Department of Medicine, Clinic of Gastroenterology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
Department of Surgery, Helsinki University, Helsinki, Finland.
Liver Int. 2018 Dec;38(12):2329-2339. doi: 10.1111/liv.13899. Epub 2018 Jul 18.
BACKGROUND & AIMS: Endoscopic retrograde cholangiography (ERCP) has been considered the gold standard for the diagnosis and follow-up of primary sclerosing cholangitis, but it has been replaced by less invasive magnetic resonance imaging and cholangiopancreatography (MRI-MRCP). However, the role of these two techniques in the evaluation of disease activity and severity needs to be elucidated.
Patients with primary sclerosing cholangitis (n: 48, male 31, median age: 35.7; 28.0-44.2) who underwent ERCP and MRI-MRCP within ±3 months for diagnosis or follow-up, were reviewed. ERCP and MRI-MRCP images were scored using the modified Amsterdam score. Serum and biliary cytology markers of disease activity and severity were related to the imaging findings. Agreement on the assessment of the ERCP/MRCP score was calculated by kappa-statistics. Spearman's ρ was calculated when appropriate.
The agreement between ERCP and MRCP in scoring bile duct changes for disease severity was only moderate (weighted kappa: 0.437; 95% CI: 0.211-0.644 for intra- and 0.512; 95% CI: 0.303-0.720 for extra-hepatic bile ducts). ERCP and MRCP intra-hepatic scores were associated to the surrogate marker alkaline phosphatase (P = .02 for both). A weak correlation between MRCP score for extra-hepatic bile ducts and liver transplantation/death was found (Spearman's ρ = .362, 95% CI: 0.080-0.590, P = .022). A weak correlation between intra- (Spearman's ρ = .322, 95% CI: 0.048-0.551, P = .022) and extra-hepatic (Spearman`s ρ = .319, 95% CI: 0.045-0.549, P = .025) peribiliary enhancement on contrast-enhanced MRI and severity of biliary cytologic classification was found.
The overall agreement between ERCP and MRI-MRCP in assessing disease severity was moderate for intra- and extra-hepatic bile ducts. MRI-MRCP seems to have a minor role as surrogate marker of disease activity and progression in PSC.
内镜逆行胰胆管造影术（ERCP）一直被认为是原发性硬化性胆管炎（PSC）诊断和随访的金标准，但它已被侵袭性较小的磁共振胰胆管成像（MRI-MRCP）所取代。然而，这两种技术在评估疾病活动度和严重程度方面的作用仍需阐明。
对 48 例（男 31 例，中位年龄 35.7 岁；28.0-44.2 岁）接受 ERCP 和 MRI-MRCP 检查以诊断或随访的原发性硬化性胆管炎患者进行回顾性分析。采用改良阿姆斯特丹评分系统对 ERCP 和 MRI-MRCP 图像进行评分。血清和胆汁细胞学标志物与影像学表现相关。采用 Kappa 统计计算 ERCP/MRCP 评分评估的一致性。当合适时，计算 Spearman ρ。
在胆管疾病严重程度的评分中，ERCP 和 MRCP 对胆管改变的评估一致性仅为中度（加权 Kappa：0.437；95%CI：0.211-0.644 为肝内，0.512；95%CI：0.303-0.720 为肝外）。ERCP 和 MRCP 肝内评分与替代标志物碱性磷酸酶相关（均 P=.02）。MRCP 对肝外胆管评分与肝移植/死亡之间存在弱相关性（Spearman ρ=0.362，95%CI：0.080-0.590，P=.022）。肝内（Spearman ρ=0.322，95%CI：0.048-0.551，P=.022）和肝外（Spearman ρ=0.319，95%CI：0.045-0.549，P=.025）磁共振胆管成像增强对比剂的胆管周围增强与胆汁细胞学分类的严重程度之间存在弱相关性。
ERCP 和 MRI-MRCP 评估肝内外胆管疾病严重程度的总体一致性为中度。MRI-MRCP 似乎可作为 PSC 疾病活动度和进展的替代标志物。
