Eaton John E, Welle Christopher L, Monahan Hannah, Tahboub Amawi Ali Dean, Idilman Ilkay, Harmsen William S, Dzyubak Bogdan, Beiermann Elizabeth W, Bakhshi Zeinab, Gores Gregory J, LaRusso Nicholas F, Gossard Andrea A, Lazaridis Konstantinos N, Venkatesh Sudhakar K
Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, Minnesota.
Department of Radiology, Mayo Clinic, Rochester, Minnesota.
Gastro Hep Adv. 2022 Mar 30;1(3):287-295. doi: 10.1016/j.gastha.2022.01.003. eCollection 2022.
Several quantitative and qualitative magnetic resonance imaging (MRI) metrics have been reported to predict outcomes among those with primary sclerosing cholangitis (PSC). We aimed to compare the reproducibility and prognostic performances of MRI biomarkers and examine if combining these measurements adds value.
We performed a retrospective review of 388 patients with PSC who underwent a magnetic resonance elastography and magnetic resonance cholangiopancreatography. Liver stiffness (LS) was determined by validated automated software, whereas spleen volume was calculated by semiautomated software, and radiologists manually determined the ANALI scores. The primary endpoint was hepatic decompensation.
LS and spleen volume values had perfect and near-perfect agreement (intraclass correlation coefficient of 1.00 and 0.9996, respectively), whereas ANALI with and without gadolinium had a moderate inter-rater agreement between 3 radiologists (kappa = 0.42-0.54 and 0.46-0.57, respectively). As a continuous variable, LS alone was the best predictor of hepatic decompensation (concordance score = 0.90; 95% confidence interval, 0.87-0.93). A quantitative-only MRI model [LS (>4.70 kPa = 2 or ≤4.70 kPa = 0) + spleen volume (>600 mm = 1 or ≤600 mm = 0)] had the optimal reproducibility and performance (concordance score = 0.85; 95% confidence interval = 0.80-0.89) and enabled patient risk stratification by estimating the 5-year incidence of hepatic decompensation: 7.49%, 44.50%, 70.00%, and 91.30% (score 0-3).
Quantitative MRI markers of fibrosis and portal hypertension generated by automated and semiautomated software are highly reproducible. LS is the single best imaging predictor of hepatic decompensation. However, a quantitative MRI score using LS and spleen volume is well suited to risk stratify those with PSC.
已有多项定量和定性磁共振成像（MRI）指标被报道可用于预测原发性硬化性胆管炎（PSC）患者的预后。我们旨在比较MRI生物标志物的可重复性和预后性能，并探讨将这些测量值相结合是否能增加价值。
我们对388例接受磁共振弹性成像和磁共振胰胆管造影的PSC患者进行了回顾性研究。肝脏硬度（LS）由经过验证的自动化软件测定，脾脏体积由半自动软件计算，放射科医生手动确定ANALI评分。主要终点是肝失代偿。
LS和脾脏体积值具有完美和近乎完美的一致性（组内相关系数分别为1.00和0.9996），而使用和不使用钆剂的ANALI在3位放射科医生之间具有中等程度的评分者间一致性（kappa分别为0.42 - 0.54和0.46 - 0.57）。作为连续变量，单独的LS是肝失代偿的最佳预测指标（一致性评分 = 0.90；95%置信区间，0.87 - 0.93）。仅基于定量指标的MRI模型[LS（>4.70 kPa = 2或≤4.70 kPa = 0）+脾脏体积（>600 mm = 1或≤600 mm = 0）]具有最佳的可重复性和性能（一致性评分 = 0.85；95%置信区间 = 0.80 - 0.89），并通过估计肝失代偿的5年发生率实现患者风险分层：7.49%、44.50%、70.00%和91.30%（评分0 - 3）。
由自动化和半自动软件生成的纤维化和门静脉高压的定量MRI标志物具有高度可重复性。LS是肝失代偿的最佳单一影像学预测指标。然而，使用LS和脾脏体积的定量MRI评分非常适合对PSC患者进行风险分层。
