Abstract
Objectives
To study the association of MRCP+ parameters with biochemical scoring systems and MR elastography (MRE) in primary sclerosing cholangitis (PSC). To evaluate the incremental value of combining MRCP+ with morphological scores in associating with biochemical scores.
Methods and materials
MRI images, liver stiffness measurements by MRE, and biochemical testing of 65 patients with PSC that were retrospectively enrolled between January 2014 and December 2015 were obtained. MRCP+ was used to post-process MRCP images to obtain quantitative measurements of the bile ducts and biliary tree. Linear regression analysis was used to test the associations. Bootstrapping was used as a validation method.
Results
The total number of segmental strictures had the strongest association with Mayo Risk Score (R2 = 0.14), minimum stricture diameter had the highest association with Amsterdam Oxford Prognostic Index (R2 = 0.12), and the percentage of duct nodes with width 0–3 mm had the strongest association with PSC Risk Estimate Tool (R2 = 0.09). The presence of Ducts with medians > 9 mm had the highest association with MRE (R2= 0.21). The strength of association of MRCP+ to Mayo Risk Score was similar to ANALI2 and weaker than MRE (R2 = 0.23, 0.24, 0.38 respectively). MRCP+ enhanced the association of ANALI 2 and MRE with the Mayo Risk Score.
Conclusions
MRCP+ demonstrated a significant association with biochemical scores and MRE. The association of MRCP+ with the biochemical scores was generally comparable to ANALI scores. MRCP+ enhanced the association of ANALI2 and MRE with the Mayo Risk Score.
Key Points
• MRCP+ has the potential to act as a risk stratfier in PSC.
• MRE outperformed MRCP+ for risk stratifcation.
• Combination of MRCP+ with MRE and ANALI scores improved overall performace as risk stratifiers.
Similar content being viewed by others
Abbreviations
- 2D GRE:
-
Two-dimensional Gradient Refocused Echo
- AOPI:
-
Amsterdam-Oxford Prognostic Index
- CI:
-
Confidence interval
- ERCP :
-
Endoscopic retrograde cholangiopancreatography
- IBD:
-
Inflammatory bowel disease
- LSM :
-
Liver stiffness measurements
- MRCP:
-
Magnetic resonance cholangiopancreatography
- MRE :
-
Magnetic resonance elastography
- MRI :
-
Magnetic resonance imaging
- MRS:
-
Mayo Risk Score
- PREsT :
-
PSC Risk Estimate tool
- PSC :
-
Primary sclerosing cholangitis
- VIF:
-
Variance inflation factor
References
Hirschfield GM, Karlsen TH, Lindor KD, Adams DH (2013) Primary sclerosing cholangitis. Lancet 382(9904):1587–1599
Karlsen TH, Folseraas T, Thorburn D, Vesterhus M (2017) Primary sclerosing cholangitis – a comprehensive review. J Hepatol 67(6):1298–1323
Tabibian JH, Ali AH, Lindor KD (2018) Primary sclerosing cholangitis, part 2: Cancer risk, prevention, and surveillance. Gastroenterol Hepatol 14(7):427–432
Chapman R, Fevery J, Kalloo A et al (2010) Diagnosis and management of primary sclerosing cholangitis. Hepatology 51(2):660–678
Schramm C, Eaton J, Ringe KI, Venkatesh S, Yamamura J (2017) Recommendations on the use of magnetic resonance imaging in PSC-A position statement from the International PSC Study Group. Hepatology 66(5):1675–1688
Selvaraj EA, Culver EL, Bungay H, Bailey A, Chapman RW, Pavlides M (2019) Evolving role of Magnetic resonance techniques in primary sclerosing cholangitis. World J Gastroenterol 25(6):644–658
de Vries EMG, de Krijger M, Färkkilä M et al (2017) Validation of the prognostic value of histologic scoring systems in primary sclerosing cholangitis: an international cohort study. Hepatology 65(3):907–919
Ruiz A, Lemoinne S, Carrat F, Corpechot C, Chazouillères O, Arrivé L (2014) Radiologic course of primary sclerosing cholangitis: assessment by three-dimensional magnetic resonance cholangiography and predictive features of progression. Hepatology 59(1):242–250
Lemoinne S, Cazzagon N, El Mouhadi S et al (2019) Simple magnetic resonance scores associate with outcomes of patients with primary sclerosing cholangitis. Clin Gastroenterol Hepatol 17(13):2785–2792.e3
Cazzagon N, Lemoinne S, El Mouhadi S et al (2019) The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis. Am J Gastroenterol 114(12):1878–1885
Goldfinger MH, Ridgway GR, Ferreira C et al (2020) Quantitative MRCP imaging: accuracy, repeatability, reproducibility, and cohort-derived normative ranges. J Magn Reson Imaging 52(3):807–820
Lam S, Singh R, Dillman JR et al (2020) Serum matrix metalloproteinase 7 is a diagnostic biomarker of biliary injury and fibrosis in pediatric autoimmune liver disease. Hepatol Commun 24;4(11):1680–1693
Kim WR, Therneau TM, Wiesner RH et al (2000) A revised natural history model for primary sclerosing cholangitis. Mayo Clin Proc 75(7):688–694
De Vries EM, Wang J, Williamson KD et al (2018) A novel prognostic model for transplant-free survival in primary sclerosing cholangitis. Gut 67(10):1864–1869
PRESTO https://rtools.mayo.edu/PRESTO_calculator/. Accessed March 22, 2021.
Eaton JE, Vesterhus M, McCauley BM et al (2020) Primary Sclerosing Cholangitis Risk Estimate Tool (PREsTo) predicts outcomes of the disease: a derivation and validation study using machine learning. Hepatology 71(1):214–224
R: The R Project for Statistical Computing. https://www.r-project.org/. Accessed March 22, 2021.
Drummond GB, Vowler SL (2012) Categorized or continuous? Strength of an association - and linear regression. J Physiol 590(9):2061–2064
Lee DH, Lee JM, Yoon JH et al (2018) Liver stiffness measured by two-dimensional shear-wave elastography: prognostic value after radiofrequency ablation for hepatocellular carcinoma. Liver Cancer 7(1):65–75
Tafur M, Cheung A, Menezes RJ et al (2020) Risk stratification in primary sclerosing cholangitis: comparison of biliary stricture severity on MRCP versus liver stiffness by MR elastography and vibration-controlled transient elastography. Eur Radiol 30(7):3735–3747
Zenouzi R, Liwinski T, Yamamura J et al (2018) Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis: challenging for experts to interpret. Aliment Pharmacol Ther 48(2):169–178
Grigoriadis A, Morsbach F, Voulgarakis N, Said K, Bergquist A, Kartalis N (2020) Inter-reader agreement of interpretation of radiological course of bile duct changes between serial follow-up magnetic resonance imaging/3D magnetic resonance cholangiopancreatography of patients with primary sclerosing cholangitis. Scand J Gastroenterol 55(2):228–235
Funding
The authors state that this work has not received any funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Guarantor
The scientific guarantor of this publication is Kartik Jhaveri.
Conflict of interest
The authors of this manuscript declare relationships with the following companies:
Gideon Hirschfield: has received speaker’s fees from Perspectum.
Marc H. Goldfinger: Perspectum Diagnostics Limited, UK Employee
Gerard R. Ridgway: Perspectum Diagnostics Limited, UK Employee
Statistics and biometry
Bettina Hansen kindly provided statistical advice for this manuscript.
Informed consent
Written informed consent was waived by the Institutional Review Board.
Ethical approval
Institutional Review Board approval was obtained.
Methodology
• Retrospective
• Observational
• Performed at one institution
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Ismail, M.F., Hirschfield, G.M., Hansen, B. et al. Evaluation of quantitative MRCP (MRCP+) for risk stratification of primary sclerosing cholangitis: comparison with morphological MRCP, MR elastography, and biochemical risk scores. Eur Radiol 32, 67–77 (2022). https://doi.org/10.1007/s00330-021-08142-y
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-021-08142-y