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

• Published in: European radiology 2024-12, Vol.34 (12), p.7632-7644
• Main Authors: Poetter-Lang, Sarah, Ba-Ssalamah, Ahmed, Messner, Alina, Bastati, Nina, Ambros, Raphael, Kristic, Antonia, Kittinger, Jakob, Pochepnia, Svitlana, Ba-Ssalamah, Sami A., Hodge, Jacqueline. C., Halilbasic, Emina, Venkatesh, Sudhakar K., Kartalis, Nikolaos, Ringe, Kristina, Arrivé, Lionel, Trauner, Michael
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; Bile ducts; Cholangitis; Cholangitis, Sclerosing - complications; Cholangitis, Sclerosing - diagnostic imaging; Cirrhosis; Constriction, Pathologic - diagnostic imaging; Contrast Media; Diagnostic Radiology; Female; Functional magnetic resonance imaging; Gadolinium; Gadolinium DTPA; Hepatobiliary-Pancreas; Heterogeneity; Humans; Hypertension; Image contrast; Imaging; Internal Medicine; Interventional Radiology; Liver; Liver transplantation; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Monitoring; Multivariate analysis; Neuroradiology; Prognosis; Radiology; Regression analysis; Reproducibility of Results; Retrospective Studies; Risk factors; Severity of Illness Index; Stricture; Survival analysis; Telemedicine; Ultrasound
• ISSN: 1432-1084; 0938-7994; 1432-1084
• DOI: 10.1007/s00330-024-10787-4

Objectives Our aim was twofold. First, to validate Anali scores with and without gadolinium (ANALI Gd and ANALI NoGd ) 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 ANALI Gd and ANALI NoGd 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. ANALI NoGd , ANALI Gd , 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 ANALI NoGd . For binary ANALI Gd , 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