Crohn’s Disease on CT/MR Enterography - SAR/AGA/ASCRS/SSAT Consensus Statement on Nomenclature for Reporting - Sept 20, 2016

Sep 15, 2026

Consensus material outlining standardized terminology for reporting Crohn’s disease findings on CT and MR enterography (CTE/MRE). Focuses on why uniform nomenclature is required to stage inflammation and intestinal damage, support outcome measures, and enable consistent interpretation of how imaging findings guide or alter therapy and predict results. Reviews Vienna/Montreal classification phenotypes (non-stricturing, stricturing, penetrating, and perianal disease) and discusses active inflammation alongside fibro-stenosis, including relationships between fistulae and strictures and relevant example reporting terms.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages57

Reading Time2 h 24 min

AccessFree to download

Objectives

Purpose of a common/standardized nomenclature

CTE/MRE impressions and reporting terms

Meaning and examples

Purpose of standardized nomenclature

Imaging to stage inflammation and intestinal damage

Outcome measures and standardized reporting

Vienna/Montreal classification/phenotypes

Non-stricturing/non-penetrating (B1)

Stricturing (B2)

Penetrating (B3)

Perianal (p)

Active inflammation and fibro-stenosis

Evidence of coexistence

Relationship between fistulae and strictures

Study observations and proposed rules

Montreal/Vienna vs clinical, pathologic and imaging findings

Limitations in reconciling phenotypes

Dynamic disease process considerations

Crohn’s Disease on CT/MR Enterography: SAR/AGA/ASCRS/SSAT Consensus Statement on Nomenclature for Reporting Sept 20, 2016, 8:30-8:45 AM Mark E. Baker, MD, FACR, FSAR, FSCBT/MR Professor of Radiology Cleveland Clinic Lerner College of Medicine of CWRU Staff Radiologist, Abdominal Imaging, Imaging & Digestive Disease Institutes, Cleveland Clinic CONFLICT OF INTEREST DISCLOSURE: BRACCO: Informal Consultations SIEMENS HEALTHCARE: Research Agreement Radiation Dose Assessment & Reduction in MDCT including Iterative Reconstruction (Salary Support, Hardware & Software)(Not Applicable to the Presentation) Reed P Rice, M.D. Richard H Marshak, M.D. Alec J Megibow, M.D. SAR Crohn’s Disease Focused Panel • Mahmoud Al-Hawary • Amy Hara • Sudha Anupindi • Tracy Jaffe • Mark E. Baker • Jim Huprich • Dean Maglinte • David Bruining (Gastro) • Alec Megibow • Jonathan Dillman • Seong Ho Park • Jeff Fidler • Joel Platt • JG Fletcher • Daniel Podberesky • Jordi Romola • Michael Gee • Dushant Sahani • David Grand • Jorge Soto • “Buddy” Guglielmo • Stuart Taylor Objectives • Purpose of a Common/Standardized Nomenclature • CTE/MRE Impressions of Crohn’s – Image Based Morphologic Phenotypes • Terms to Use in Dictation • Meaning of Terms • Examples • CTE/MRE Findings of & Report Template for Crohn’s Disease – Insufficient Time for Presentation – CT enterography for Crohn’s disease: optimal technique & imaging issues. Baker ME, Hara AK, Platt JF, Maglinte DDT, Fletcher JG • Abdominal Imaging 2015; 40: 938-952. Purpose of Standardized Nomenclature • Imaging is Increasingly Used to “Stage” Degree of Inflammation & Intestinal Damage – Lémann Score • Outcome Measures – If We are to Determine Whether CTE/MRE Findings Appropriately Direct &/or Alter Rx & Predict Outcomes, the Nomenclature Must be Standardized Vienna/Montreal Classification/Phenotypes • Nonstricturing/Nonpenetrating (B1) – Active Inflammatory • Stricturing (B2) – Fibrostenotic • Penetrating (B3) – Sinus Tracts – Fistulae – Abscess • Perianal (p) Active Inflammation & “Fibro”-Stenosis • Compelling Evidence that Active Inflammation &“Fibro”Stenosis Commonly Coexist – Rieder F, Zimmerman EM, Remzi FH, Sandborn WJ. Crohn’s disease complicated by strictures: a systematic review. Gut 2013; 62(7):1072-1084 • Crohn’s Disease is a Dynamic, Often Progressive Process, Which Waxes & Wanes – Imaging Identifies This Dynamic Process Relationship Between Fistulae & Strictures Vircows Arch 2000; 437: 293 • 42 Patients – Strictures in 38 – Fistulae in 27 • Stricture Present 96% • Fistulae Within (41%) or at Proximal End (56%) of Stricture J Clin Gastro 1989; 11: 193 • 236 Specimens – Fistulae in 60 • Strictures Present in 93% • Fistulae in Proximal End of Stricture-62% • Fistulae Within Stricture-31% – No Stricture in 7% Ian Lavery- “Penetrating Disease without Strictures is Rare” Reed Rice Rule- “No Stricture-No Fistula” Montreal/Vienna vs. Clinical, Pathologic & Imaging Findings • Montreal/Vienna Phenotypes Cannot Be Reconciled with: –Clinical Findings –Pathologic Findings –Imaging Findings • Does Not Account for Dynamic Disease Process

FAQs

Why is standardized nomenclature needed for CTE/MRE reporting in Crohn’s disease?

Uniform terminology is required so imaging findings can be used consistently to stage inflammation and intestinal damage, support outcome measures, and help determine whether CTE/MRE results guide or alter treatment and predict outcomes.

What are the Vienna/Montreal phenotypes discussed in the consensus?

The document covers non-stricturing/non-penetrating disease (B1), stricturing disease (B2, fibrostenotic), penetrating disease (B3, including sinus tracts, fistulae, and abscess), and perianal disease (p).

How do the document’s findings address the relationship between fistulae and strictures?

It describes evidence that active stricturing and fistulae frequently coexist, with fistulae often located within a stricture or near its proximal end, and notes statements such as “No stricture—no fistula” as a rule-based framing.

Sep 15, 2026

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