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

  • Hepatobiliary-Pancreas
  • Published:
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Abstract

Objectives

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).

Methods

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).

Results

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.

Conclusions

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.

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Abbreviations

AIH:

Autoimmune hepatitis

ALP:

Alkaline phosphatase

ALT:

Alanine aminotransferase

APRI:

Aspartate aminotransferase-to-platelet ratio

AST:

Aspartate aminotransferase

AUROC:

Area under the receiver operating characteristic

BMI:

Body mass index

CI:

Confidence interval

GGT:

Gamma-glutamyltransferase

IBD:

Inflammatory bowel disease

GRE:

Gradient recalled echo

INR:

International normalised ratio

IQR:

Interquartile range

LS:

Liver stiffness

MRCP:

Magnetic resonance cholangiopancreaticogram

MRE:

Magnetic resonance elastography

MRS:

Mayo Risk score

Na-MELD:

Sodium-model for end-stage liver disease

PBC:

Primary biliary cirrhosis

PSC:

Primary sclerosing cholangitis

PT:

Prothrombin time

ROI:

Region-of-interest

ULN:

Upper limit of normal

VCTE:

Vibration-controlled transient elastography

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Funding

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.

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Authors and Affiliations

  1. Joint Department of Medical Imaging, University of Toronto, University Health Network and Mount Sinai Hospital, 610 University Ave, 3-957, Toronto, Ontario, M5G 2M9, Canada

    Kartik S. Jhaveri, Hooman Hosseini-Nik, Nima Sadoughi & Ravi Menezes

  2. Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Harry Janssen, Jordan J. Feld & Angela C. Cheung

  3. Department of Laboratory Medicine and Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada

    Sandra Fischer

Authors
  1. Kartik S. Jhaveri
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  2. Hooman Hosseini-Nik
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  3. Nima Sadoughi
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  4. Harry Janssen
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  5. Jordan J. Feld
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  6. Sandra Fischer
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  7. Ravi Menezes
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  8. Angela C. Cheung
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Corresponding author

Correspondence to Kartik S. Jhaveri.

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Guarantor

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.

Methodology

• prospective

• diagnostic study

• performed at one institution

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Jhaveri, K.S., Hosseini-Nik, H., Sadoughi, N. et al. The development and validation of magnetic resonance elastography for fibrosis staging in primary sclerosing cholangitis. Eur Radiol 29, 1039–1047 (2019). https://doi.org/10.1007/s00330-018-5619-4

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  • DOI: https://doi.org/10.1007/s00330-018-5619-4

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