Quantitative magnetic resonance cholangiopancreatography metrics are associated with disease severity and outcomes in people with primary sclerosing cholangitis

Abstract

Background & aims: People with primary sclerosing cholangitis (PSC) have a variable and often progressive disease course that is associated with biliary and parenchymal changes. These changes are typically assessed by magnetic resonance imaging (MRI), including qualitative assessment of magnetic resonance cholangiopancreatography (MRCP). Our aim was to study the association of novel objective quantitative MRCP metrics with prognostic scores and patient outcomes.

Methods: We performed a retrospective study including 77 individuals with large-duct PSC with baseline MRCP images, which were postprocessed to obtain quantitative measures of bile ducts using MRCP+™. The participants' ANALI scores, liver stiffness by vibration-controlled transient elastography, and biochemical indices were collected at baseline. Adverse outcome-free survival was measured as the absence of decompensated cirrhosis, liver transplantation (LT), or liver-related death over a 12-year period. The prognostic value of MRCP+-derived metrics was assessed by Cox regression modelling.

Results: During a total of 386 patients-years, 16 cases of decompensation, 2 LTs, and 5 liver-related deaths were recorded. At baseline, around 50% of the patients were classified as being at risk of developing disease complications. MRCP+ metrics, particularly those describing the severity of bile duct dilatations, were correlated with all prognostic factors. Univariate analysis showed that MRCP+ metrics representing duct diameter, dilatations, and the percentage of ducts with strictures and/or dilatations were associated with survival. In a multivariable-adjusted analysis, the median duct diameter was significantly associated with survival (hazard ratio 10.9, 95% CI 1.3-90.3).

Conclusions: MRCP+ metrics in people with PSC correlate with biochemical, elastographic, and radiological prognostic scores and are predictive of adverse outcome-free survival.

Lay summary: In this study, we assessed in people with primary sclerosing cholangitis (PSC) the association of novel objective quantitative MRCP metrics automatically provided by a software tool (MRCP+) with prognostic scores and patient outcomes. We observed that MRCP+ metrics in people with PSC correlate with biochemical, elastographic, and radiological prognostic scores and are predictive of adverse outcome-free survival.

Keywords: 3D, 3-dimensional; Cholestasis; ERCP, endoscopic retrograde cholangiopancreatography; HR, hazard ratio; IBD, inflammatory bowel disease; IHBD, intrahepatic bile duct; LSM, liver stiffness measurement; LT, liver transplantation; Liver stiffness; MR, magnetic resonance; MRCP+; MRCP, magnetic resonance cholangiopancreatography; MRI, magnetic resonance imaging; Magnetic resonance imaging; PSC, primary sclerosing cholangitis; Prognosis; VCTE, vibration-controlled transient elastography.

Graphical abstract

Fig. 1

MRCP and MRCP+ of a 36-year-old man with intrahepatic and extrahepatic PSC. (A) Maximum intensity projection image and (B) the corresponding parametric biliary 3D-tree model generated from MRCP+, colour coded according to duct diameter. The gallbladder has been automatically segmented and its volume provided separately. The cystic and pancreatic ducts were excluded. MRCP, magnetic resonance cholangiopancreatography; PSC, primary sclerosing cholangitis.

Fig. 2

Flowchart of the study. MRI, magnetic resonance imaging; PSC, primary sclerosing cholangitis.

Fig. 3

Adverse outcome-free survival according to different MRCP+-derived biliary metrics. (A) Kaplan–Meier curves for adverse outcome-free survival according to median duct diameter, (B) percentage of duct with median range between 1 and 3 mm, (C) percentage of duct with median range between 3 and 5 mm, (D) maximum dilatation diameter, (E) maximum relative dilatation severity, and (F) percentage of ducts with abnormal length.