A quantitative MRCP-derived score for medium-term outcome prediction in primary sclerosing cholangitis. Issue 3 (March 2023)

• Record Type: Journal Article
• Authors: Cristoferi, Laura; Porta, Marco; Bernasconi, Davide Paolo; Leonardi, Filippo; Gerussi, Alessio; Mulinacci, Giacomo; Palermo, Andrea; Gallo, Camilla; Scaravaglio, Miki; Stucchi, Eliana; Maino, Cesare; Ippolito, Davide; D'Amato, Daphne; Ferreira, Carlos; Nardi, Alessandra; Banerjee, Rajarshi; Valsecchi, Maria Grazia; Antolini, Laura; Corso, Rocco; Sironi, Sandro; Fagiuoli, Stefano; Invernizzi, Pietro; Carbone, Marco
• Is Part Of: Digestive and liver disease. Volume 55:Issue 3(2023)
• Page Start: 373
• Page End: 380
• Publication Date: 2023-03
• Subjects: Artificial intelligence -- MRCP -- Primary sclerosing cholangitis -- Prognostic score; AI artificial intelligence -- AIH autoimmune hepatitis -- ALP alkaline phosphatase -- AOM Amsterdam Oxford model -- CCA cholangiocarcinoma -- CI confidence intervals -- HR hazard ratio -- IBD inflammatory bowel disease -- LT liver transplantation -- MRCP magnetic resonance cholangio-pancreatography -- MRI magnetic resonance imaging -- MRS Mayo risk score -- PH proportional hazards -- PSC primary sclerosing cholangitis -- qMRCP-PSC quantitative MRCP-derived PSC score -- Q1-Q3 Interquartile range -- ROC receiver operating characteristic -- TD-ROC time dependent receiver operating characteristic; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2022.10.015
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: Magnetic resonance cholangiopancreatography (MRCP) is the gold standard for diagnosis of patients with primary sclerosing cholangitis (PSC). The semi-quantitative MRCP-derived Anali scores proposed for risk stratification, have poor-to-moderate inter-reader agreement. Aims: To evaluate the prognostic performance of quantitative MRCP metrics in PSC. Methods: This is a retrospective study of PSC patients undergoing MRCP. Images were processed using MRCP+ software (Perspectum Ltd, Oxford) that provides quantitative biliary features, semi-automatically extracted by artificial intelligence-driven analysis of MRCP-3D images. The prognostic value of biliary features has been assessed for all hepato-biliary complications. Results: 87 PSC patients have been included in the analysis. Median follow-up from MRCP to event/censoring of 30.9 months (Q1-Q3=13.6–46.6). An adverse outcome occurred in 27 (31.0%) patients. The number of biliary strictures (HR=1.05 per unit, 95%CI 1.02–1.08, p < 0.0001), spleen length (HR=1.16 per cm, 95%CI 1.01–1.34, p = 0.039), adjusted for height, age at MRCP, and time from diagnosis to MRCP predicted higher risk of hepatobiliary complications. These were incorporated into a the quantitative MRCP-derived PSC (qMRCP-PSC) score (C-statistic=0.80). After 3-fold cross-validation, qMRCP-PSC outperformed the Anali score in our cohort (C-statistic of 0.78 vs 0.64) and enabled the discrimination of survival of PSC patients (log-rank p < 0.0001). Conclusions: The qMRCP-PSC score identified patients at higher risk of hepatobiliary complications and outperformed the available radiological scores. It represents a novel quantitative biomarker for disease monitoring and a potential surrogate endpoint for clinical trials.