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European Radiology
Article . 2024 . Peer-reviewed
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Disease severity prognostication in primary sclerosing cholangitis: a validation of the Anali scores and comparison with the potential functional stricture

Authors: Sarah Poetter-Lang; Ahmed Ba-Ssalamah; Alina Messner; Nina Bastati; Raphael Ambros; Antonia Kristic; Jakob Kittinger; +9 Authors

Disease severity prognostication in primary sclerosing cholangitis: a validation of the Anali scores and comparison with the potential functional stricture

Abstract

Abstract Objectives Our aim was twofold. First, to validate Anali scores with and without gadolinium (ANALIGd and ANALINoGd) in primary sclerosing cholangitis (PSC) patients. Second, to compare the ANALIs prognostic ability with the recently-proposed potential functional stricture (PFS). Materials and methods This retrospective study included 123 patients with a mean age of 41.5 years, who underwent gadoxetic acid-enahnced MRI (GA-MRI). Five readers independently evaluated all images for calculation of ANALIGd and ANALINoGd scores based upon following criteria: intrahepatic bile duct change severity, hepatic dysmorphia, liver parenchymal heterogeneity, and portal hypertension. In addition, hepatobiliary contrast excretion into first-order bile ducts was evaluated on 20-minute hepatobiliary-phase (HBP) images to assess PFS. Inter- and intrareader agreement were calculated (Fleiss´and Cohen kappas). Kaplan-Meier curves were generated for survival analysis. ANALINoGd, ANALIGd, and PFS were correlated with clinical scores, labs and outcomes (Cox regression analysis). Results Inter-reader agreement was almost perfect (ϰ = 0.81) for PFS, but only moderate-(ϰ = 0.55) for binary ANALINoGd. For binary ANALIGd, the agreement was slightly better on HBP (ϰ = 0.64) than on arterial-phase (AP) (ϰ = 0.53). Univariate Cox regression showed that outcomes for decompensated cirrhosis, orthotopic liver transplantation or death significantly correlated with PFS (HR (hazard ratio) = 3.15, p < 0.001), ANALINoGd (HR = 6.42, p < 0.001), ANALIGdHBP (HR = 3.66, p < 0.001) and ANALIGdAP (HR = 3.79, p < 0.001). Multivariate analysis identified the PFS, all three ANALI scores, and Revised Mayo Risk Score as independent risk factors for outcomes (HR 3.12, p < 0.001; 6.12, p < 0.001; 3.56, p < 0.001;3.59, p < 0.001; and 4.13, p < 0.001, respectively). Conclusion ANALINoGd and GA-MRI-derived ANALI scores and PFS could noninvasively predict outcomes in PSC patients. Clinical relevance statement The combined use of Anali scores and the potential functional stricture (PFS), both derived from unenhanced-, and gadoxetic acid enhanced-MRI, could be applied as a diagnostic and prognostic imaging surrogate for counselling and monitoring primary sclerosing cholangitis patients. Key Points Primary sclerosing cholangitis patients require radiological monitoring to assess disease stability and for the presence and type of complications. A contrast-enhanced MRI algorithm based on potential functional stricture and ANALI scores risk-stratified these patients. Unenhanced ANALI score had a high negative predictive value, indicating some primary sclerosing cholangitis patients can undergo non-contrast MRI surveillance. Graphical Abstract

Keywords

Male, Adult, Gadolinium DTPA, Cholangitis, Sclerosing, Contrast Media, Reproducibility of Results, Constriction, Pathologic, Middle Aged, Prognosis, Hepatobiliary-Pancreas, Severity of Illness Index, Magnetic Resonance Imaging, Humans, Female, Female [MeSH] ; Constriction (pathologic) ; Adult [MeSH] ; Humans [MeSH] ; Cholangiopancreatography (prognosis) ; Severity of Illness Index [MeSH] ; Gadolinium DTPA [MeSH] ; Retrospective Studies [MeSH] ; Middle Aged [MeSH] ; Contrast Media [MeSH] ; Cholangitis (sclerosing) ; Hepatobiliary-Pancreas ; Male [MeSH] ; Reproducibility of Results [MeSH] ; Cholangitis, Sclerosing/complications [MeSH] ; Prognosis [MeSH] ; Constriction, Pathologic/diagnostic imaging [MeSH] ; Magnetic resonance imaging (functional) ; Magnetic Resonance Imaging/methods [MeSH] ; Cholangitis, Sclerosing/diagnostic imaging [MeSH] ; Contrast media, Retrospective Studies

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    influence
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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
8
Top 10%
Top 10%
Top 10%
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hybrid