PURPOSE To assess the diagnostic performance of magnetic resonance imaging (MRI) compared to blood tests and clinical scoring systems for the evaluation of histopathologic severity in patients with primary sclerosing cholangitis (PSC). MATERIALS Fifty-one patients (M/F 37/14, mean age 41 years) with PSC who underwent MRI and liver histopathology were included in this IRB-approved retrospective study. Two radiologists independently graded the severity of biliary abnormalities on magnetic resonance cholangiopancreatography (MRCP) using a standardized scoring system, parenchymal enhancement, and diffusion-weighted imaging (DWI) signal. Liver function tests, Mayo Risk score, APRI, FIB-4 Index, MELD, and Child-Pugh scores were recorded. Histopathology was assessed using a modified Nakanuma's scoring system. Correlation and diagnostic performance of MRI scores and blood tests for assessment of PSC histopathologic disease severity were evaluated. RESULTS Findings of cirrhosis and portal hypertension were the only imaging features diagnostic of advanced PSC (stages 3 and 4) with AUC up to 0.90 (p < 0.001) for both observers. Parenchymal enhancement and overall qualitative biliary ductal abnormality identified advanced PSC stage with AUC up to 0.767 (p = 0.002) only for one observer. There was weak correlation between the overall qualitative biliary ductal abnormality on MRCP and histopathologic stage (r = 0.36, p = 0.01) for one observer. FIB-4 index, Child-Pugh, MELD, Mayo Risk, APRI, and alkaline phosphatase demonstrated good to excellent performance for advanced PSC stage (AUCs 0.672-0.915, p < 0.045). CONCLUSIONS MRI findings of cirrhosis/portal hypertension, blood tests, and clinical scoring systems had high performance for advanced histopathologic PSC stage diagnosis, while the severity of biliary abnormalities on MRI did not.

中文翻译：

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原发性硬化性胆管炎：与血液检查和临床评分系统相比，MRI的诊断性能可评估疾病的组织病理学严重程度。

目的评估磁共振成像（MRI）与血液检查和临床评分系统的诊断性能，以评估原发性硬化性胆管炎（PSC）患者的组织病理学严重程度。材料该IRB批准的回顾性研究纳入了51例行MRI和肝组织病理学检查的PSC患者（男/女37/14，平均年龄41岁）。两名放射科医生使用标准化评分系统，实质增强和弥散加权成像（DWI）信号，对磁共振胆胰管造影（MRCP）胆道异常的严重程度进行了独立分级。记录肝功能测试，梅奥风险评分，APRI，FIB-4指数，MELD和Child-Pugh评分。使用改良的Nakanuma评分系统评估组织病理学。评估了MRI评分和血液检查以评估PSC组织病理学疾病严重程度的相关性和诊断性能。结果肝硬化和门静脉高压症的发现是两位观察者诊断为AUC高达0.90（p <0.001）的晚期PSC（3和4期）的唯一影像学特征。实质性增强和胆总管总体定性异常仅对一名观察者为PSC晚期，AUC高达0.767（p = 0.002）。一名观察者的MRCP总体定性胆管异常与组织病理学分期之间的相关性较弱（r = 0.36，p = 0.01）。FIB-4指数，Child-Pugh，MELD，Mayo Risk，APRI和碱性磷酸酶在晚期PSC阶段表现出良好的良好表现（AUC为0.672-0.915，p <0.045）。