European Radiology

, Volume 29, Issue 2, pp 1039–1047 | Cite as

The development and validation of magnetic resonance elastography for fibrosis staging in primary sclerosing cholangitis

  • Kartik S. JhaveriEmail author
  • Hooman Hosseini-Nik
  • Nima Sadoughi
  • Harry Janssen
  • Jordan J. Feld
  • Sandra Fischer
  • Ravi Menezes
  • Angela C. Cheung



To develop and internally validate MR elastography (MRE) quantified liver stiffness (LS) cut-off values for distinguishing early/moderate fibrosis from cirrhosis in primary sclerosing cholangitis (PSC) against non-invasive fibrosis test of vibration-controlled transient elastography (VCTE).


Sixty-seven patients were enrolled prospectively at a tertiary care centre to undergo MRE and VCTE. MRE-quantified LS was calculated using three region-of-interest (ROI) methods: Trace, Average and Maximum. Each ROI method was compared with the reference standard of VCTE. Internal validation was performed with bootstrapping. Univariable and multivariable linear regression determined independent predictors for MRE-quantified LS and final Mayo Risk Score (MRS).


MRE-quantified LS by Trace ROI method had the highest sensitivity [87.5%; 95% confidence interval (CI), 66.0-96.8] and specificity (96.1%; 95%CI, 89.6-99.0) for distinguishing cirrhosis; and was the strongest predictor of final MRS (β, 0.44; 95% CI, 0.27-0.61). Alkaline phosphatase twice the normal upper limit (β, 1.55; 95% CI, 0.95-2.17), abnormal bilirubin (β, 1.27; 95% CI, 0.41-2.14) and thrombocytopaenia (β, 0.79; 95% CI, 0.12-1.46) were independent predictors of LS.


MRE has a higher correlation with MRS than VCTE; and though MRE is possibly influenced by severe cholestasis and portal hypertension, MRE-quantified LS is an independent predictor of worse MRS.

Key Points

MRE is valid and reliable in assessing cirrhosis in PSC, and MRE-quantified Liver stiffness (LS) score was the strongest predictor of final Mayo Risk Score (MRS).

• Trace ROI performs best for distinguishing moderate fibrosis from cirrhosis and has the highest correlation with Mayo Risk Score (MRS).

• Cholestasis, hyperbilirubinaemia and portal hypertension may influence MRE LS score.


Magnetic resonance imaging Primary sclerosing cholangitis Elasticity imaging techniques Liver cirrhosis Bile ducts 



Autoimmune hepatitis


Alkaline phosphatase


Alanine aminotransferase


Aspartate aminotransferase-to-platelet ratio


Aspartate aminotransferase


Area under the receiver operating characteristic


Body mass index


Confidence interval




Inflammatory bowel disease


Gradient recalled echo


International normalised ratio


Interquartile range


Liver stiffness


Magnetic resonance cholangiopancreaticogram


Magnetic resonance elastography


Mayo Risk score


Sodium-model for end-stage liver disease


Primary biliary cirrhosis


Primary sclerosing cholangitis


Prothrombin time




Upper limit of normal


Vibration-controlled transient elastography



This study has received peer-reviewed research grant funding by “The Physicians Services Incorporated Foundation, Toronto, Canada".

There has been no financial support for this work to the authors that could have influenced its outcome.

Compliance with ethical standards


The scientific guarantor of this publication is Dr. Kartik Jhaveri.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Ravi Menezes kindly provided statistical advice for this manuscript. Dr. Angela Cheung, one of the co-authors, also has significant statistical expertise.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• diagnostic study

• performed at one institution


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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Kartik S. Jhaveri
    • 1
    Email author
  • Hooman Hosseini-Nik
    • 1
  • Nima Sadoughi
    • 1
  • Harry Janssen
    • 2
  • Jordan J. Feld
    • 2
  • Sandra Fischer
    • 3
  • Ravi Menezes
    • 1
  • Angela C. Cheung
    • 2
  1. 1.Joint Department of Medical ImagingUniversity of Toronto, University Health Network and Mount Sinai HospitalTorontoCanada
  2. 2.Toronto Centre for Liver DiseaseUniversity Health Network, University of TorontoTorontoCanada
  3. 3.Department of Laboratory Medicine and PathologyUniversity Health Network, University of TorontoTorontoCanada

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