A composite score using quantitative magnetic resonance cholangiopancreatography predicts clinical outcomes in primary sclerosing cholangitis

Vuppalanchi, Raj; Are, Vijay S.; Telford, Alison; Young, Liam A J; Mouchti, Sofia; Ferreira, Carlos; Kettler, Carla; Gromski, Mark A.; Akisik, Fatih; Chalasani, Naga

doi:10.1016/j.jhepr.2023.100834

Cited by 7 publications

(2 citation statements)

References 33 publications

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“…32,33 Additionally, several retrospective studies have reported the prognostic value of quantitative biliary metrics at a single timepoint to predict transplant-free survival or decompensation. [39][40][41] The data presented herein provides added value, as the first prospective investigation shows an increase in the total number of strictures over time despite stability in other disease parameters. Furthermore, quantitative MRCP+ was able to discriminate PSC from healthy controls and other immunemediated liver diseases, highlighting its potential as an adjunctive diagnostic tool.…”

Section: Discussionmentioning

confidence: 77%

“…Previous retrospective analyses using quantitative MRCP+ have highlighted intrahepatic dilatation as a key discriminatory metric of high‐risk versus low‐risk PSC, 28 and provided correlation between biliary metrics and the Mayo Risk Score, magnetic resonance elastography, Modified Amsterdam Cholangiographic Score, the Amsterdam Oxford PSC Score, the paediatric PSC SCOPE Index and the PSC Risk Estimate Tool (PRESTO) 32,33 . Additionally, several retrospective studies have reported the prognostic value of quantitative biliary metrics at a single timepoint to predict transplant‐free survival or decompensation 39–41 . The data presented herein provides added value, as the first prospective investigation shows an increase in the total number of strictures over time despite stability in other disease parameters.…”

Section: Discussionmentioning

confidence: 99%

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Quantitative MRCP and metrics of bile duct disease over time in patients with primary sclerosing cholangitis: A prospective study

Trivedi,

Arndtz,

Abbas

et al. 2024

Aliment Pharmacol Ther

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SummaryBackgroundImaging markers of biliary disease in primary sclerosing cholangitis (PSC) have potential for use in clinical and trial disease monitoring. Herein, we evaluate how quantitative magnetic resonance cholangiopancreatography (MRCP) metrics change over time, as per the natural history of disease.MethodsIndividuals with PSC were prospectively scanned using non‐contrast MRCP. Quantitative metrics were calculated using MRCP+ post‐processing software to assess duct diameters and dilated and strictured regions. Additionally, a hepatopancreatobiliary radiologist (blinded to clinical details, biochemistry and quantitative biliary metrics) reported each scan, including ductal disease assessment according to the modified Amsterdam Cholangiographic Score (MAS).ResultsAt baseline, 14 quantitative MRCP+ metrics were found to be significantly different in patients with PSC (N = 55) compared to those with primary biliary cholangitis (N = 55), autoimmune hepatitis (N = 57) and healthy controls (N = 18). In PSC specifically, baseline metrics quantifying the number of strictures and the number and length of bile ducts correlated with the MAS, transient elastography and serum ALP values (p < 0.01 for all correlations). Over a median 371‐day follow‐up (range: 364–462), 29 patients with PSC underwent repeat MRCP, of whom 15 exhibited quantitative changes in MRCP+ metrics. Compared to baseline, quantitative MRCP+ identified an increasing number of strictures over time (p < 0.05). Comparatively, no significant differences in biochemistry, elastography or the MAS were observed between timepoints. Quantitative MRCP+ metrics remained stable in non‐PSC liver disease.ConclusionQuantitative MRCP+ identifies changes in ductal disease over time in PSC, despite stability in biochemistry, liver stiffness and radiologist‐derived cholangiographic assessment (trial registration: ISRCTN39463479).

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Quantitative MRCP and metrics of bile duct disease over time in patients with primary sclerosing cholangitis: A prospective study

Trivedi,

Arndtz,

Abbas

et al. 2024

Aliment Pharmacol Ther

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Risk Stratification in Primary Sclerosing Cholangitis: Does Size Matter?

Hussain,

Trivedi

2024

Dig Dis Sci

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Medical treatment of primary sclerosing cholangitis: What have we learned and where are we going?

Karlsen,

Kaasen Jørgensen,

Bergquist

2024

Hepatology

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It has proven difficult to establish robust evidence for significant clinical benefits of medical treatment in primary sclerosing cholangitis (PSC). For ursodeoxycholic acid, clinical practice guidelines only offer vague recommendations, leading to a situation of variable prescription rates depending on local reimbursement policies and physician preference. The difficulty in drug development in PSC is partly related to poor understanding of critical disease processes with failure to identify relevant mechanisms of action of putative drugs. The variable disease course, both intra-individually and between individuals, and lack of robust definitions of what success looks like for clinical trials in PSC have also contributed to the negative outcomes of trials performed. In this review article we will discuss these uncertainties and challenges, building on key previous and ongoing clinical trials. Despite the lack of consensus for an ideal phase II and phase III study design, several trials for diverse compounds are currently ongoing, indicating a shift from therapeutic nihilism towards hope for people with PSC. While waiting for robust efficacy data for drugs currently being tested, the current lack of effective interventions should not motivate prescription of compounds to people with PSC based on low-quality evidence.

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A composite score using quantitative magnetic resonance cholangiopancreatography predicts clinical outcomes in primary sclerosing cholangitis

Cited by 7 publications

References 33 publications

Quantitative MRCP and metrics of bile duct disease over time in patients with primary sclerosing cholangitis: A prospective study

Quantitative MRCP and metrics of bile duct disease over time in patients with primary sclerosing cholangitis: A prospective study

Risk Stratification in Primary Sclerosing Cholangitis: Does Size Matter?

Medical treatment of primary sclerosing cholangitis: What have we learned and where are we going?

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