A 23-year-old female patient with CD. (a) Axial T2- and (b) axial postcontrast enhanced T1-weighted images at 7 min reconstructed from the coronal image show marked bowel wall thickening and luminal narrowing with hyperenhancement (ROIs 1–3, the percentage of enhancement gain between 70 s and 7 min=67%) in the ileocecum (arrows). Axial MT imaging without (c) and with (d) MT pulse and color MT ratio map (e) demonstrate the MT effect of terminal ileum (long arrows; ROIs 1–3, MT ratio=44%, yellow-red) to be similar to that of skeletal muscle (arrow head; ROIs 4–6, MT ratio=49%; yellow-red) and higher than that of the normal small bowel wall (short arrow; ROIs 7–9, MT ratio=23%; blue-yellow). The normalized MT ratio of the affected bowel wall in the ileocecum is 0.90. Hyperintensity on the axial DWI with b=800 s/mm2 (f) and hypointensity on the corresponding ADC map (g) (ROIs 1–3, ADC=0.78×10−3 mm2/s) are shown in the same segment (arrows). The macroscopic specimen (h) shows a thickened bowel wall with a gray-white cut surface in the area of stenosis (arrows). H & E (i) and Masson’s trichrome (j) staining depict moderate inflammation (score=2) and marked transmural fibrosis (blue area; score=3), respectively. (×2 magnification). (ROI, region of interest; MT, magnetization transfer; DWI, diffusion-weighted imaging; ADC, apparent diffusion coefficient; H & E, hematoxylin and eosin)