche, Samsung, Sanofi, Surmodics, Surrozen, Takeda, Techlab, Teva, Theravance, Thetis, Tr1x Bio, UCB, Ysios, and 89bio. J.G.F. Grant to institution from the Leona M. and Harry B. Helmsley Charitable Trust, Siemens Healthineers, Alimentiv, and Pfizer; consulting funds to institution from Alimentiv, Genentech, Boehringer Ingelheim, Glaxo Smith Kline, Janssen, Medtronic, Takeda, and Redx Pharma; grant co-investigator for Motilent. M.E.B. No relevant relationships.

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