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Primary sclerosing cholangitis: diagnostic performance of MRI compared to blood tests and clinical scoring systems for the evaluation of histopathological severity of disease

  • Hepatobiliary
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Abstract

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.

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Abbreviations

ADC:

Apparent diffusion coefficient

APRI:

AST to Platelet Ratio Index

DWI:

Diffusion-weighted imaging

EHD:

Extrahepatic duct

ERC:

Endoscopic retrograde cholangiography

HASTE:

Half-Fourier acquisition single-shot turbo spin echo imaging

HBP:

Hepatobiliary phase

LAVA:

Liver acquisition with volume acceleration

LIH:

Left intrahepatic duct

LLIHD:

Left lateral intrahepatic duct

LMIHD:

Left medial intrahepatic duct

MELD:

Model for end-stage liver disease

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance imaging

PSC:

Primary sclerosing cholangitis

RAIHD:

Right anterior intrahepatic duct

ROI:

Region of interest

RIH:

Right intrahepatic duct

RPIHD:

Right posterior intrahepatic duct

SSFSE:

Single-shot fast spin echo

VIBE:

Volumetric interpolated breath-hold examination

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Author information

Author notes

  1. Christopher Song

    Present address: Department of Radiology, Weill Cornell Medical College/New York Presbyterian Hospital, 525 East 68th Street, New York, NY, 10065, USA

Authors and Affiliations

  1. Department of Diagnostic, Molecular and Interventional Radiology, BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA

    Christopher Song, Sara Lewis, Stefanie Hectors, Shingo Kihira, Octavia Bane & Bachir Taouli

  2. Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, Mount Sinai West, 1000 Tenth Avenue, New York, NY, 10019, USA

    Amita Kamath

  3. Department of Pathology, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA

    Juan Putra & Swan Thung

  4. Department of Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA

    Jawad Ahmad

  5. Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY, 10016, USA

    James Babb

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Song, C., Lewis, S., Kamath, A. et al. Primary sclerosing cholangitis: diagnostic performance of MRI compared to blood tests and clinical scoring systems for the evaluation of histopathological severity of disease. Abdom Radiol 45, 354–364 (2020). https://doi.org/10.1007/s00261-019-02366-9

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