Quantitative magnetic resonance cholangiopancreatography metrics are associated with disease severity and outcomes in people with primary sclerosing cholangitis
Nora Cazzagon,
Sanaâ El Mouhadi,
Quentin Vanderbecq,
Carlos Ferreira,
Sarah Finnegan,
Sara Lemoinne,
Christophe Corpechot,
Olivier Chazouillères,
Lionel Arrivé
Affiliations
Nora Cazzagon
Assistance Publique – Hôpitaux de Paris (AP-HP), Sorbonne Université, Department of Hepatology, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis (CRMR MIVB-H), ERN RARE-LIVER, Saint-Antoine Hospital, Paris, France; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy; ERN RARE-LIVER, Azienda Ospedale – Università Padova, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy. Via N. Giustiniani 2, 35128 Padua, Italy. Tel.: +39-049-821-2894.
Sanaâ El Mouhadi
Assistance Publique – Hôpitaux de Paris (AP-HP), Sorbonne Université, Department of Radiology, Saint-Antoine Hospital, Paris, France
Quentin Vanderbecq
Assistance Publique – Hôpitaux de Paris (AP-HP), Sorbonne Université, Department of Radiology, Saint-Antoine Hospital, Paris, France
Carlos Ferreira
Perspectum Ltd., Oxford, UK
Sarah Finnegan
Perspectum Ltd., Oxford, UK
Sara Lemoinne
Assistance Publique – Hôpitaux de Paris (AP-HP), Sorbonne Université, Department of Hepatology, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis (CRMR MIVB-H), ERN RARE-LIVER, Saint-Antoine Hospital, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Foundation for Innovation in Cardiometabolism and Nutrition (ICAN), Paris, France
Christophe Corpechot
Assistance Publique – Hôpitaux de Paris (AP-HP), Sorbonne Université, Department of Hepatology, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis (CRMR MIVB-H), ERN RARE-LIVER, Saint-Antoine Hospital, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Foundation for Innovation in Cardiometabolism and Nutrition (ICAN), Paris, France
Olivier Chazouillères
Assistance Publique – Hôpitaux de Paris (AP-HP), Sorbonne Université, Department of Hepatology, Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis (CRMR MIVB-H), ERN RARE-LIVER, Saint-Antoine Hospital, Paris, France; Sorbonne Université, INSERM, Centre de Recherche Saint-Antoine (CRSA), Foundation for Innovation in Cardiometabolism and Nutrition (ICAN), Paris, France
Lionel Arrivé
Assistance Publique – Hôpitaux de Paris (AP-HP), Sorbonne Université, Department of Radiology, Saint-Antoine Hospital, Paris, France; Corresponding authors. Addresses: Assistance Publique – Hôpitaux de Paris, Sorbonne University, Department of Radiology, Saint-Antoine Hospital, 184 rue du Fauborg Saint-Antoine, 75012 Paris, France. Tel.: +33-014-928-2257; Fax: +33-014-928-2259.
Background & Aims: People with primary sclerosing cholangitis (PSC) have a variable and often progressive disease course that is associated with biliary and parenchymal changes. These changes are typically assessed by magnetic resonance imaging (MRI), including qualitative assessment of magnetic resonance cholangiopancreatography (MRCP). Our aim was to study the association of novel objective quantitative MRCP metrics with prognostic scores and patient outcomes. Methods: We performed a retrospective study including 77 individuals with large-duct PSC with baseline MRCP images, which were postprocessed to obtain quantitative measures of bile ducts using MRCP+™. The participants’ ANALI scores, liver stiffness by vibration-controlled transient elastography, and biochemical indices were collected at baseline. Adverse outcome-free survival was measured as the absence of decompensated cirrhosis, liver transplantation (LT), or liver-related death over a 12-year period. The prognostic value of MRCP+-derived metrics was assessed by Cox regression modelling. Results: During a total of 386 patients-years, 16 cases of decompensation, 2 LTs, and 5 liver-related deaths were recorded. At baseline, around 50% of the patients were classified as being at risk of developing disease complications. MRCP+ metrics, particularly those describing the severity of bile duct dilatations, were correlated with all prognostic factors. Univariate analysis showed that MRCP+ metrics representing duct diameter, dilatations, and the percentage of ducts with strictures and/or dilatations were associated with survival. In a multivariable-adjusted analysis, the median duct diameter was significantly associated with survival (hazard ratio 10.9, 95% CI 1.3–90.3). Conclusions: MRCP+ metrics in people with PSC correlate with biochemical, elastographic, and radiological prognostic scores and are predictive of adverse outcome-free survival. Lay summary: In this study, we assessed in people with primary sclerosing cholangitis (PSC) the association of novel objective quantitative MRCP metrics automatically provided by a software tool (MRCP+) with prognostic scores and patient outcomes. We observed that MRCP+ metrics in people with PSC correlate with biochemical, elastographic, and radiological prognostic scores and are predictive of adverse outcome-free survival.
