Inter-reader agreement of interpretation of radiological course of bile duct changes between serial follow-up magnetic resonance imaging/3D magnetic resonance cholangiopancreatography of patients with primary sclerosing cholangitis

Grigoriadis, Aristeidis; Morsbach, Fabian; Voulgarakis, Nikolaos; Said, Karouk; Bergquist, Annika; Kartalis, Nikolaos

doi:10.1080/00365521.2020.1720281

Cited by 15 publications

(13 citation statements)

References 21 publications

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“…Poor agreement between readers in the evaluation of MRI of patients with PSC is well known. The results of our study are in line with two previously performed studies evaluating interreader agreement of MRI/ MRCP examinations in patients with PSC, although these studies did not specifically evaluate the parameters assessed here [8,9]. Altogether, it can be concluded that evaluation of the MRI/MRCP of patients with PSC is challenging.…”

Section: Discussionsupporting

confidence: 88%

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Assessment of prognostic value and interreader agreement of ANALI scores in patients with primary sclerosing cholangitis

Grigoriadis

Ringe

Andersson

et al. 2021

European Journal of Radiology

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ANALI-scores are two prognostic magnetic resonance imaging (MRI)-based scores developed for patients with primary sclerosing cholangitis (PSC). Our study aims to assess the interreader agreement between expert radiologists of the two ANALI-scores and of the radiological parameters they utilize, and to test the prognostic performance of the scores in our population. Method: Three radiologists evaluated MRIs of 98 PSC-patients from a prospectively collected cohort with median follow-up of 6.7 years. Each parameter of ANALI-scores was assessed, and the scores were calculated. Interreader agreement was assessed with intraclass correlation coefficient (ICC). After consensus reading was reached, the prognostic value of ANALI-scores was assessed with Cox regression, and outcome-free survival rates were evaluated with Kaplan-Meier estimates. Results: The ANALI-score without gadolinium had poor to moderate (ICC = 0.56, 95 %CI: 0.42-0.68) and with gadolinium poor (ICC = 0.30, 95 %CI: 0.16-0.44) agreement. Liver deformity (ICC = 0.28, 95 %CI: 0.13-0.44) and parenchymal enhancement heterogeneity (ICC = 0.24, 95 %CI: 0.12-0.38) had poor agreement. Portal hypertension had poor to moderate (ICC = 0.48, 95 %CI: 0.36-0.59) and dilatation of the intrahepatic ducts had moderate (ICC = 0.64, 95 %CI: 0.54-0.73) agreement. Hazard ratios for liver-related death, transplantation or cirrhosis decompensation of the ANALI-scores with and without gadolinium were 3.53 (95 %CI: 1.40-8.93) and 2.25 (95 %CI: 1.56-3.24), respectively. Outcome-free survival was better for patients with low ANALI-scores. Conclusions: The ANALI-scores show poor to moderate agreement, which challenges their usefulness in clinical practice. They are associated with clinical outcomes, confirming the value of imaging in prognosis of PSC, but need further multicenter evaluation.

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Section: Discussionsupporting

confidence: 88%

“…Although the two ANALI scores seem promising, their interreader agreement has not been evaluated to date. Interpretation of MRI examinations of patients with PSC is challenging, as shown by two recent studies [8,9]. Agreement therefore needs to be assessed before the ANALI scores can be utilized in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Assessment of prognostic value and interreader agreement of ANALI scores in patients with primary sclerosing cholangitis

Grigoriadis

Ringe

Andersson

et al. 2021

European Journal of Radiology

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“…( 7 ) Similarly, interobserver agreement for bile duct changes between two serial follow‐up MRI‐MRCP examinations was also poor, with ICC values ranging between −0.45 and 0.22. ( 30 ) It is therefore unsurprising that there is significant variability on the reported prognostic ability of biliary features in predicting clinical outcomes in PSC.…”

Section: Discussionmentioning

confidence: 99%

A Quantitative Magnetic Resonance Cholangiopancreatography Metric of Intrahepatic Biliary Dilatation Severity Detects High‐Risk Primary Sclerosing Cholangitis

et al. 2021

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Magnetic resonance imaging with magnetic resonance cholangiopancreatography (MRI‐MRCP) in primary sclerosing cholangitis (PSC) is currently based on qualitative assessment and has high interobserver variability. We investigated the utility and performance of quantitative metrics derived from a three‐dimensional biliary analysis tool in adult patients with PSC. MRI‐MRCP, blood‐based biomarkers, and FibroScan were prospectively performed in 80 participants with large‐duct PSC and 20 healthy participants. Quantitative analysis was performed using MRCP+ (Perspectum Ltd., United Kingdom), and qualitative reads were performed by radiologists. Inter‐reader agreements were compared. Patients were classified into high risk or low risk for disease progression, using Mayo risk score (MRS), Amsterdam‐Oxford model (AOM), upper limit of normal (ULN) alkaline phosphatase (ALP), disease distribution, and presence of dominant stricture. Performance of noninvasive tools was assessed using binomial logistic regressions and receiver operating characteristic curve analyses. Quantitative biliary metrics performed well to distinguish abnormal from normal bile ducts (P < 0.0001). Interobserver agreements for MRCP+ dilatation metrics (intraclass correlation coefficient, 0.90‐0.96) were superior to modified Amsterdam intrahepatic stricture severity score (κ = 0.74) and Anali score (κ = 0.38). MRCP+ intrahepatic dilatation severity showed excellent performance to classify patients into high‐risk and low‐risk groups, using predictors of disease severity as the reference (MRS, P < 0.0001; AOM, P = 0.0017; 2.2 × ULN ALP, P = 0.0007; 1.5 × ULN ALP, P = 0.0225; extrahepatic disease, P = 0.0331; dominant stricture, P = 0.0019). MRCP+ intrahepatic dilatation severity was an independent predictor of MRS >0 (odds ratio, 31.3; P = 0.035) in the multivariate analysis. Conclusion: Intrahepatic biliary dilatation severity calculated using MRCP+ is elevated in patients with high‐risk PSC and may be used as an adjunct for risk stratification in PSC. This exploratory study has provided the groundwork for examining the utility of novel quantitative biliary metrics in multicenter studies.

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“…In this study, the same MRC scanner was used for all cases and negative controls, although some of the positive controls were imaged at an earlier date. The overall quality of MRCs was high, with only 1 of 174 MRC scans needing to be repeated 24 …”

Section: Discussionmentioning

confidence: 99%

“…The overall quality of MRCs was high, with only 1 of 174 MRC scans needing to be repeated. 24 Patients with classical PSC-UC are at a four-fold greater risk of developing CRD or CRC than those with UC alone. 35,36 Because of the increased CRC risk, patients with PSC-UC are enrolled in surveillance programs with annual colonoscopy and biopsies from the time of diagnosis of PSC.…”

Section: Ta B L Ementioning

confidence: 99%

Prevalence and long‐term outcome of sub‐clinical primary sclerosing cholangitis in patients with ulcerative colitis

Culver

Bungay

Betts

et al. 2020

Liver International

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Inter-reader agreement of interpretation of radiological course of bile duct changes between serial follow-up magnetic resonance imaging/3D magnetic resonance cholangiopancreatography of patients with primary sclerosing cholangitis

Abstract: Kartalis (2020) Inter-reader agreement of interpretation of radiological course of bile duct changes between serial follow-up magnetic resonance imaging/3D magnetic resonance cholangiopancreatography of patients with primary sclerosing cholangitis, Scandinavian

Cited by 15 publications

References 21 publications

Assessment of prognostic value and interreader agreement of ANALI scores in patients with primary sclerosing cholangitis

Assessment of prognostic value and interreader agreement of ANALI scores in patients with primary sclerosing cholangitis

A Quantitative Magnetic Resonance Cholangiopancreatography Metric of Intrahepatic Biliary Dilatation Severity Detects High‐Risk Primary Sclerosing Cholangitis

Prevalence and long‐term outcome of sub‐clinical primary sclerosing cholangitis in patients with ulcerative colitis

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