Correlation Between Findings on MRCP and Gadolinium-Enhanced MR of the Liver and a Survival Model for Primary Sclerosing Cholangitis

Abstract

Primary sclerosing cholangitis is a chronic, progressive disease of inflammation and fibrosis of the bile ducts. The ability to predict survival is important for appropriate management and treatment decisions. The purpose of this study was to examine the relationship between specific findings on the enhanced magnetic resonance imaging (MRI) examination of the liver and the corresponding magnetic resonance cholangiopancreatogram (MRCP) and a survival model for primary sclerosing cholangitis (PSC), the Mayo Risk Score. During a five-year period, 47 patients with primary sclerosing cholangitis were identified who had a complete MRI/MRCP examination. The extent of anatomical changes of the biliary tree and the degree of peribiliary enhancement in the hepatic parenchyma were compared with the Mayo Risk Score for each patient. Peribiliary enhancement was present to a varying extent in 38 of 47 cases of PSC. Peribiliary enhancement 3 min after gadolinium administration had a weak correlation with the Mayo Risk Score (analysis of variance P<0.01, Pearson correlation r=0.37). No statistically significant relationship between the severity of extrahepatic or intrahepatic duct changes and the Mayo Risk Score was found (analysis of variance P=0.24, P=0.38, respectively). Although biliary tree changes on MRCP aid in the diagnosis of PSC, they do not correlate with survival, as predicted by the Mayo Risk Score. Peribiliary enhancement on MRI of the liver is a finding occurring to a variable extent in primary sclerosing cholangitis but does not correlate significantly with survival.

Recommendations on the use of magnetic resonance imaging in PSC‐A position statement from the International PSC Study Group

“…While in the early phases of development, several dynamic gadoxetate‐enhanced MRI studies have shown that patients with PSC have a heterogeneously distributed liver function (compared to healthy controls) with delayed hepatobiliary excretion of this contrast agent. Delayed excretion correlated with liver tests, Mayo PSC risk score, and downstream biliary obstruction . Liver stiffness, as measured by MRE, has been shown to predict hepatic decompensation in PSC and the optimal cutoff to predict cirrhosis was 4.9 kPa.…”

Biomarkers for disease progression of primary sclerosing cholangitis

“…[71,72] MRI features of PSC have been mainly described using two dimensional (2D) MRC, and have shown no correlation with disease severity measured by MRS. [73,74] Using the newer three-dimensional (3D) MRC, visibility of the biliary tree has improved. [75] Systematic analysis of bile ducts and liver parenchyma over time visualized by 3D MRC has recently been used to discriminate two radiologic PSC disease patterns; stability and worsening.…”

Association between progressive hepatic morphology changes on serial MR imaging and clinical outcome in primary sclerosing cholangitis

“…Whilst hepatic parenchymal changes are commonly seen in end‐stage PSC disease, a significant association between non‐invasive imaging findings and clinical severity has not previously been established on single time point or cross‐sectional studies . In our study, we focused on radiological progression over time which may be more reflective of disease activity.…”

“…These hepatic morphology changes have been described both as an early finding in PSC and as a feature of end‐stage PSC disease . Whilst severe biliary changes on ERCP have been shown to be associated with poor survival, previous single time point studies have not established a significant correlation between specific hepatic morphology changes and disease severity . In particular, the clinical significance of radiological progression with atrophy or hypertrophy changes has not been established.…”