Background and aim Patients with primary sclerosing cholangitis (PSC) have a variable, and often progressive disease course which is associated with biliary and parenchymal changes. These changes are typically assessed by magnetic resonance imaging (MRI), including qualitative assessment of magnetic resonance cholangiopancreatography (MRCP). Our aim was to study the association of novel objective quantitative MRCP metrics with prognostic scores and patient outcomes. Methods We performed a retrospective study including 77 large-duct PSC patients with baseline MRCP images, which were post-processed to obtain quantitative measures of bile ducts using MRCP+™. The participants’ ANALI scores, liver stiffness by vibration controlled transient elastography and biochemical indices were collected at baseline. Adverse outcome-free survival was measured as the absence of decompensated cirrhosis, liver transplantation (LT) or liver-related death over a 12-year period.The prognostic value of MRCP+-derived metrics was assessed by Cox regression modelling. Results During a total of 386 patients-years, 16 cases of decompensation, 2 LT and 5 liver-related deaths were recorded. At baseline, around 50% of the patients were classified as being at risk of developing disease complications. MRCP+ metrics, particularly those describing the severity of bile duct dilatations, were correlated with all prognostic factors. Univariate analysis showed that MRCP+ metrics representing duct diameter, dilatations, and the percentage of ducts with strictures and/or dilatations were associated with survival. In a multivariable-adjusted analysis, the median duct diameter was significantly associated with survival (Hazard Ratio 10.9, 95% CI 1.3-90.3). Conclusion MRCP+ metrics in patients with PSC correlate with biochemical, elastographic and radiological prognostic scores and are predictive of adverse outcome-free survival.
Quantitative magnetic resonance cholangiopancreatography metrics are associated with disease severity and outcomes in patients with primary sclerosing cholangitis
Cazzagon, Nora
;
2022
Abstract
Background and aim Patients with primary sclerosing cholangitis (PSC) have a variable, and often progressive disease course which is associated with biliary and parenchymal changes. These changes are typically assessed by magnetic resonance imaging (MRI), including qualitative assessment of magnetic resonance cholangiopancreatography (MRCP). Our aim was to study the association of novel objective quantitative MRCP metrics with prognostic scores and patient outcomes. Methods We performed a retrospective study including 77 large-duct PSC patients with baseline MRCP images, which were post-processed to obtain quantitative measures of bile ducts using MRCP+™. The participants’ ANALI scores, liver stiffness by vibration controlled transient elastography and biochemical indices were collected at baseline. Adverse outcome-free survival was measured as the absence of decompensated cirrhosis, liver transplantation (LT) or liver-related death over a 12-year period.The prognostic value of MRCP+-derived metrics was assessed by Cox regression modelling. Results During a total of 386 patients-years, 16 cases of decompensation, 2 LT and 5 liver-related deaths were recorded. At baseline, around 50% of the patients were classified as being at risk of developing disease complications. MRCP+ metrics, particularly those describing the severity of bile duct dilatations, were correlated with all prognostic factors. Univariate analysis showed that MRCP+ metrics representing duct diameter, dilatations, and the percentage of ducts with strictures and/or dilatations were associated with survival. In a multivariable-adjusted analysis, the median duct diameter was significantly associated with survival (Hazard Ratio 10.9, 95% CI 1.3-90.3). Conclusion MRCP+ metrics in patients with PSC correlate with biochemical, elastographic and radiological prognostic scores and are predictive of adverse outcome-free survival.
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