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- Title
Diagnosis of functional strictures in patients with primary sclerosing cholangitis using hepatobiliary contrast-enhanced MRI: a proof-of-concept study.
- Authors
Poetter-Lang, Sarah; Messner, Alina; Bastati, Nina; Ringe, Kristina I.; Ronot, Maxime; Venkatesh, Sudhakar K.; Ambros, Raphael; Kristic, Antonia; Korajac, Aida; Dovjak, Gregor; Zalaudek, Martin; Hodge, Jacqueline. C.; Schramm, Christoph; Halilbasic, Emina; Trauner, Michael; Ba-Ssalamah, Ahmed
- Abstract
Objectives: PSC strictures are routinely diagnosed on T2-MRCP as dominant- (DS) or high-grade stricture (HGS). However, high inter-observer variability limits their utility. We introduce the "potential functional stricture" (PFS) on T1-weighted hepatobiliary-phase images of gadoxetic acid-enhanced MR cholangiography (T1-MRC) to assess inter-reader agreement on diagnosis, location, and prognostic value of PFS on T1-MRC vs. DS or HGS on T2-MRCP in PSC patients, using ERCP as the gold standard. Methods: Six blinded readers independently reviewed 129 MRIs to diagnose and locate stricture, if present. DS/HGS was determined on T2-MRCP. On T1-MRC, PFS was diagnosed if no GA excretion was seen in the CBD, hilum or distal RHD, or LHD. If excretion was normal, "no functional stricture" (NFS) was diagnosed. T1-MRC diagnoses (NFS = 87; PFS = 42) were correlated with ERCP, clinical scores, labs, splenic volume, and clinical events. Statistical analyses included Kaplan–Meier curves and Cox regression. Results: Interobserver agreement was almost perfect for NFS vs. PFS diagnosis, but fair to moderate for DS and HGS. Forty-four ERCPs in 129 patients (34.1%) were performed, 39 in PFS (92.9%), and, due to clinical suspicion, five in NFS (5.7%) patients. PFS and NFS diagnoses had 100% PPV and 100% NPV, respectively. Labs and clinical scores were significantly worse for PFS vs. NFS. PFS patients underwent more diagnostic and therapeutic ERCPs, experienced more clinical events, and reached significantly more endpoints (p < 0.001) than those with NFS. Multivariate analysis identified PFS as an independent risk factor for liver-related events. Conclusion: T1-MRC was superior to T2-MRCP for stricture diagnosis, stricture location, and prognostication. Clinical relevance statement: Because half of PSC patients will develop clinically-relevant strictures over the course of the disease, earlier more confident diagnosis and correct localization of functional stricture on gadoxetic acid-enhanced MRI may optimize management and improve prognostication. Key Points: • There is no consensus regarding biliary stricture imaging features in PSC that have clinical relevance. • Twenty-minute T1-weighted MRC images correctly classified PSC patients with potential (PFS) vs with no functional stricture (NFS). • T1-MRC diagnoses may reduce the burden of diagnostic ERCPs.
- Subjects
CHOLANGITIS; CONTRAST-enhanced magnetic resonance imaging; PROOF of concept; DIAGNOSIS; PROGNOSIS; MAGNETIC resonance imaging
- Publication
European Radiology, 2023, Vol 33, Issue 12, p9022
- ISSN
0938-7994
- Publication type
Article
- DOI
10.1007/s00330-023-09915-3