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Early Peribiliary Hyperenhancement on MRI in Patients with Primary Sclerosing Cholangitis: Significance and Association with the Mayo Risk Score

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Abstract

The aims of this study are to assess any relationship between peribiliary hyperenhancement on MRI in patients with primary sclerosing cholangitis (PSC) and their Mayo risk score and to assess which timing of peribiliary hyperenhancement correlates best with the Mayo risk score. In this HIPAA-compliant, IRB-approved retrospective study, 101 patients who underwent MRI for known or suspected PSC were identified. Of those, 62 patients (mean age 48 years; 40 males) were diagnosed with PSC by a hepatologist based on findings on MRI, ERCP, and/or liver biopsy, and comprise the final cohort. Data were recorded on whether peribiliary hyperenhancement was present, the post-contrast phase and the extent of involvement. The components to calculate the Mayo risk score were recorded. Statistical analysis was performed using the student T test, Fisher’s exact test, and the Kaplan–Meier estimate. Of 62 patients, 41 (66.1%) patients had a low-Mayo risk score (<0), 14 (22.6%) had an intermediate-risk score (≤2 and >0), and 7 (11.3%) had a high-risk score (>2). On MRI, 29 (46.8%) patients demonstrated arterial peribiliary hyperenhancement. Both the presence and extent of peribiliary hyperenhancement showed significant associations with Mayo risk score (p < 0.01). Using the combined end point of liver transplantation or death, there was a statistically significant difference in survival times between those with and those without arterial peribiliary hyperenhancement (p < 0.05). The presence of arterial peribiliary hyperenhancement in patients with PSC on MRI is associated with higher Mayo risk scores and may suggest a poorer prognosis.

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References

  1. Lee YM, Kaplan MM (1995) Primary sclerosing cholangitis. N Engl J Med 332(14):924–933. doi:10.1056/NEJM199504063321406

    Article  CAS  PubMed  Google Scholar 

  2. Sherlock S (1991) Pathogenesis of sclerosing cholangitis: the role of nonimmune factors. Semin Liver Dis 11(1):5–10. doi:10.1055/s-2008-1040416

    Article  CAS  PubMed  Google Scholar 

  3. Razumilava N, Gores GJ, Lindor KD (2011) Cancer surveillance in patients with primary sclerosing cholangitis. Hepatology 54(5):1842–1852. doi:10.1002/hep.24570

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lee YM, Kaplan MM (2002) Management of primary sclerosing cholangitis. Am J Gastroenterol 97(3):528–534. doi:10.1111/j.1572-0241.2002.05585.x

    Article  PubMed  Google Scholar 

  5. Majoie CB, Reeders JW, Sanders JB, Huibregtse K, Jansen PL (1991) Primary sclerosing cholangitis: a modified classification of cholangiographic findings. AJR Am J Roentgenol 157(3):495–497

    Article  CAS  PubMed  Google Scholar 

  6. Bader TR, Beavers KL, Semelka RC (2003) MR imaging features of primary sclerosing cholangitis: patterns of cirrhosis in relationship to clinical severity of disease. Radiology 226(3):675–685. doi:10.1148/radiol.2263011623

    Article  PubMed  Google Scholar 

  7. Berstad AE, Aabakken L, Smith HJ, et al. (2006) Diagnostic accuracy of magnetic resonance and endoscopic retrograde cholangiography in primary sclerosing cholangitis. Clin Gastroenterol Hepatol 4(4):514–520. doi:10.1016/j.cgh.2005.10.007

    Article  PubMed  Google Scholar 

  8. Elsayes KM, Oliveira EP, Narra VR, et al. (2006) MR and MRCP in the evaluation of primary sclerosing cholangitis: current applications and imaging findings. J Comput Assist Tomogr 30(3):398–404

    Article  PubMed  Google Scholar 

  9. Weber C, Kuhlencordt R, Grotelueschen R, et al. (2008) Magnetic resonance cholangiopancreatography in the diagnosis of primary sclerosing cholangitis. Endoscopy 40(9):739–745. doi:10.1055/s-2008-1077509

    Article  CAS  PubMed  Google Scholar 

  10. Petrovic BD, Nikolaidis P, Hammond NA, et al. (2007) Correlation between findings on MRCP and gadolinium-enhanced MR of the liver and a survival model for primary sclerosing cholangitis. Dig Dis Sci 52(12):3499–3506. doi:10.1007/s10620-006-9720-1

    Article  PubMed  Google Scholar 

  11. Kim WR, Therneau TM, Wiesner RH, et al. (2000) A revised natural history model for primary sclerosing cholangitis. Mayo Clin Proc 75(7):688–694. doi:10.4065/75.7.688

    Article  CAS  PubMed  Google Scholar 

  12. Wiesner RH, Porayko MK, Hay JE, et al. (1996) Liver transplantation for primary sclerosing cholangitis: impact of risk factors on outcome. Liver Transplant Surg Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc 2(5 Suppl 1):99–108

    CAS  Google Scholar 

  13. Vitellas KM, Keogan MT, Freed KS, Enns RA, Spritzer CE, Baillie JM, Nelson RC (2000) Radiologic manifestations of sclerosing cholangitis with emphasis on MR cholangiopancreatography. Radiogr Rev Publ Radiol Soc N Am Inc 20(4):959–975; quiz 1108-1109, 1112. doi:10.1148/radiographics.20.4.g00jl04959

  14. Earls JP, Rofsky NM, DeCorato DR, Krinsky GA, Weinreb JC (1997) Hepatic arterial-phase dynamic gadolinium-enhanced MR imaging: optimization with a test examination and a power injector. Radiology 202(1):268–273. doi:10.1148/radiology.202.1.8988222

    Article  CAS  PubMed  Google Scholar 

  15. Kim WR, Poterucha JJ, Wiesner RH, et al. (1999) The relative role of the Child-Pugh classification and the Mayo natural history model in the assessment of survival in patients with primary sclerosing cholangitis. Hepatology 29(6):1643–1648. doi:10.1002/hep.510290607

    Article  CAS  PubMed  Google Scholar 

  16. Lindor KD (2011) New treatment strategies for primary sclerosing cholangitis. Dig Dis 29(1):113–116. doi:10.1159/000324145

    Article  PubMed  Google Scholar 

  17. Semelka RC, Chung JJ, Hussain SM, Marcos HB, Woosley JT (2001) Chronic hepatitis: correlation of early patchy and late linear enhancement patterns on gadolinium-enhanced MR images with histopathology initial experience. J Magn Reson Imaging JMRI 13(3):385–391

    Article  CAS  PubMed  Google Scholar 

  18. Balci NC, Semelka RC (2005) Contrast agents for MR imaging of the liver. Radiol Clin North Am 43(5):887–898, viii. doi:10.1016/j.rcl.2005.05.004

  19. Faria SC, Ganesan K, Mwangi I, Shiehmorteza M, Viamonte B, Mazhar S, Peterson M, Kono Y, Santillan C, Casola G, Sirlin CB (2009) MR imaging of liver fibrosis: current state of the art. Radiogr Rev Publ Radiol Soc N Am Inc 29(6):1615–1635. doi:10.1148/rg.296095512

    Google Scholar 

  20. Corpechot C, Gaouar F, El Naggar A, et al. (2014) Baseline values and changes in liver stiffness measured by transient elastography are associated with severity of fibrosis and outcomes of patients with primary sclerosing cholangitis. Gastroenterology 146(4):970–979 ((quiz e915-976)). doi:10.1053/j.gastro.2013.12.030

    Article  PubMed  Google Scholar 

  21. Eaton JE, Dzyubak B, Venkatesh SK, et al. (2016) Performance of magnetic resonance elastography in primary sclerosing cholangitis. J Gastroenterol Hepatol 31(6):1184–1190. doi:10.1111/jgh.13263

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Ehlken H, Wroblewski R, Corpechot C, et al. (2016) Spleen size for the prediction of clinical outcome in patients with primary sclerosing cholangitis. Gut 65(7):1230–1232. doi:10.1136/gutjnl-2016-311452

    Article  PubMed  Google Scholar 

  23. Ruiz A, Lemoinne S, Carrat F, et al. (2014) Radiologic course of primary sclerosing cholangitis: assessment by three-dimensional magnetic resonance cholangiography and predictive features of progression. Hepatology 59(1):242–250. doi:10.1002/hep.26620

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Jennifer M Ni Mhuircheartaigh, Karen S Lee & Koenraad J Mortele

  2. Department of Hepatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    Michael P Curry

  3. Department of Radiology, UT Southwestern, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA

    Ivan Pedrosa

Authors
  1. Jennifer M Ni Mhuircheartaigh
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  2. Karen S Lee
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  3. Michael P Curry
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  4. Ivan Pedrosa
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  5. Koenraad J Mortele
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Correspondence to Jennifer M Ni Mhuircheartaigh.

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Jennifer M Ni Mhuircheartaigh declares she has no conflict of interest. Karen S Lee declares she has no conflict of interest. Michael P Curry declares he has no conflict of interest. Ivan Pedrosa declares he has no conflict of interest. Koenraad J Mortele declares he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ni Mhuircheartaigh, J.M., Lee, K.S., Curry, M.P. et al. Early Peribiliary Hyperenhancement on MRI in Patients with Primary Sclerosing Cholangitis: Significance and Association with the Mayo Risk Score. Abdom Radiol 42, 152–158 (2017). https://doi.org/10.1007/s00261-016-0847-z

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  • DOI: https://doi.org/10.1007/s00261-016-0847-z

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