The role of magnetic resonance imaging and endoscopic retrograde cholangiography in the evaluation of disease activity and severity in primary sclerosing cholangitis

Andrea Tenca; Harri Mustonen; Kati Lind; Eila Lantto; Kaija-Leena Kolho; Sonja Boyd; Johanna Arola; Kalle Jokelainen; Martti Färkkilä

doi:10.1111/liv.13899

The role of magnetic resonance imaging and endoscopic retrograde cholangiography in the evaluation of disease activity and severity in primary sclerosing cholangitis

Liver Int. 2018 Dec;38(12):2329-2339. doi: 10.1111/liv.13899. Epub 2018 Jul 18.

Authors

Andrea Tenca¹, Harri Mustonen², Kati Lind³, Eila Lantto³, Kaija-Leena Kolho⁴, Sonja Boyd⁵, Johanna Arola⁵, Kalle Jokelainen¹, Martti Färkkilä¹

Affiliations

¹ Department of Medicine, Clinic of Gastroenterology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
² Department of Surgery, Helsinki University, Helsinki, Finland.
³ Medical Imaging Centre, Helsinki University and Helsinki University Hospital, Helsinki, Finland.
⁴ Department of Paediatric Gastroenterology, Helsinki University and Children's Hospital, Helsinki, Finland.
⁵ Department of Pathology, Helsinki University and Helsinki University Hospital, Helsinki, Finland.

PMID: 29901259
DOI: 10.1111/liv.13899

Abstract

Background & aims: Endoscopic retrograde cholangiography (ERCP) has been considered the gold standard for the diagnosis and follow-up of primary sclerosing cholangitis, but it has been replaced by less invasive magnetic resonance imaging and cholangiopancreatography (MRI-MRCP). However, the role of these two techniques in the evaluation of disease activity and severity needs to be elucidated.

Methods: Patients with primary sclerosing cholangitis (n: 48, male 31, median age: 35.7; 28.0-44.2) who underwent ERCP and MRI-MRCP within ±3 months for diagnosis or follow-up, were reviewed. ERCP and MRI-MRCP images were scored using the modified Amsterdam score. Serum and biliary cytology markers of disease activity and severity were related to the imaging findings. Agreement on the assessment of the ERCP/MRCP score was calculated by kappa-statistics. Spearman's ρ was calculated when appropriate.

Results: The agreement between ERCP and MRCP in scoring bile duct changes for disease severity was only moderate (weighted kappa: 0.437; 95% CI: 0.211-0.644 for intra- and 0.512; 95% CI: 0.303-0.720 for extra-hepatic bile ducts). ERCP and MRCP intra-hepatic scores were associated to the surrogate marker alkaline phosphatase (P = .02 for both). A weak correlation between MRCP score for extra-hepatic bile ducts and liver transplantation/death was found (Spearman's ρ = .362, 95% CI: 0.080-0.590, P = .022). A weak correlation between intra- (Spearman's ρ = .322, 95% CI: 0.048-0.551, P = .022) and extra-hepatic (Spearman`s ρ = .319, 95% CI: 0.045-0.549, P = .025) peribiliary enhancement on contrast-enhanced MRI and severity of biliary cytologic classification was found.

Conclusions: The overall agreement between ERCP and MRI-MRCP in assessing disease severity was moderate for intra- and extra-hepatic bile ducts. MRI-MRCP seems to have a minor role as surrogate marker of disease activity and progression in PSC.

Keywords: biliary brush cytology; cholangiocarcinoma; imaging; surrogate markers.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Bile Ducts / pathology*
Cholangiopancreatography, Endoscopic Retrograde*
Cholangiopancreatography, Magnetic Resonance*
Cholangitis, Sclerosing / diagnostic imaging*
Cholangitis, Sclerosing / physiopathology
Female
Finland
Humans
Liver Transplantation
Longitudinal Studies
Male
Retrospective Studies
Severity of Illness Index
Young Adult