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Interobserver agreement and prognostic value of image-based scoring systems in patients with primary sclerosing cholangitis

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Background

Primary sclerosing cholangitis (PSC) is a cholestatic liver disease that progresses to cirrhosis and liver failure. The Anali and Amsterdam scores are based upon imaging features on MRI and ERCP, respectively.

Aims

We aimed to compare the interobserver variability and performances of these scores.

Methods

Patients with PSC with at least 1 MRCP were included. Images were independently scored by 2 experts. Agreement and prognostic performance with a primary end point of hepatic decompensation was assessed.

Results

Fifty-nine patients were included (67.8% male, 86.4% IBD). Interobserver agreement for the Anali and Amsterdam scores were moderate (k = 0.49; 95% CI 0.35–0.64 and k = 0.43; 95% CI 0.30–0.56, respectively). Among the Anali components, dysmorphy (caudate/right lobe ratio > 0.9) had fair agreement (k = 0.37; 95% CI 0.14–0.60) and portal hypertension (k = 0.64, 95% CI 0.32–0.89) and intrahepatic dilation (k = 0.70; 95% CI 0.53–0.87) had substantial agreement. The Amsterdam extrahepatic and intrahepatic scores had fair agreement (k = 0.38; 95% CI 0.23–0.52) and moderate agreement (k = 0.50; 95% CI 0.34–0.67), respectively. Anali score (HR 5.90, 95% CI 1.64–21.21), total bilirubin (HR = 3.23; 95% Cl 1.06–9.91), and age (HR = 1.05; 95% CI 1.00–1.11) were independent predictors of hepatic decompensation. Mayo risk score and Anali score had good discriminative ability with c-statistics of 0.78 (CI 0.59–0.96) and 0.76 (CI 0.56–0.91). Anali score remained an independent predictor after adjusting for Mayo risk score.

Conclusion

Anali score adds additional predictive value for hepatic decompensation in patients with PSC.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, Sacramento, USA

    Erick Cruz Grave, Joseph Zepeda, Harjot K. Bath, Sandeep Dhaliwal, Maryam Yazdanfar & Christopher L. Bowlus

  2. Department of Radiology, University of California Davis School of Medicine, Sacramento, USA

    Thomas Loehfelm & Michael T. Corwin

  3. Division of Gastroenterology and Hepatology, University of California Davis School of Medicine, 4150 V Street, Suite 3500, Sacramento, CA, 95817, USA

    Christopher L. Bowlus

Authors
  1. Erick Cruz Grave
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  2. Thomas Loehfelm
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  3. Michael T. Corwin
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  4. Joseph Zepeda
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  5. Harjot K. Bath
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  6. Sandeep Dhaliwal
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  7. Maryam Yazdanfar
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  8. Christopher L. Bowlus
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Correspondence to Christopher L. Bowlus.

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Conflict of interest

CLB has received grants from Boston Scientific, Calliditas Therapeutics, Cara Therapeutics, ChemoMab, COUR Pharmaceuticals, Cymabay Therapeutics, Gilead Sciences, GSK Pharmaceuticals, Hanmi Pharmaceuticals, Intercept Pharmaceuticals, Ipsen Bioscience, Mirum Pharmaceuticals, Novo Nordisk, Pliant Therapeutics, and Viking Therapeutics. CLB has been an advisor for Cymabay Therapeutics, GSK Pharmaceuticals, Invea Therapeutics, and Ipsen Bioscience. MTC is a consultant for Corcept Therapeutics.

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Grave, E.C., Loehfelm, T., Corwin, M.T. et al. Interobserver agreement and prognostic value of image-based scoring systems in patients with primary sclerosing cholangitis. Abdom Radiol 49, 60–68 (2024). https://doi.org/10.1007/s00261-023-04051-4

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  • DOI: https://doi.org/10.1007/s00261-023-04051-4

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