Diagnostic value of magnetic resonance parametric mapping for non-invasive assessment of liver fibrosis in patients with primary sclerosing cholangitis.
Extracellular volume fraction
Magnetic resonance elastography
Primary sclerosing cholangitis
Journal
BMC medical imaging
ISSN: 1471-2342
Titre abrégé: BMC Med Imaging
Pays: England
ID NLM: 100968553
Informations de publication
Date de publication:
07 04 2021
07 04 2021
Historique:
received:
01
01
2021
accepted:
24
03
2021
entrez:
8
4
2021
pubmed:
9
4
2021
medline:
27
1
2022
Statut:
epublish
Résumé
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. In 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. 32 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)). Hepatic 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.
Sections du résumé
BACKGROUND
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.
METHODS
In 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.
RESULTS
32 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)).
CONCLUSIONS
Hepatic 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.
Identifiants
pubmed: 33827475
doi: 10.1186/s12880-021-00598-0
pii: 10.1186/s12880-021-00598-0
pmc: PMC8028226
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
65Références
Weismüller TJ, Trivedi PJ, Bergquist A, Imam M, Lenzen H, Ponsioen CY, et al. Patient age, sex, and inflammatory bowel disease phenotype associate with course of primary sclerosing cholangitis. Gastroenterology. 2017;152(1975–1984):e8. https://doi.org/10.1053/j.gastro.2017.02.038 .
doi: 10.1053/j.gastro.2017.02.038
Hirschfield GM, Karlsen TH, Lindor KD, Adams DH. Primary sclerosing cholangitis. Lancet. 2013;382:1587–99. https://doi.org/10.1016/S0140-6736(13)60096-3 .
doi: 10.1016/S0140-6736(13)60096-3
pubmed: 23810223
Hildebrand T, Pannicke N, Dechene A, Gotthardt DN, Kirchner G, Reiter FP, et al. Biliary strictures and recurrence after liver transplantation for primary sclerosing cholangitis: a retrospective multicenter analysis. Liver Transpl. 2016;22:42–52. https://doi.org/10.1002/lt.24350 .
doi: 10.1002/lt.24350
pubmed: 26438008
Dyson JK, Beuers U, Jones DEJ, Lohse AW, Hudson M. Primary sclerosing cholangitis. Lancet. 2018;391:2547–59. https://doi.org/10.1016/S0140-6736(18)30300-3 .
doi: 10.1016/S0140-6736(18)30300-3
pubmed: 29452711
Chapman R, Fevery J, Kalloo A, Nagorney DM, Boberg KM, Shneider B, Gores GJ. Diagnosis and management of primary sclerosing cholangitis. Hepatology. 2010;51:660–78. https://doi.org/10.1002/hep.23294 .
doi: 10.1002/hep.23294
EASL Clinical Practice Guidelines. management of cholestatic liver diseases. J Hepatol. 2009;51:237–67. https://doi.org/10.1016/j.jhep.2009.04.009 .
doi: 10.1016/j.jhep.2009.04.009
Ruiz A, Lemoinne S, Carrat F, Corpechot C, Chazouillères O, Arrivé L. Radiologic course of primary sclerosing cholangitis: assessment by three-dimensional magnetic resonance cholangiography and predictive features of progression. Hepatology. 2014;59:242–50. https://doi.org/10.1002/hep.26620 .
doi: 10.1002/hep.26620
Cazzagon N, Lemoinne S, El Mouhadi S, Trivedi PJ, Gaouar F, Kemgang A, et al. The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis. Am J Gastroenterol. 2019;114:1878–85. https://doi.org/10.14309/ajg.0000000000000461 .
doi: 10.14309/ajg.0000000000000461
pubmed: 31738286
Faria SC, Ganesan K, Mwangi I, Shiehmorteza M, Viamonte B, Mazhar S, et al. MR imaging of liver fibrosis: current state of the art. Radiographics. 2009;29:1615–35. https://doi.org/10.1148/rg.296095512 .
doi: 10.1148/rg.296095512
pubmed: 19959511
pmcid: 6939850
Jhaveri KS, Hosseini-Nik H, Sadoughi N, Janssen H, Feld JJ, Fischer S, et al. The development and validation of magnetic resonance elastography for fibrosis staging in primary sclerosing cholangitis. Eur Radiol. 2019;29:1039–47. https://doi.org/10.1007/s00330-018-5619-4 .
doi: 10.1007/s00330-018-5619-4
pubmed: 30051141
Hoodeshenas S, Welle CL, Navin PJ, Dzyubak B, Eaton JE, Ehman RL, Venkatesh SK. Magnetic resonance elastography in primary sclerosing cholangitis: interobserver agreement for liver stiffness measurement with manual and automated methods. Acad Radiol. 2019;26:1625–32. https://doi.org/10.1016/j.acra.2019.02.004 .
doi: 10.1016/j.acra.2019.02.004
pubmed: 30878345
Hoodeshenas S, Yin M, Venkatesh SK. Magnetic resonance elastography of liver: current update. Top Magn Reson Imaging. 2018;27:319–33. https://doi.org/10.1097/RMR.0000000000000177 .
doi: 10.1097/RMR.0000000000000177
pubmed: 30289828
pmcid: 6176736
Eaton JE, Dzyubak B, Venkatesh SK, Smyrk TC, Gores GJ, Ehman RL, et al. Performance of magnetic resonance elastography in primary sclerosing cholangitis. J Gastroenterol Hepatol. 2016;31:1184–90. https://doi.org/10.1111/jgh.13263 .
doi: 10.1111/jgh.13263
pubmed: 26691631
pmcid: 4885758
Radenkovic D, Weingärtner S, Ricketts L, Moon JC, Captur G. T1 mapping in cardiac MRI. Heart Fail Rev. 2017;22:415–30. https://doi.org/10.1007/s10741-017-9627-2 .
doi: 10.1007/s10741-017-9627-2
pubmed: 28623475
pmcid: 5487768
Li Z, Sun J, Hu X, Huang N, Han G, Chen L, et al. Assessment of liver fibrosis by variable flip angle T1 mapping at 3.0T. J Magn Reson Imaging. 2016;43:698–703. https://doi.org/10.1002/jmri.25030 .
doi: 10.1002/jmri.25030
pubmed: 26267123
Guimaraes AR, Siqueira L, Uppal R, Alford J, Fuchs BC, Yamada S, et al. T2 relaxation time is related to liver fibrosis severity. Quant Imaging Med Surg. 2016;6:103–14. https://doi.org/10.21037/qims.2016.03.02 .
doi: 10.21037/qims.2016.03.02
pubmed: 27190762
pmcid: 4858462
Luetkens JA, Klein S, Träber F, Schmeel FC, Sprinkart AM, Kuetting DLR, et al. Quantification of liver fibrosis at T1 and T2 mapping with extracellular volume fraction MRI: preclinical results. Radiology. 2018;288:748–54. https://doi.org/10.1148/radiol.2018180051 .
doi: 10.1148/radiol.2018180051
pubmed: 29944086
Moon JC, Messroghli DR, Kellman P, Piechnik SK, Robson MD, Ugander M, et al. Myocardial T1 mapping and extracellular volume quantification: a society for cardiovascular magnetic resonance (SCMR) and CMR Working Group of the European Society of Cardiology consensus statement. J Cardiovasc Magn Reson. 2013;15:92. https://doi.org/10.1186/1532-429X-15-92 .
doi: 10.1186/1532-429X-15-92
pubmed: 24124732
pmcid: 3854458
Flett AS, Hayward MP, Ashworth MT, Hansen MS, Taylor AM, Elliott PM, et al. Equilibrium contrast cardiovascular magnetic resonance for the measurement of diffuse myocardial fibrosis: preliminary validation in humans. Circulation. 2010;122:138–44. https://doi.org/10.1161/CIRCULATIONAHA.109.930636 .
doi: 10.1161/CIRCULATIONAHA.109.930636
pubmed: 20585010
Mesropyan N, Kupczyk P, Dold L, Weismüller TJ, Sprinkart AM, Mädler B, et al. Non-invasive assessment of liver fibrosis in autoimmune hepatitis: Diagnostic value of liver magnetic resonance parametric mapping including extracellular volume fraction. Abdom Radiol (NY). 2020. https://doi.org/10.1007/s00261-020-02822-x .
doi: 10.1007/s00261-020-02822-x
Mesropyan N, Isaak A, Faron A, Praktiknjo M, Jansen C, Kuetting D, et al. Magnetic resonance parametric mapping of the spleen for non-invasive assessment of portal hypertension. Eur Radiol. 2020. https://doi.org/10.1007/s00330-020-07080-5 .
doi: 10.1007/s00330-020-07080-5
pubmed: 32749584
pmcid: 7755629
Wang H-Q, Jin K-P, Zeng M-S, Chen C-Z, Rao S-X, Ji Y, et al. Assessing liver fibrosis in chronic hepatitis B using MR extracellular volume measurements: comparison with serum fibrosis indices. Magn Reson Imaging. 2019;59:39–45. https://doi.org/10.1016/j.mri.2019.03.002 .
doi: 10.1016/j.mri.2019.03.002
pubmed: 30849483
Luetkens JA, Klein S, Traeber F, Schmeel FC, Sprinkart AM, Kuetting DLR, et al. Quantitative liver MRI including extracellular volume fraction for non-invasive quantification of liver fibrosis: a prospective proof-of-concept study. Gut. 2018;67:593–4. https://doi.org/10.1136/gutjnl-2017-314561 .
doi: 10.1136/gutjnl-2017-314561
pubmed: 28754777
Corpechot C, Gaouar F, El Naggar A, Kemgang A, Wendum D, Poupon R, et al. Baseline values and changes in liver stiffness measured by transient elastography are associated with severity of fibrosis and outcomes of patients with primary sclerosing cholangitis. Gastroenterology. 2014;146:970–9; quiz e15–6. https://doi.org/10.1053/j.gastro.2013.12.030 .
Imperiale TF, Born LJ. Clinical utility of the AST/ALT ratio in chronic hepatitis C. Am J Gastroenterol. 2001;96:919–20. https://doi.org/10.1111/j.1572-0241.2001.03647.x .
doi: 10.1111/j.1572-0241.2001.03647.x
pubmed: 11280582
Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43:1317–25. https://doi.org/10.1002/hep.21178 .
doi: 10.1002/hep.21178
Li J, Gordon SC, Rupp LB, Zhang T, Boscarino JA, Vijayadeva V, et al. The validity of serum markers for fibrosis staging in chronic hepatitis B and C. J Viral Hepat. 2014;21:930–7. https://doi.org/10.1111/jvh.12224 .
doi: 10.1111/jvh.12224
pubmed: 24472062
Messroghli DR, Radjenovic A, Kozerke S, Higgins DM, Sivananthan MU, Ridgway JP. Modified look-locker inversion recovery (MOLLI) for high-resolution T1 mapping of the heart. Magn Reson Med. 2004;52:141–6. https://doi.org/10.1002/mrm.20110 .
doi: 10.1002/mrm.20110
pubmed: 15236377
Sprinkart AM, Luetkens JA, Träber F, Doerner J, Gieseke J, Schnackenburg B, et al. Gradient Spin Echo (GraSE) imaging for fast myocardial T2 mapping. J Cardiovasc Magn Reson. 2015;17:12. https://doi.org/10.1186/s12968-015-0127-z .
doi: 10.1186/s12968-015-0127-z
pubmed: 25885268
pmcid: 4326516
Schelbert EB, Messroghli DR. State of the art: clinical applications of cardiac T1 mapping. Radiology. 2016;278:658–76. https://doi.org/10.1148/radiol.2016141802 .
doi: 10.1148/radiol.2016141802
pubmed: 26885733
Singh S, Venkatesh SK, Wang Z, Miller FH, Motosugi U, Low RN, et al. Diagnostic performance of magnetic resonance elastography in staging liver fibrosis: a systematic review and meta-analysis of individual participant data. Clin Gastroenterol Hepatol. 2015;13(440–451):e6. https://doi.org/10.1016/j.cgh.2014.09.046 .
doi: 10.1016/j.cgh.2014.09.046
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.
doi: 10.2307/2531595
Khoshpouri P, Habibabadi RR, Hazhirkarzar B, Ameli S, Ghadimi M, Ghasabeh MA, et al. Imaging features of primary sclerosing cholangitis: from diagnosis to liver transplant follow-up. Radiographics. 2019;39:1938–64. https://doi.org/10.1148/rg.2019180213 .
doi: 10.1148/rg.2019180213
Kennedy P, Wagner M, Castéra L, Hong CW, Johnson CL, Sirlin CB, Taouli B. Quantitative elastography methods in liver disease: current evidence and future directions. Radiology. 2018;286:738–63. https://doi.org/10.1148/radiol.2018170601 .
doi: 10.1148/radiol.2018170601
pubmed: 29461949
pmcid: 5831316
Kovač JD, Ješić R, Stanisavljević D, Kovač B, Maksimovic R. MR imaging of primary sclerosing cholangitis: additional value of diffusion-weighted imaging and ADC measurement. Acta Radiol. 2013;54:242–8. https://doi.org/10.1177/0284185112471792 .
doi: 10.1177/0284185112471792
pubmed: 23386736
Tokgöz Ö, Unal I, Turgut GG, Yildiz S. The value of liver and spleen ADC measurements in the diagnosis and follow up of hepatic fibrosis in chronic liver disease. Acta Clin Belg. 2014;69:426–32. https://doi.org/10.1179/2295333714Y.0000000062 .
doi: 10.1179/2295333714Y.0000000062
pubmed: 25103596
Müller A, Hochrath K, Stroeder J, Hittatiya K, Schneider G, Lammert F, et al. Effects of liver fibrosis progression on tissue relaxation times in different mouse models assessed by ultrahigh field magnetic resonance imaging. Biomed Res Int. 2017;2017:8720367. https://doi.org/10.1155/2017/8720367 .
doi: 10.1155/2017/8720367
pubmed: 28194423
pmcid: 5286538
McDonald N, Eddowes PJ, Hodson J, Semple SIK, Davies NP, Kelly CJ, et al. Multiparametric magnetic resonance imaging for quantitation of liver disease: a two-centre cross-sectional observational study. Sci Rep. 2018;8:9189. https://doi.org/10.1038/s41598-018-27560-5 .
doi: 10.1038/s41598-018-27560-5
pubmed: 29907829
pmcid: 6003924
Hoy AM, McDonald N, Lennen RJ, Milanesi M, Herlihy AH, Kendall TJ, et al. Non-invasive assessment of liver disease in rats using multiparametric magnetic resonance imaging: a feasibility study. Biol Open. 2018. https://doi.org/10.1242/bio.033910 .
doi: 10.1242/bio.033910
pubmed: 29915139
pmcid: 6078340