Abstract
BackgroundPrimary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease, characterized by bile duct inflammation and destruction, leading to biliary fibrosis and cirrhosis. The purpose of this study was to investigate the utility of T1 and T2 mapping parameters, including extracellular volume fraction (ECV) for non-invasive assessment of fibrosis severity in patients with PSC.MethodsIn this prospective study, patients with PSC diagnosis were consecutively enrolled from January 2019 to July 2020 and underwent liver MRI. Besides morphological sequences, MR elastography (MRE), and T1 and T2 mapping were performed. ECV was calculated from T1 relaxation times. The presence of significant fibrosis (≥ F2) was defined as MRE-derived liver stiffness ≥ 3.66 kPa and used as the reference standard, against which the diagnostic performance of MRI mapping parameters was tested. Student t test, ROC analysis and Pearson correlation were used for statistical analysis.Results32 patients with PSC (age range 19–77 years) were analyzed. Both, hepatic native T1 (r = 0.66; P < 0.001) and ECV (r = 0.69; P < 0.001) correlated with MRE-derived liver stiffness. To diagnose significant fibrosis (≥ F2), ECV revealed a sensitivity of 84.2% (95% confidence interval (CI) 62.4–94.5%) and a specificity of 84.6% (CI 57.8–95.7%); hepatic native T1 revealed a sensitivity of 52.6% (CI 31.7–72.7%) and a specificity of 100.0% (CI 77.2–100.0%). Hepatic ECV (area under the curve (AUC) 0.858) and native T1 (AUC 0.711) had an equal or higher diagnostic performance for the assessment of significant fibrosis compared to serologic fibrosis scores (APRI (AUC 0.787), FIB-4 (AUC 0.588), AAR (0.570)).ConclusionsHepatic T1 and ECV can diagnose significant fibrosis in patients with PSC. Quantitative mapping has the potential to be a new non-invasive biomarker for liver fibrosis assessment and quantification in PSC patients.
Highlights
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease, characterized by bile duct inflammation and destruction, leading to biliary fibrosis and cirrhosis
At the time of magnetic resonance imaging (MRI) examination, 40.6% (13/32) patients received therapy with ursodeoxycholic acid (UDCA) alone; 31.3% (10/32) patients received a combination of 5-aminosalicylic acid (5-ASA) with UDCA due to accompanying IBD; 12.5% (4/32) patient the combination of corticosteroids with UDCA due to overlap with autoimmune hepatitis (AIH). 20.0% (5/32) patients received no therapy at the time of MRI examination
We found significant correlations between liver stiffness measurements derived by time of echo (TE) and MR elastography (MRE) (r = 0.78, P < 0.001) as well as hepatic extracellular volume fraction (ECV) (r = 0.52, P = 0.026)
Summary
Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease, characterized by bile duct inflammation and destruction, leading to biliary fibrosis and cirrhosis. The purpose of this study was to investigate the utility of T1 and T2 mapping parameters, including extracellular volume fraction (ECV) for non-invasive assessment of fibrosis severity in patients with PSC. Primary sclerosing cholangitis (PSC) is a rare cholestatic liver disease, leading to biliary fibrosis and cirrhosis. PSC is believed to be immune-mediated, the etiopathogenesis of the disease has still not been completely investigated and remains unclear. According to the guidelines of the European (EASL) and American (AASLD) Associations for the Study of Liver Diseases, magnetic resonance imaging (MRI) including MR-cholangiography has been established as the standard imaging modality when PSC is suspected [5, 6]. Diagnostic approaches enabling these efficiently and non-invasively in the same clinical setting without adding costs and burdens in patients’ care are required [7, 8]
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