Magnetic resonance enterography for predicting poor prognosis in Crohn's disease: a systematic review with meta-analysis.

Background: Magnetic resonance enterography (MRE) is a noninvasive and radiation-free option for managing Crohn's disease (CD), for which various predictors have been reported to show significant prognostic value. Objectives: The aim of this review was to summarize MRE predictors that indicated poor prognosis, including surgeries, complications, relapses, therapeutic escalations, and persistent pathological changes in patients with CD. Design: Systematic review with meta-analysis. Data sources and methods: Web of Science and PubMed were systematically searched for articles exploring the predictive performance of MRE in patients with luminal CD, with the latest search performed on July 21, 2025. Pooled analyses of odds ratios (OR) and hazard ratios for predicting poor prognosis were conducted using a random-effects model when available. Results: Thirty articles were included in this study. Meta-analysis identified five significant MRE predictors for predicting CD poor prognosis over 12 months, including inflammation (OR 3.40, 95% confidence interval (CI 1.96-5.89)), bowel wall thickening (OR 2.88, 95% CI (1.95-4.25)), strictures (OR 4.95, 95% CI (1.99-12.34)), edema (OR 2.67, 95% CI (1.25-5.69)), and fistula (OR 5.15, 95% CI (2.72-9.76)). Furthermore, scoring systems, such as the Magnetic Resonance Index of Activity (MaRIA) and Clermont scores, showed significant predictive values. Conclusion: MRE is effective in predicting the prognosis of patients with CD, with significant predictors including inflammation, bowel wall thickening, strictures, edema, fistula, and MaRIA score. Trial registration: The study protocol was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42022365965).