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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

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.

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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

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The authors state that this work has not received any funding.

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Correspondence to Kartik S. Jhaveri.

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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.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

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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). https://doi.org/10.1007/s00330-021-08142-y

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  • DOI: https://doi.org/10.1007/s00330-021-08142-y

Keywords

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