BACKGROUND AND AIMS: Crohn's disease (CD) strictures exhibit varying levels of inflammation and chronicity. We evaluate whether intestinal ultrasound (IUS) is accurate in characterizing stricture composition. METHODS: This prospective, cross-sectional study included CD patients who underwent (IUS) prior to a small bowel segment resection. Histology in the resection specimen was assessed in location-matched tissue sections. Following a consensus session, two pathologists blindly assessed the predominant phenotype (inflammatory (IP), chronic (CP) or a mixed (MP)) in the strictures. The primary objective of the study was to find a parameter to identify strictures with IP. RESULTS: A total of 36 patients were included (IP:7 (20%), CP:16 (44%), MP:13 (36%)). Univariate analysis showed a positive association with an IP for loss of wall layer stratification (WLS) (OR:7.86, p=0.029) and higher contrast-enhanced ultrasound (CEUS) parameters. Bowel wall thickness (BWT) (5.74 vs 7.46 mm, p=0.002) was lower and colour Doppler signal (CDS) (OR:0.14, p=0.03) and loss of WLS (OR:0.14, p=0.027) were less present in CP. In multivariate analysis, loss of WLS and wash-in area under the curve at CEUS indicated an IP, whereas lower BWT and CDS</=2 indicated a CP. With these parameters, the Stricture Score Amsterdam (SSA) was constructed and demonstrated accuracy for IP (AUROC:0.88, p=0.002) and CP (AUROC:0.90, p<0.0001), respectively. Inter-observer agreement for the score was good (ICC:0.73, p<0.0001). CONCLUSION: A combination of IUS and CEUS is accurate to differentiate between inflammatory and chronic strictures in CD. The SSA needs external validation and confirmation in its potential as a diagnostic decision aid when choosing between surgical and available medical treatments.