Skip to main content

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

European Radiology volume 32, pages 67–77 (2022)Cite this article

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.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

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

References

  1. Hirschfield GM, Karlsen TH, Lindor KD, Adams DH (2013) Primary sclerosing cholangitis. Lancet 382(9904):1587–1599

    Article  Google Scholar 

  2. Karlsen TH, Folseraas T, Thorburn D, Vesterhus M (2017) Primary sclerosing cholangitis – a comprehensive review. J Hepatol 67(6):1298–1323

    Article  Google Scholar 

  3. Tabibian JH, Ali AH, Lindor KD (2018) Primary sclerosing cholangitis, part 2: Cancer risk, prevention, and surveillance. Gastroenterol Hepatol 14(7):427–432

    Google Scholar 

  4. Chapman R, Fevery J, Kalloo A et al (2010) Diagnosis and management of primary sclerosing cholangitis. Hepatology 51(2):660–678

    CAS  Article  Google Scholar 

  5. Schramm C, Eaton J, Ringe KI, Venkatesh S, Yamamura J (2017) Recommendations on the use of magnetic resonance imaging in PSC-A position statement from the International PSC Study Group. Hepatology 66(5):1675–1688

    Article  Google Scholar 

  6. Selvaraj EA, Culver EL, Bungay H, Bailey A, Chapman RW, Pavlides M (2019) Evolving role of Magnetic resonance techniques in primary sclerosing cholangitis. World J Gastroenterol 25(6):644–658

    CAS  Article  Google Scholar 

  7. de Vries EMG, de Krijger M, Färkkilä M et al (2017) Validation of the prognostic value of histologic scoring systems in primary sclerosing cholangitis: an international cohort study. Hepatology 65(3):907–919

    Article  Google Scholar 

  8. Ruiz A, Lemoinne S, Carrat F, Corpechot C, Chazouillères O, Arrivé L (2014) Radiologic course of primary sclerosing cholangitis: assessment by three-dimensional magnetic resonance cholangiography and predictive features of progression. Hepatology 59(1):242–250

    Article  Google Scholar 

  9. Lemoinne S, Cazzagon N, El Mouhadi S et al (2019) Simple magnetic resonance scores associate with outcomes of patients with primary sclerosing cholangitis. Clin Gastroenterol Hepatol 17(13):2785–2792.e3

    Article  Google Scholar 

  10. Cazzagon N, Lemoinne S, El Mouhadi S et al (2019) The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis. Am J Gastroenterol 114(12):1878–1885

    Article  Google Scholar 

  11. Goldfinger MH, Ridgway GR, Ferreira C et al (2020) Quantitative MRCP imaging: accuracy, repeatability, reproducibility, and cohort-derived normative ranges. J Magn Reson Imaging 52(3):807–820

    Article  Google Scholar 

  12. Lam S, Singh R, Dillman JR et al (2020) Serum matrix metalloproteinase 7 is a diagnostic biomarker of biliary injury and fibrosis in pediatric autoimmune liver disease. Hepatol Commun 24;4(11):1680–1693

    Article  Google Scholar 

  13. Kim WR, Therneau TM, Wiesner RH et al (2000) A revised natural history model for primary sclerosing cholangitis. Mayo Clin Proc 75(7):688–694

    CAS  Article  Google Scholar 

  14. De Vries EM, Wang J, Williamson KD et al (2018) A novel prognostic model for transplant-free survival in primary sclerosing cholangitis. Gut 67(10):1864–1869

    Article  Google Scholar 

  15. PRESTO https://rtools.mayo.edu/PRESTO_calculator/. Accessed March 22, 2021.

  16. Eaton JE, Vesterhus M, McCauley BM et al (2020) Primary Sclerosing Cholangitis Risk Estimate Tool (PREsTo) predicts outcomes of the disease: a derivation and validation study using machine learning. Hepatology 71(1):214–224

    CAS  Article  Google Scholar 

  17. R: The R Project for Statistical Computing. https://www.r-project.org/. Accessed March 22, 2021.

  18. Drummond GB, Vowler SL (2012) Categorized or continuous? Strength of an association - and linear regression. J Physiol 590(9):2061–2064

    CAS  Article  Google Scholar 

  19. Lee DH, Lee JM, Yoon JH et al (2018) Liver stiffness measured by two-dimensional shear-wave elastography: prognostic value after radiofrequency ablation for hepatocellular carcinoma. Liver Cancer 7(1):65–75

    Article  Google Scholar 

  20. Tafur M, Cheung A, Menezes RJ et al (2020) Risk stratification in primary sclerosing cholangitis: comparison of biliary stricture severity on MRCP versus liver stiffness by MR elastography and vibration-controlled transient elastography. Eur Radiol 30(7):3735–3747

    Article  Google Scholar 

  21. Zenouzi R, Liwinski T, Yamamura J et al (2018) Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis: challenging for experts to interpret. Aliment Pharmacol Ther 48(2):169–178

    CAS  Article  Google Scholar 

  22. Grigoriadis A, Morsbach F, Voulgarakis N, Said K, Bergquist A, Kartalis N (2020) Inter-reader agreement of interpretation of radiological course of bile duct changes between serial follow-up magnetic resonance imaging/3D magnetic resonance cholangiopancreatography of patients with primary sclerosing cholangitis. Scand J Gastroenterol 55(2):228–235

    CAS  Article  Google Scholar 

Download references

Funding

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

Author information

Author notes

  1. Monica Tafur

    Present address: St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada

Authors and Affiliations

  1. Toronto Centre for Liver Disease, University Health Network, University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada

    Marwa F. Ismail & Bettina Hansen

  2. Toronto Centre for Liver Disease, University Health Network, Mt. Sinai & WCH, University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada

    Gideon M. Hirschfield

  3. Joint Department of Medical Imaging, University Health Network, Mt. Sinai & WCH, University of Toronto, 610 University Ave, 3-957, Toronto, ON, M5G 2M9, Canada

    Monica Tafur, Khaled Y. Elbanna & Kartik S. Jhaveri

  4. Perspectum Ltd, Oxford, UK

    Marc H. Goldfinger & Gerard R. Ridgway

Authors
  1. Marwa F. Ismail
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gideon M. Hirschfield
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bettina Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Monica Tafur
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Khaled Y. Elbanna
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marc H. Goldfinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gerard R. Ridgway
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kartik S. Jhaveri
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kartik S. Jhaveri.

Ethics declarations

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.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Observational

• Performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

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

Keywords

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