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The emphasis of treatment in Crohn's disease has evolved from a reactive model to "treat-to-target" approaches. Cross-sectional imaging has rapidly evolved in parallel, with a growing evidence base supporting its abilities for diagnosis, monitoring and prognostication. Whilst there are differences in emphasis between Europe and North America, particularly around the type of imaging modalities and patterns of multidisciplinary care, there is increasing convergence. This perspective piece provides an overview of the evolving role of cross-sectional imaging in Crohn's disease, discusses practice differences between North America and Europe and provides suggestions on areas for future collaboration and research priorities.