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

Marwa F Ismail; Gideon M Hirschfield; Bettina Hansen; Monica Tafur; Khaled Y Elbanna; Marc H Goldfinger; Gerard R Ridgway; Kartik S Jhaveri

doi:10.1007/s00330-021-08142-y

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

Eur Radiol. 2022 Jan;32(1):67-77. doi: 10.1007/s00330-021-08142-y. Epub 2021 Jul 6.

Authors

Marwa F Ismail¹, Gideon M Hirschfield², Bettina Hansen¹, Monica Tafur^{3

4}, Khaled Y Elbanna³, Marc H Goldfinger⁵, Gerard R Ridgway⁵, Kartik S Jhaveri⁶

Affiliations

¹ Toronto Centre for Liver Disease, University Health Network, University of Toronto, Institute of Health Policy Management and Evaluation, Toronto, ON, Canada.
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.
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.
⁴ St. Michael's Hospital, University of Toronto, Toronto, ON, Canada.
⁵ Perspectum Ltd, Oxford, UK.
⁶ Joint Department of Medical Imaging, University Health Network, Mt. Sinai & WCH, University of Toronto, 610 University Ave, 3-957, Toronto, ON, M5G 2M9, Canada. Kartik.Jhaveri@uhn.ca.

PMID: 34231037
DOI: 10.1007/s00330-021-08142-y

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.

Keywords: Cirrhosis; Elastography; Liver; Magnetic resonance cholangiopancreatography; Strictures.

MeSH terms

Cholangiopancreatography, Magnetic Resonance
Cholangitis, Sclerosing* / diagnostic imaging
Elasticity Imaging Techniques*
Humans
Magnetic Resonance Imaging
Retrospective Studies
Risk Assessment
Risk Factors