Background Increased small bowel permeability leads to bacterial translocation, associated with significant morbidity and mortality. Biomarkers are needed to evaluate these changes in vivo, stratify an individual's risk, and evaluate the efficacy of interventions. MRI is an established biomarker of small bowel inflammation. Purpose To characterize changes in the small bowel with quantitative MRI measures associated with increased permeability induced by indomethacin. Study Type Prospective single‐center, double‐blind, two‐way crossover provocation study. Subjects A provocation cohort (22 healthy volunteers) and intrasubject reproducibility cohort (8 healthy volunteers). Field Strength/Sequence 2D balanced turbo field echo sequences to measure small bowel wall thickness, T2, and motility acquired at 3T. Assessment Participants were randomized to receive indomethacin or placebo prior to assessment. After a minimum 2‐week washout, measures were repeated with the alternative allocation. MR measures (wall thickness, T2, motility) at each study visit were compared to the reference standard 2‐hour lactulose/mannitol urinary excretion ratio (LMR) test performed by a lab technician. All analyses were performed blind. Statistical Tests Normality was tested (Shapiro–Wilk's test). Paired testing (Student's t‐test or Wilcoxon) determined the significance of paired differences with indomethacin provocation. Pearson's correlation coefficient compared significant measures with indomethacin provocation to LMR. Intrasubject (intraclass correlation) and interrater variability (Bland–Altman) were assessed. Results Indomethacin provocation induced a significant increase in LMR compared to placebo (P < 0.05) and a significant increase in small bowel T2 (0.12 seconds compared to placebo 0.07 seconds, P < 0.05). Small bowel wall thickness (P = 0.17) and motility (P = 0.149) showed no significant change. T2 and LMR were positively correlated (r = 0.68, P < 0.05). T2 measurements were robust to interobserver (intraclass correlation 0.89) and intrasubject variability (Bland–Altman bias of 0.005 seconds, 95% confidence interval [CI] –0.04 to +0.05 seconds, and 0.0006 seconds, 95% CI –0.05 to +0.06 seconds). Data Conclusion MR measures of small bowel wall T2 were significantly increased following indomethacin provocation and correlated with 2‐hour LMR test results. Level of Evidence 1 Technical Efficacy Stage 2

Inflammatory bowel disease (IBD) is a global health concern that has been on the rise in recent years. In addition, imaging is the established method of care for detecting, diagnosing, planning treatment, and monitoring the progression of IBD. While conventional imaging techniques are limited in their ability to provide comprehensive information, cross-sectional imaging plays a crucial role in the clinical management of IBD. However, accurately characterizing, detecting, and monitoring fibrosis in Crohn’s disease remains a challenging task for clinicians. Recent advances in artificial intelligence technology, machine learning, computational power, and radiomic emergence have enabled the automated evaluation of medical images to generate prognostic biomarkers and quantitative diagnostics. Radiomics analysis can be achieved via deep learning algorithms or by extracting handcrafted radiomics features. As radiomic features capture pathophysiological and biological data, these quantitative radiomic features have been shown to offer accurate and rapid non-invasive tools for IBD diagnostics, treatment response monitoring, and prognosis. For these reasons, the present review aims to provide a comprehensive review of the emerging radiomics methods in intestinal fibrosis research that are highlighted and discussed in terms of challenges and advantages.