Abstract
PurposeANALI-scores are two prognostic magnetic resonance imaging (MRI)-based scores developed for patients with primary sclerosing cholangitis (PSC). Our study aims to assess the interreader agreement between expert radiologists of the two ANALI-scores and of the radiological parameters they utilize, and to test the prognostic performance of the scores in our population. MethodThree radiologists evaluated MRIs of 98 PSC-patients from a prospectively collected cohort with median follow-up of 6.7 years. Each parameter of ANALI-scores was assessed, and the scores were calculated. Interreader agreement was assessed with intraclass correlation coefficient (ICC). After consensus reading was reached, the prognostic value of ANALI-scores was assessed with Cox regression, and outcome-free survival rates were evaluated with Kaplan-Meier estimates. ResultsThe ANALI-score without gadolinium had poor to moderate (ICC = 0.56, 95 %CI: 0.42–0.68) and with gadolinium poor (ICC = 0.30, 95 %CI: 0.16–0.44) agreement. Liver deformity (ICC = 0.28, 95 %CI: 0.13–0.44) and parenchymal enhancement heterogeneity (ICC = 0.24, 95 %CI: 0.12–0.38) had poor agreement. Portal hypertension had poor to moderate (ICC = 0.48, 95 %CI: 0.36–0.59) and dilatation of the intrahepatic ducts had moderate (ICC = 0.64, 95 %CI: 0.54–0.73) agreement. Hazard ratios for liver-related death, transplantation or cirrhosis decompensation of the ANALI-scores with and without gadolinium were 3.53 (95 %CI: 1.40–8.93) and 2.25 (95 %CI: 1.56–3.24), respectively. Outcome-free survival was better for patients with low ANALI-scores. ConclusionsThe ANALI-scores show poor to moderate agreement, which challenges their usefulness in clinical practice. They are associated with clinical outcomes, confirming the value of imaging in prognosis of PSC, but need further multicenter evaluation.
Highlights
Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease that leads to biliary cirrhosis and liver failure, and carries an increased risk of hepatobiliary cancer [1,2]
One patient was excluded due to incomplete magnetic resonance imaging (MRI)/Magnetic resonance cholangiopancreatography (MRCP), three pa tients had no MRI/MRCP performed after inclusion in the cohort, and European Journal of Radiology 142 (2021) 109884 one patient was lost to follow-up
From the four parameters used in the scores, two have poor agreement, one has poor to moderate agreement and one (IHBD dilatation) has moderate agreement
Summary
Primary sclerosing cholangitis (PSC) is a progressive cholestatic liver disease that leads to biliary cirrhosis and liver failure, and carries an increased risk of hepatobiliary cancer [1,2]. Liver transplantation is still the only potentially curative therapy available. There is a lack of good prognostic markers that could be used for patient stratification, counseling, and evaluation of treatment effects. Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) is generally accepted as the mo dality of choice for imaging of PSC patients [3,4,5]. The potential prognostic value of MRI for PSC patients has been an area of interest in recent years. In 2014, a French group developed a standardized inter pretation model for MRI/MRCP examinations, based on which up to half
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