TY - JOUR
T1 - The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis
AU - Cazzagon, Nora
AU - Lemoinne, Sara
AU - El Mouhadi, Sanaâ
AU - Trivedi, Palak J
AU - Gaouar, Farid
AU - Kemgang, Astrid
AU - Ben Belkacem, Karima
AU - Floreani, Annarosa
AU - Hirschfield, Gideon
AU - Chretien, Yves
AU - Housset, Chantal
AU - Motta, Raffaella
AU - Russo, Francesco P
AU - Chazouillères, Olivier
AU - Arrivé, Lionel
AU - Corpechot, Christophe
PY - 2019/12/31
Y1 - 2019/12/31
N2 - OBJECTIVES: Magnetic resonance (MR) risk scores and liver stiffness (LS) have individually been shown to predict clinical outcomes in primary sclerosing cholangitis (PSC). The aim of this study was to assess their complementary prognostic value.METHODS: Patients with PSC from 3 European centers with a 3-dimensional MR cholangiography available for central reviewing and a valid LS measurement assessed by vibration-controlled transient elastography by FibroScan performed within a 6-month interval were included in a longitudinal retrospective study. The MR score (Anali) without gadolinium (Gd) was calculated according to the formula: (1 × dilatation of intrahepatic bile ducts) + (2 × dysmorphy) + (1 × portal hypertension). The primary end point was survival without liver transplantation or cirrhosis decompensation. The prognostic values of LS and Anali score without Gd were assessed using Cox proportional hazard models.RESULTS: One hundred sixty-two patients were included. Over a total follow-up of 753 patient-years, 40 patients experienced an adverse outcome (4 liver transplantations, 6 liver-related deaths, and 30 cirrhosis decompensations). LS and Anali score without Gd were significantly correlated (ρ = 0.51, P < 0.001) and were independently associated with the occurrence of an adverse outcome. Optimal prognostic thresholds were 10.5 kPa for LS and 2 for the Anali score without Gd. Hazard ratios (95% confidence interval) were 2.07 (1.06-4.06) and 3.78 (1.67-8.59), respectively. The use in combination of these 2 thresholds allowed us to separate patients into low-, medium-, and high-risk groups for developing adverse outcomes. The 5-year cumulative rates of adverse outcome in these 3 groups were 8%, 16%, and 38% (P < 0.001), respectively.DISCUSSION: The combined use of MRI and vibration-controlled transient elastography permits easy risk stratification of patients with PSC.
AB - OBJECTIVES: Magnetic resonance (MR) risk scores and liver stiffness (LS) have individually been shown to predict clinical outcomes in primary sclerosing cholangitis (PSC). The aim of this study was to assess their complementary prognostic value.METHODS: Patients with PSC from 3 European centers with a 3-dimensional MR cholangiography available for central reviewing and a valid LS measurement assessed by vibration-controlled transient elastography by FibroScan performed within a 6-month interval were included in a longitudinal retrospective study. The MR score (Anali) without gadolinium (Gd) was calculated according to the formula: (1 × dilatation of intrahepatic bile ducts) + (2 × dysmorphy) + (1 × portal hypertension). The primary end point was survival without liver transplantation or cirrhosis decompensation. The prognostic values of LS and Anali score without Gd were assessed using Cox proportional hazard models.RESULTS: One hundred sixty-two patients were included. Over a total follow-up of 753 patient-years, 40 patients experienced an adverse outcome (4 liver transplantations, 6 liver-related deaths, and 30 cirrhosis decompensations). LS and Anali score without Gd were significantly correlated (ρ = 0.51, P < 0.001) and were independently associated with the occurrence of an adverse outcome. Optimal prognostic thresholds were 10.5 kPa for LS and 2 for the Anali score without Gd. Hazard ratios (95% confidence interval) were 2.07 (1.06-4.06) and 3.78 (1.67-8.59), respectively. The use in combination of these 2 thresholds allowed us to separate patients into low-, medium-, and high-risk groups for developing adverse outcomes. The 5-year cumulative rates of adverse outcome in these 3 groups were 8%, 16%, and 38% (P < 0.001), respectively.DISCUSSION: The combined use of MRI and vibration-controlled transient elastography permits easy risk stratification of patients with PSC.
KW - Adult
KW - Cholangiocarcinoma/epidemiology
KW - Cholangiography
KW - Cholangitis/mortality
KW - Cholangitis, Sclerosing/diagnostic imaging
KW - Comorbidity
KW - Elasticity Imaging Techniques
KW - Female
KW - Humans
KW - Inflammatory Bowel Diseases/epidemiology
KW - Liver/diagnostic imaging
KW - Liver Cirrhosis, Biliary/diagnostic imaging
KW - Liver Transplantation
KW - Magnetic Resonance Imaging
KW - Male
KW - Middle Aged
KW - Prognosis
KW - Progression-Free Survival
KW - Risk Assessment
KW - Shock, Septic/mortality
KW - Vibration
U2 - 10.14309/ajg.0000000000000461
DO - 10.14309/ajg.0000000000000461
M3 - Article
C2 - 31738286
SN - 0002-9270
VL - 114
SP - 1878
EP - 1885
JO - The American Journal of Gastroenterology
JF - The American Journal of Gastroenterology
IS - 12
ER -