Associations Between Quantitative MRI Metrics and Clinical Risk Scores in Children and Young Adults With Autoimmune Liver Disease

McCrary, Joseph; Trout, Andrew T.; Mahalingam, Neeraja; Singh, Ruchi; Rojas, Cyd C.; Miethke, Alexander; Dillman, Jonathan R.

doi:10.2214/ajr.21.27204

Cited by 6 publications

(6 citation statements)

References 22 publications

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“…In this study, we validate correlations between specific quantitative MRCP+ metrics and existing markers of disease severity. 32,33 Most striking, was the ability of quantitative MRCP+ to capture changes in ductal disease over time in a prospective cohort of PSC patients. Temporal changes were apparent despite liver biochemistry, elastography and standard qualitative MRCP readouts being stable.…”

Section: Discussionmentioning

confidence: 99%

“…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][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.…”

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: 99%

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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“…Magnetic resonance imaging (MRI), with its high soft-tissue resolution, is an important noninvasive modality for the diagnosis of hepatobiliary disease ( 7 ), but the MRI characteristics of bile duct adenoma have not yet been clearly defined. In the report on bile duct adenoma by Aslam et al.…”

Section: Introductionmentioning

confidence: 99%

Magnetic resonance imaging features of bile duct adenoma

Huang,

Gao

et al. 2023

Front. Oncol.

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ObjectivesTo evaluate the magnetic resonance imaging (MRI) features of bile duct adenoma.MethodsThe data of 28 patients [with 32 pathologically confirmed bile duct adenomas, including 15 with malignant change (malignant group) and 17 without malignant change (benign adenoma group)] were retrospectively reviewed. Abdominal MRI was performed for all patients; in addition, dynamic enhanced MRI was performed for 18 lesions. The MRI features, including lesion location, maximum size, morphology, signal characteristics, enhancement type, and appearance of the bile duct, were assessed by two abdominal radiologists. Apparent diffusion coefficient (ADC) values were measured and compared.ResultsOf the 32 bile duct adenomas, 22 (68.75%) involved the common bile duct (CBD). While 14/32 (43.75%) lesions presented as focal eccentric-type masses, 9/32 (28.13%) presented as plaque-like masses, 4/32 (12.50%) as bile duct casting masses, and 5/32 (15.62%) as infiltrative masses. A frond-like superficial appearance was seen in 8/32 (25%) lesions. Infiltrative masses were significantly more common in the malignant group than in the benign adenoma group (P = 0.015). While 23/32 (71.88%) lesions were isointense on T1-weighted imaging (T1WI), 24/32 (75%) were hyperintense on T2-weighted imaging (T2WI). Bile duct dilatation was present upstream of the lesion in all cases. Bile duct dilatation at the lesion was seen in 24/32 (75%) cases and downstream of the lesion in 6/32 (18.75%) cases. Of the 18 lesions that underwent dynamic enhanced MRI, 14 (77.78%) showed moderate enhancement and 13 (72.22%) showed persistent enhancement. On diffusion-weighted imaging (DWI), 27/32 (84.37%) lesions showed hyperintensity. Mean ADC value was comparable between the malignant group and the benign adenoma group (P = 0.156).ConclusionsBile duct adenoma primarily presents as intraductal growth in the CBD, usually with bile duct dilatation at the lesion site or upstream to it. Most lesions are isointense on T1WI, are hyperintense on T2WI and DWI, and show moderate enhancement. A superficial frond-like appearance of the lesion and bile duct dilatation at the lesion or downstream to it might be characteristics of bile duct adenoma. An infiltrative appearance might indicate malignant transformation.

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“…Liver magnetic resonance imaging (MRI) T1 relaxation measurements correlate with hepatic tissue aberrations that can occur in the setting of chronic liver disease, including inflammation and fibrosis 1,2 . Furthermore, these measurements as well as their interquartile range, a measure of tissue heterogeneity, have been demonstrated to be associated with meaningful clinical outcomes 3–5 …”

mentioning

confidence: 99%

“…1,2 Furthermore, these measurements as well as their interquartile range, a measure of tissue heterogeneity, have been demonstrated to be associated with meaningful clinical outcomes. [3][4][5] T1 relaxation times are commonly measured through the acquisition of a series of images, acquired at different time points during inversion recovery (IR) of longitudinal magnetization. [6][7][8][9] This approach can be challenging in some patients because of long scan times or the need for multiple consecutive breath holds.…”

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confidence: 99%

Liver T1 Relaxation Quantification Using a 3-Dimensional Interleaved Look-Locker Acquisition With T2 Preparation Pulse Sequence (3D-QALAS): Comparison With Conventional 2-Dimensional MOLLI

Gandhi

Pednekar

Wang

et al. 2022

J Comput Assist Tomogr

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Background: Changes in liver magnetic resonance imaging T1 relaxation times are associated with histologic inflammation and fibrosis.Objective: To compare liver T1 measurements obtained using a novel single-breath-hold 3-dimensional (3D) whole-liver T1 estimation method (3D-QALAS) to standard-of-care 2-dimensional (2D) modified Look-Locker (2D-MOLLI) measurements.Methods: With institutional review board approval, research magnetic resonance imaging examinations were performed in 19 participants at 1.5 T. T1 relaxometry of the liver was performed using a novel 3D whole-liver T1 estimation method (3D-QALAS) as well as a 2D modified Look-Locker (2D-MOLLI) method. The 3D method covered the entire liver in a single breath hold, whereas 2D imaging was performed at 4 anatomic levels in 4 consecutive breath holds. T1 measurements from parametric maps were obtained by a single operator, and region-of-interest area-weighted mean T1 values were calculated. Pearson correlation (r) was used to assess correlation between T1 estimation methods, and the paired t test and Bland-Altman analysis were used to compare agreement in T1 measurements. Results:In 18 participants (1 participant was excluded from analysis because of respiratory motion artifacts on 3D-QALAS images), 2D-MOLLI and 3D-QALAS mean T1 measurements were strongly correlated (r = 0.95, [95% CI: 0.87-0.98]; P < 0.0001). 2D-MOLLI T1 values were significantly longer than 3D-QALAS values (647.2 ± 87.3 milliseconds vs. 554.7 ± 75.8 milliseconds; P < 0.0001) with mean bias = 92.5 milliseconds (95% limits of agreement, 36.8, 148.2 milliseconds). Conclusion:Whole-liver T1 measurements obtained using a novel singlebreath-hold 3D T1 estimation method correlate with a standard-of-care multiple consecutive-breath-hold 2D single-slice method but demonstrate systematic bias that should be considered or corrected when used in a clinical or research setting.

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Associations Between Quantitative MRI Metrics and Clinical Risk Scores in Children and Young Adults With Autoimmune Liver Disease

Cited by 6 publications

References 22 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

Magnetic resonance imaging features of bile duct adenoma

Liver T1 Relaxation Quantification Using a 3-Dimensional Interleaved Look-Locker Acquisition With T2 Preparation Pulse Sequence (3D-QALAS): Comparison With Conventional 2-Dimensional MOLLI

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