Crohn’s Disease: Ongoing Challenges and Future Directions in Diagnosis and Monitoring

Dear Colleagues,

Crohn’s disease (CD) is a chronic, progressive inflammatory disorder of the gastrointestinal tract, characterized by a relapsing–remitting course and a significant risk of cumulative structural bowel damage. Inadequate or delayed diagnosis may result in the development of irreversible complications, including stricturing and penetrating disease, ultimately increasing the need for surgical intervention. Therefore, early diagnosis and continuous, accurate disease monitoring are essential to improve long-term outcomes and to guide timely therapeutic strategies based on a treat-to-target approach.

Endoscopy remains the gold standard for the diagnosis of CD and the direct assessment of mucosal inflammation. However, given the transmural and often extraintestinal nature of the disease, cross-sectional imaging techniques are essential complementary tools. Magnetic resonance enterography (MRE) plays a pivotal role in evaluating bowel wall inflammation, disease extent, and complications, while avoiding ionizing radiation. Computed tomography (CT) remains crucial in emergency settings, particularly for the assessment of acute complications such as bowel obstruction or perforation. In addition, intestinal ultrasound is increasingly recognized as a non-invasive, accessible, and repeatable tool for real-time disease monitoring.

Recent advances have highlighted the importance of integrating clinical, endoscopic, and radiological data within a multimodal monitoring strategy. In this context, radiomics has emerged as a promising and rapidly evolving field, enabling the extraction of quantitative imaging features that may improve disease characterization and prognostication. In CD, radiomics may help reduce interobserver variability, distinguish inflammatory from fibrotic changes, predict therapeutic response, and support clinical decision-making, including the need for surgery. Furthermore, it may contribute to the differential diagnosis between Crohn’s disease and ulcerative colitis.

This Special Issue aims to provide an updated overview of the latest advances in the diagnosis and monitoring of CD, with a particular focus on innovative imaging techniques and their integration into clinical practice. We invite the submission of original research articles, reviews, and expert perspectives addressing clinical, endoscopic, and radiological developments. Topics of interest include, but are not limited to, radiomics, magnetic resonance enterography, intestinal ultrasound, computed tomography, and novel approaches to personalized disease assessment and management.

Dr. Laura Maria Minordi
Dr. Lucrezia Laterza
Guest Editors

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• Crohn’s disease
• imaging
• endoscopy
• complications
• advanced therapies
• radiomic
• surgery