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Development of a prognostic MRCP score (DiStrict) for patients with large-duct primary sclerosing cholangitis

Grigoriadis, Aristeidis ; Ringe, Kristina Imeen ; Bengtsson, Johan LU orcid ; Baubeta, Erik LU orcid ; Forsman, Cecilia ; Korsavidou-Hult, Nafsika ; Rorsman, Fredrik ; Nilsson, Emma ; Kartalis, Nikolaos and Bergquist, Annika (2022) In JHEP Reports 4(12).
Abstract
Background and Aims
MRCP is used for diagnosis and follow-up of patients with primary sclerosing cholangitis (PSC). Interest in the prognostic value of MRCP is increasing. The aim of our study is to develop an MRCP-score based on cholangiographic findings previously associated with outcomes and assess its reproducibility and prognostic value in PSC.
Methods
The score (DiStrict-score) was developed based on the extent and severity of cholangiographic changes of intrahepatic and extrahepatic bile ducts (range 0–8) on 3D-MRCP. In this retrospective, ethics review board approved, multicentre study, three pairs of radiologists with different levels of expertise from three tertiary centres applied the score independently. MRCP-... (More)
Background and Aims
MRCP is used for diagnosis and follow-up of patients with primary sclerosing cholangitis (PSC). Interest in the prognostic value of MRCP is increasing. The aim of our study is to develop an MRCP-score based on cholangiographic findings previously associated with outcomes and assess its reproducibility and prognostic value in PSC.
Methods
The score (DiStrict-score) was developed based on the extent and severity of cholangiographic changes of intrahepatic and extrahepatic bile ducts (range 0–8) on 3D-MRCP. In this retrospective, ethics review board approved, multicentre study, three pairs of radiologists with different levels of expertise from three tertiary centres applied the score independently. MRCP- examinations of 220 consecutive PSC-patients from a prospectively collected PSC-cohort, with median follow-up of 7.4 years, were reviewed. Interreader and intrareader agreements were assessed via intraclass correlation coefficient (ICC). After consensus, the prognostic value of the score was assessed using Cox-regression and outcome-free survival rates were assessed via Kaplan-Meier estimates. Harrell´s C-statistic was calculated.
Results
40 patients developed outcomes (liver transplantation or liver-related death). Interreader agreement between experienced radiologists was good (ICC=0.82; 95%CI:0.74–0.87, and ICC=0.81; 95%CI:0.70–0.87, respectively) and better than the agreement for the pair of experienced/less experienced radiologist (ICC=0.48; 95%CI:0.05–0.72). Agreement between radiologists from the three centres was good (ICC=0.76; 95%CI:0.57–0.89). Intrareader agreement was good to excellent (ICC=0.85–0.93). Harrell´s C was 0.78. Patients with DiStrict-score of 5 – 8 had 8.2 times higher risk (HR=8.2; 95%CI:2.97–22.65) for developing outcomes, and significantly worse survival (P Conclusions
The novel DiStrict-score is reproducible and strongly associated with outcomes, indicating its value for PSC-patient prognoses in clinical practice.
Lay summary
Diagnosis of primary sclerosing cholangitis (PSC) is based on magnetic resonance cholangiopancreatography (MRCP). However, the role of MRCP in the prognosis of PSC is still unclear. We developed a novel, simple, and reproducible risk-score, based on MRCP findings, that showed a strong association with PSC patient prognoses (DiStrict score). This score can be easily used in clinical practice and thus has the potential to be useful in clinical trials and in patient counselling and management. (Less)
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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cholangitis sclerosing, Cholangiopancreatography, Magnetic Resonance, Bile Ducts, Prognosis
in
JHEP Reports
volume
4
issue
12
article number
100595
pages
35 pages
publisher
Elsevier
external identifiers
  • scopus:85142441925
  • pmid:36444388
ISSN
2589-5559
DOI
10.1016/j.jhepr.2022.100595
language
English
LU publication?
yes
id
97e87016-c687-43ce-a858-b40e8972b2d9
date added to LUP
2022-11-14 10:57:09
date last changed
2025-04-04 14:13:58
@article{97e87016-c687-43ce-a858-b40e8972b2d9,
  abstract     = {{Background and Aims<br/>MRCP is used for diagnosis and follow-up of patients with primary sclerosing cholangitis (PSC). Interest in the prognostic value of MRCP is increasing. The aim of our study is to develop an MRCP-score based on cholangiographic findings previously associated with outcomes and assess its reproducibility and prognostic value in PSC.<br/>Methods<br/>The score (DiStrict-score) was developed based on the extent and severity of cholangiographic changes of intrahepatic and extrahepatic bile ducts (range 0–8) on 3D-MRCP. In this retrospective, ethics review board approved, multicentre study, three pairs of radiologists with different levels of expertise from three tertiary centres applied the score independently. MRCP- examinations of 220 consecutive PSC-patients from a prospectively collected PSC-cohort, with median follow-up of 7.4 years, were reviewed. Interreader and intrareader agreements were assessed via intraclass correlation coefficient (ICC). After consensus, the prognostic value of the score was assessed using Cox-regression and outcome-free survival rates were assessed via Kaplan-Meier estimates. Harrell´s C-statistic was calculated.<br/>Results<br/>40 patients developed outcomes (liver transplantation or liver-related death). Interreader agreement between experienced radiologists was good (ICC=0.82; 95%CI:0.74–0.87, and ICC=0.81; 95%CI:0.70–0.87, respectively) and better than the agreement for the pair of experienced/less experienced radiologist (ICC=0.48; 95%CI:0.05–0.72). Agreement between radiologists from the three centres was good (ICC=0.76; 95%CI:0.57–0.89). Intrareader agreement was good to excellent (ICC=0.85–0.93). Harrell´s C was 0.78. Patients with DiStrict-score of 5 – 8 had 8.2 times higher risk (HR=8.2; 95%CI:2.97–22.65) for developing outcomes, and significantly worse survival (P Conclusions<br/>The novel DiStrict-score is reproducible and strongly associated with outcomes, indicating its value for PSC-patient prognoses in clinical practice.<br/>Lay summary<br/>Diagnosis of primary sclerosing cholangitis (PSC) is based on magnetic resonance cholangiopancreatography (MRCP). However, the role of MRCP in the prognosis of PSC is still unclear. We developed a novel, simple, and reproducible risk-score, based on MRCP findings, that showed a strong association with PSC patient prognoses (DiStrict score). This score can be easily used in clinical practice and thus has the potential to be useful in clinical trials and in patient counselling and management.}},
  author       = {{Grigoriadis, Aristeidis and Ringe, Kristina Imeen and Bengtsson, Johan and Baubeta, Erik and Forsman, Cecilia and Korsavidou-Hult, Nafsika and Rorsman, Fredrik and Nilsson, Emma and Kartalis, Nikolaos and Bergquist, Annika}},
  issn         = {{2589-5559}},
  keywords     = {{Cholangitis sclerosing; Cholangiopancreatography; Magnetic Resonance; Bile Ducts; Prognosis}},
  language     = {{eng}},
  number       = {{12}},
  publisher    = {{Elsevier}},
  series       = {{JHEP Reports}},
  title        = {{Development of a prognostic MRCP score (DiStrict) for patients with large-duct primary sclerosing cholangitis}},
  url          = {{http://dx.doi.org/10.1016/j.jhepr.2022.100595}},
  doi          = {{10.1016/j.jhepr.2022.100595}},
  volume       = {{4}},
  year         = {{2022}},
}