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Mesenteric and antimesenteric border subregionalization using MR enterography: advancing fibrosis evaluation in Crohn

Luyao Wu¹, Jinjiang Lin¹, Weikai Zheng¹

¹Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People's Republic of China.

European Radiology Experimental

|March 30, 2026

Abstract

Objective:

Assessment of intestinal fibrosis is an unmet need for patients with Crohn's disease (CD), but spatial heterogeneity of fibrosis may affect accuracy. We developed and validated a novel strategy based on subregionalization into mesenteric and antimesenteric borders on magnetic resonance enterography (MRE).

Materials And Methods:

We included 184 CD patients across two surgical and one follow-up cohorts. For 12 patients who underwent MRE and surgery (Cohort 1), MRE coregistration with ileal specimens was achieved for 88 sections using three-dimensional-printing and creeping fat information. Optimal multivariable MRE models for mesenteric border, antimesenteric border, and whole-circle regions were constructed referencing histological fibrosis and validated in another 21 patients (Cohort 2). The impact of this strategy on the prediction of disease progression was assessed in a retrospective follow-up cohort of 151 patients (Cohort 3).

Results:

Histological fibrosis scores were higher in mesenteric than antimesenteric regions in both surgical cohorts (p < 0.001). MRE models showed the highest diagnostic accuracy for fibrosis in the mesenteric border (area under the receiver operating characteristic curve [AUROC] 0.91), followed by the antimesenteric border (AUROC 0.84), and the whole-circle (AUROC 0.77) regions in Surgical Cohort 1. In surgical Cohort 2, MRE also showed higher efficacy in mesenteric (AUROC 0.87) than antimesenteric border (AUROC 0.77). In Cohort 3, baseline fibrosis measurements in the mesenteric border (hazard ratio [HR] 9.25) had the greatest predictive value on disease progression versus other regions (HR 0.28‒2.09).

Conclusion:

Intestinal fibrosis demonstrates spatial heterogeneity. Subregionalization into mesenteric and antimesenteric borders improves MRE diagnostic power and may aid in predicting CD progression.

Relevance Statement:

Mesenteric and antimesenteric border subregionalization on MRE advances fibrosis evaluation in CD by addressing the spatial heterogeneity of fibrosis, enabling tailored therapeutic strategies and identifying high-risk patients with disease progression.

Key Points:

Spatial heterogeneity of intestinal fibrosis in CD limits the diagnostic accuracy of conventional whole-region MRE analysis. Fibrosis is more severe in the mesenteric than the antimesenteric border, with subregional MRE analysis outperforming whole-circle analysis in fibrosis detection. Baseline mesenteric border fibrosis severity most strongly predicts CD progression, necessitating subregionalization for outcome prediction and management.

Insights

Assessing intestinal fibrosis in Crohn's disease (CD) is improved by magnetic resonance enterography (MRE) subregionalization. This novel strategy accurately identifies fibrosis severity in the mesenteric border, aiding in predicting disease progression.

Area of Science:

Gastroenterology
Radiology
Medical Imaging

Background:

Intestinal fibrosis assessment is crucial for Crohn's disease (CD) management.
Spatial heterogeneity of fibrosis complicates accurate MRE evaluation.
A novel subregionalization strategy is needed to improve diagnostic accuracy.

Purpose of the Study:

To develop and validate a novel MRE strategy for assessing intestinal fibrosis in CD.
To evaluate the diagnostic accuracy of subregional MRE analysis (mesenteric vs. antimesenteric borders).
To assess the predictive value of subregional MRE fibrosis measurements for CD progression.

Main Methods:

184 CD patients across surgical and follow-up cohorts.
MRE coregistration with ileal specimens using 3D printing.
Construction and validation of multivariable MRE models for mesenteric, antimesenteric, and whole-circle regions.
Retrospective analysis of disease progression in a follow-up cohort.

Main Results:

Histological fibrosis scores were significantly higher in mesenteric than antimesenteric regions.
MRE models demonstrated highest diagnostic accuracy for fibrosis in the mesenteric border (AUROC 0.91).
Mesenteric border fibrosis severity was the strongest predictor of CD disease progression (HR 9.25).

Conclusions:

Intestinal fibrosis in CD exhibits significant spatial heterogeneity.
Subregionalization of MRE into mesenteric and antimesenteric borders enhances fibrosis detection and diagnostic power.
This approach improves prediction of CD progression, enabling tailored management strategies.

Read full analysis

Keywords:

Crohn disease Disease progression Fibrosis Magnetic resonance imaging Printing (three-dimensional)

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