Magnetic Resonance Imaging in Primary Sclerosing Cholangitis—Current State and Future Directions

Zenouzi, Roman; Welle, Christopher L.; Venkatesh, Sudhakar K.; Schramm, Christoph; Eaton, John E.

doi:10.1055/s-0039-1687853

Cited by 19 publications

(13 citation statements)

References 111 publications

(144 reference statements)

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“…We conducted a study using MRE to evaluate the spatial heterogeneity of hepatic fibrosis as a potential new biomarker. Our results quantitatively confirm known visual impressions of experienced abdominal radiologists and pathologists 1 , 2 , 9 by demonstrating increased stiffness-based heterogeneity in PSC as compared to viral hepatitis where a rather homogenous fibrosis distribution was found. The CV of MRE-based stiffness has the potential to quantify heterogeneity in PSC-related hepatic fibrosis as a new biomarker besides global stiffness, whereas the CV of fluidity was not found to be sensitive.…”

Section: Discussionsupporting

confidence: 86%

“…Currently, there is no effective medical treatment besides liver transplantation. While magnetic resonance cholangiopancreatography allows noninvasive detection of PSC, determination of disease severity remains challenging 1 , 2 , 6 – 8 . Early efforts have been made for an MRI-based assessment of disease severity in PSC.…”

Section: Introductionmentioning

confidence: 99%

“…Based on reported visual impressions of experienced abdominal radiologists and pathologists, we hypothesize that fibrosis is heterogeneous in PSC and homogeneous in viral hepatitis 1 , 2 , 9 . To the best of our knowledge, this hypothesis has never been confirmed quantitatively by measuring viscoelastic tissue properties.…”

Section: Introductionmentioning

confidence: 99%

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Spatial heterogeneity of hepatic fibrosis in primary sclerosing cholangitis vs. viral hepatitis assessed by MR elastography

Reiter

Shahryari

Tzschätzsch

et al. 2021

Sci Rep

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Spatial heterogeneity of hepatic fibrosis in primary sclerosing cholangitis (PSC) in comparison to viral hepatitis was assessed as a potential new biomarker using MR elastography (MRE). In this proof-of-concept study, we hypothesized a rather increased heterogeneity in PSC and a rather homogeneous distribution in viral hepatitis. Forty-six consecutive subjects (PSC: n = 20, viral hepatitis: n = 26) were prospectively enrolled between July 2014 and April 2017. Subjects underwent multifrequency MRE (1.5 T) using drive frequencies of 35–60 Hz and generating shear-wave speed (SWS in m/s) maps as a surrogate of stiffness. The coefficient of variation (CV in %) was determined to quantify fibrosis heterogeneity. Mean SWS and CV were 1.70 m/s and 21% for PSC, and 1.84 m/s and 18% for viral hepatitis. Fibrosis heterogeneity was significantly increased for PSC (P = 0.04) while no difference was found for SWS of PSC and viral hepatitis (P = 0.17). Global hepatic stiffness was similar in PSC and viral hepatitis groups, but spatial heterogeneity may reveal spatial patterns of stiffness changes towards enhanced biophysics-based diagnosis by MRI.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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Spatial heterogeneity of hepatic fibrosis in primary sclerosing cholangitis vs. viral hepatitis assessed by MR elastography

Reiter

Shahryari

Tzschätzsch

et al. 2021

Sci Rep

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“…There are limitations as well, which include the study’s small size, retrospective nature (including retrospective review of liver biopsy reports), and relatively short follow‐up. While we recognize that MRCP technique may vary across centers, our technical parameters were consistent with standard protocols referenced in the literature …”

Section: Discussionmentioning

confidence: 76%

Magnetic Resonance Cholangiopancreatography Severity Predicts Disease Outcomes in Pediatric Primary Sclerosing Cholangitis: A Reliability and Validity Study

Patil¹,

Ricciuto

Alsharief³

et al. 2019

Hepatol Commun

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Magnetic resonance cholangiopancreatography (MRCP) has not been assessed as a surrogate biomarker in pediatrics.We aimed to determine the inter-rater reliability, prognostic utility, and construct validity of the modified Majoie endoscopic retrograde cholangiopancreatography classification applied to MRCP in a pediatric primary sclerosing cholangitis (PSC) cohort. This single-center, retrospective, cohort study included children with PSC undergoing diagnostic MRCP between 2008 and 2016. Six variations of the Majoie classification were examined: 1) intrahepatic duct (IHD) score, 2) extrahepatic duct (EHD) score (representing the worst intrahepatic and extrahepatic regions, respectively), 3) sum IHD-EHD score, 4) average IHD score, 5) average EHD score, and 6) sum average IHD-EHD score. Inter-rater reliability was assessed using weighted kappas and intraclass correlation coefficients (ICCs). Ability to predict time to PSC-related complications (ascites, esophageal varices, variceal bleed, liver transplant [LT], or cholangiocarcinoma) (primary outcome) and LT (secondary outcome) was assessed with Harrell's concordance statistic (c-statistic) and univariate/multivariable survival analysis. Construct validity was further assessed with Spearman correlations. Forty-five children were included (67% boys; median, 13.6 years). The inter-rater reliability of MRCP scores was substantial to excellent (kappas/ICCs, 0.78-0.82). The sum IHD-EHD score had the best predictive ability for time to PSC complication and LT (c-statistic, 0.80 and SE, 0.06; and c-statistic, 0.97 and SE, 0.01, respectively). Higher MRCP scores were independently associated with a higher rate of PSC-related complications, even after adjusting for the PSC Mayo risk score (hazard ratio, 1.74; 95% confidence interval, 1.14-2.). MRCP sum scores correlated significantly with METAVIR fibrosis stage, total bilirubin, and platelets (r = 0.42, r = 0.33, r = −0.31, respectively; P < 0.05). Conclusion: An MRCP score incorporating the worst affected intrahepatic and extrahepatic regions is reliable and predicts meaningful outcomes in pediatric PSC. Next steps include prospective validation and responsiveness assessment. (Hepatology Communications 2020;4:208-218).

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“…16 The MRI is better than CT or ultrasonography (USG) in cases of bilioenteric anastomosis stricture, benign inflammatory strictures like primary sclerosing cholangitis, and recurrent pyogenic cholangitis. [17][18][19] Q6. How does ultrasonography assist in preprocedure diagnosis?…”

Section: Other Methods Of Biliary Drainage and Their Indicationsmentioning

confidence: 99%

Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures

Madhusudhan

Valakkada

Keshava

2021

Indian J Radiol Imaging

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Percutaneous biliary interventions are among the commonly performed nonvascular radiological interventions. Most common of these interventions is the percutaneous transhepatic biliary drainage for malignant biliary obstruction. Other biliary procedures performed include percutaneous cholecystostomy, biliary stenting, drainage for bile leaks, and various procedures like balloon dilatation, stenting, and large-bore catheter drainage for bilioenteric or post-transplant anastomotic strictures. Although these procedures are being performed for ages, no standard guidelines have been formulated. This article attempts at preparing guidelines for performing various percutaneous image-guided biliary procedures along with discussion on the published evidence in this field.

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Magnetic Resonance Imaging in Primary Sclerosing Cholangitis—Current State and Future Directions

Cited by 19 publications

References 111 publications

Spatial heterogeneity of hepatic fibrosis in primary sclerosing cholangitis vs. viral hepatitis assessed by MR elastography

Spatial heterogeneity of hepatic fibrosis in primary sclerosing cholangitis vs. viral hepatitis assessed by MR elastography

Magnetic Resonance Cholangiopancreatography Severity Predicts Disease Outcomes in Pediatric Primary Sclerosing Cholangitis: A Reliability and Validity Study

Indian College of Radiology and Imaging Evidence-Based Guidelines for Percutaneous Image-Guided Biliary Procedures

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