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Evaluation of quantitative MRCP (MRCP+) for risk stratification of primary sclerosing cholangitis: comparison with morphological MRCP, MR elastography, and biochemical risk scores



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.


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.


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.

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Two-dimensional Gradient Refocused Echo


Amsterdam-Oxford Prognostic Index


Confidence interval


Endoscopic retrograde cholangiopancreatography


Inflammatory bowel disease


Liver stiffness measurements


Magnetic resonance cholangiopancreatography


Magnetic resonance elastography


Magnetic resonance imaging


Mayo Risk Score


PSC Risk Estimate tool


Primary sclerosing cholangitis


Variance inflation factor


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Correspondence to Kartik S. Jhaveri.

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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.

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Written informed consent was waived by the Institutional Review Board.

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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).

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  • Liver
  • Magnetic resonance cholangiopancreatography
  • Elastography
  • Strictures
  • Cirrhosis