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Diagnostics and follow-up are difficult in small bowel, that can be only partially evaluated by conventional endoscopy. Combined positron emission tomography magnetic resonance enterography (PET-MRE) has shown potential in diagnosing small bowel CD, but its role in monitoring treatment response has not been previously established. This study aimed to evaluate whether PET-MRE can be used to assess the efficacy of medical therapy. We hypothesized that standardized uptake values (SUV) in inflamed small bowel segments would decrease following initiation of standard therapy. A total of 35 volunteer patients with clinically suspected small bowel CD were recruited. All patients underwent ileocolonoscopy and laboratory testing, followed by [\n                    <jats:sup>18<\/jats:sup>\n                    F]-FDG PET-MRE. CD diagnosis was confirmed by small bowel capsule endoscopy. Clinicians initiated treatment based on standard diagnostics, blinded to the PET results. Eighteen patients completed follow-up [\n                    <jats:sup>18<\/jats:sup>\n                    F]-FDG PET-MRE at three months. Maximum SUV (SUV\n                    <jats:sub>Max<\/jats:sub>\n                    ) was measured in the small intestine and compared with MRE findings. The median SUV\n                    <jats:sub>Max<\/jats:sub>\n                    decreased significantly from baseline to follow-up (3.2 vs. 2.1,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.0025). The Simplified Magnetic Resonance Index of Activity (sMARIA) was also significantly lower at follow-up (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.001). Representatively, median fecal calprotectin declined (451\u00a0\u00b5g\/g vs. 163\u00a0\u00b5g\/g,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.004). This preliminary prospective study suggests that [\n                    <jats:sup>18<\/jats:sup>\n                    F]-FDG PET-MRE may be a useful tool for assessing biochemical response to treatment in newly diagnosed small bowel CD.\n                  <\/jats:p>\n                  <jats:p>Trial registration number: NCT06796959 (ClinicalTrials.gov). Retrospectively registered on 21.1.2025. Enrollment of first participant on 1.8.2020.<\/jats:p>","DOI":"10.1007\/s00259-025-07524-4","type":"journal-article","created":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T03:20:35Z","timestamp":1756178435000},"page":"1234-1245","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Combined [18F]-FDG PET-MR imaging for monitoring small bowel crohn\u2019s disease"],"prefix":"10.1007","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5242-927X","authenticated-orcid":false,"given":"Juho","family":"Mattila","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"Kallio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliisa","family":"L\u00f6yttyniemi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pirjo","family":"Nuutila","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jukka","family":"Koffert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,26]]},"reference":[{"key":"7524_CR1","doi-asserted-by":"publisher","first-page":"2769","DOI":"10.1016\/S0140-6736(17)32448-0","volume":"390","author":"SC Ng","year":"2017","unstructured":"Ng SC, et al. 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