Department of Radiology, HUS Diagnostic Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Paediatric Gastroenterology, Children's Hospital, University of Helsinki and University Hospital, Helsinki, Finland.
J Pediatr Gastroenterol Nutr. 2024 Sep;79(3):644-651. doi: 10.1002/jpn3.12319. Epub 2024 Jul 16.
Magnetic resonance cholangiopancreaticography (MRCP) has supplanted endoscopic retrograde cholangiopancreaticography (ERCP) as the preferred imaging modality for primary sclerosing cholangitis (PSC). However, data about the accuracy of MRCP in assessing disease severity are limited, particularly in children. We assessed the accuracy of MRCP in disease severity evaluation and investigated the correlation between imaging findings and biochemical parameters (including the multivariate risk index SCOPE) in patients with pediatric-onset PSC.
We included 36 patients with PSC (median age: 16) who had MRCP and ERCP performed within 4-month intervals. Two experts, blinded to ERCP findings, evaluated the bile duct changes in consensus using the Modified Amsterdam PSC Score. The agreement between MRCP and ERCP evaluations was tested with weighted kappa statistics and the correlation between disease severity and biochemical parameters with Spearman's rank correlation.
The agreement between MRCP and ERCP was good for extrahepatic (weighted kappa 0.69; 95% confidence of interval [CI] 0.53-0.84) but fair for intrahepatic (weighted kappa 0.35; 95% CI 0.14-0.56) bile ducts. Intrahepatic and extrahepatic MRCP scores correlated with APRI (ρ = 0.42, p = 0.020 and ρ = 0.39, p = 0.033, respectively), while extrahepatic MRCP score also correlated with biliary neutrophils (ρ = 0.36, p = 0.035). We found a good correlation between the SCOPE index and intrahepatic MRCP score (ρ = 0.53, p = 0.004), and extrahepatic MRCP score (ρ = 0.57, p = 0.001).
MRCP is accurate at evaluating the severity of extrahepatic bile duct changes in pediatric-onset PSC but tends to underestimate intrahepatic changes. The SCOPE index's robust correlation with imaging scores supports its role as a comprehensive diagnostic tool, outperforming individual laboratory metrics.
磁共振胆胰管成像（MRCP）已取代内镜逆行胰胆管造影（ERCP）成为原发性硬化性胆管炎（PSC）的首选影像学检查方法。然而，MRCP 评估疾病严重程度的准确性数据有限，尤其是在儿童中。我们评估了 MRCP 在疾病严重程度评估中的准确性，并研究了儿童发病 PSC 患者影像学表现与生化参数（包括多变量风险指数 SCOPE）之间的相关性。
我们纳入了 36 例 PSC 患者（中位年龄 16 岁），这些患者在 4 个月内先后接受了 MRCP 和 ERCP 检查。两名专家在不了解 ERCP 结果的情况下，采用改良的阿姆斯特丹 PSC 评分对胆管变化进行了共识评估。采用加权 Kappa 统计检验 MRCP 和 ERCP 评估结果的一致性，采用 Spearman 秩相关检验疾病严重程度与生化参数的相关性。
MRCP 与 ERCP 在外胆管（加权 Kappa 0.69；95%置信区间 [CI] 0.53-0.84）的评估结果一致性良好，但在肝内胆管（加权 Kappa 0.35；95%CI 0.14-0.56）的评估结果一致性一般。肝内外 MRCP 评分与 APRI 呈正相关（ρ=0.42，p=0.020 和 ρ=0.39，p=0.033），而肝外 MRCP 评分也与胆汁中性粒细胞呈正相关（ρ=0.36，p=0.035）。我们发现 SCOPE 指数与肝内 MRCP 评分（ρ=0.53，p=0.004）和肝外 MRCP 评分（ρ=0.57，p=0.001）之间具有良好的相关性。
MRCP 能准确评估儿童发病 PSC 的肝外胆管严重程度改变，但往往低估肝内胆管改变。SCOPE 指数与影像学评分具有很强的相关性，支持其作为一种全面的诊断工具的作用，优于单个实验室指标。
