BackgroundEndoscopic mucosal healing is considered as the best therapeutic target in Crohn's disease (CD) as it is associated with better long-term outcomes. We investigated whether bowel wall healing (BWH) assessed using magnetic resonance imaging (MRI) could predict favorable outcomes and could be a potential therapeutic target.MethodsWe performed a post hoc analysis from two prospective studies (n=174 patients). All the patients with previous objective signs of bowel inflammation and assessed by MRI for therapeutic efficacy had a standardized and blinded evaluation, and underwent MRI. Complete BWH was defined as no segmental MaRIA>7 or no segmental Clermont score>8.4 and BWH as no segmental MaRIA>11 or no segmental Clermont score>12.5. Clinical corticosteroid-free remission (CFREM) was defined as no reappearance or worsening of clinical manifestation leading to therapeutic modification, hospitalization or CD-related surgery. Multivariate analyses were performed including all the relevant parameters.ResultsOverall, 63 patients with CD were included (mean follow-up=4.83.1 semesters). In multivariate analysis (n=303 semesters), complete BWH or BWH was associated with sustained CFREM according to MaRIA [OR=4.42 (2.29-26.54); p=0.042 and OR=3.43 (1.02-27.02); p=0.047, respectively] or Clermont score [OR=3.09 (1.01-12.91); p=0.049 and OR=3.88 (1.40-13.80); p=0.036, respectively]. In multivariate analysis (n=63 patients), complete BWH or BWH was associated with decreased risk of surgery using MaRIA [HR=0.16 (0.043-0.63); p=0.008 and HR=0.24 (0.07-0.77); p=0.017, respectively] or Clermont score [HR=0.24 (0.07-0.78); p=0.016 and HR=0.23 (0.07-0.76); p=0.016, respectively].Conclusions p id=Par4 MRI endpoints are predictive of favorable outcomes after medical therapy and could be used as therapeutic target in daily practice and clinical trials.