title: Radiologic course of primary sclerosing cholangitis: assessment by three-dimensional magnetic resonance cholangiography and predictive features of progression.
abstract: Magnetic resonance imaging (MRI) with magnetic resonance cholangiography (MRC) has become the radiologic standard of reference for diagnosis of primary sclerosing cholangitis (PSC). However, natural history of radiologic features of PSC is poorly known. In the current study, we aimed at analyzing the course of PSC using three-dimensional (3D) MRC and liver MRI to find predictive radiologic features of progression. PSC patients, followed up in our center, with at least two 3D MRCs performed in at least a 1-year interval, were retrospectively reviewed. We built an interpretation standard model to score precisely bile ducts and liver parenchyma features. The primary endpoint was overall radiologic course, including worsening, improvement, or stabilization. Radiologic features were analyzed by logistic regression. We reviewed 289 MRIs from 64 patients upon a mean radiologic follow-up of 4 years (range, 1-9). Radiologic features worsened in 37 patients (58%) and stabilized in 27 (42%); no patient showed improvement. Multivariate analysis resulted in two MRI progression risk scores, based on the combination of predictive radiologic features (score without gadolinium administration = 1 × dilatation of intrahepatic bile ducts + 2 × dysmorphy + 1 × portal hypertension; score with gadolinium administration = 1 × dysmorphy + 1 × parenchymal enhancement heterogeneity). These scores were associated with radiologic progression, with an area under the curve of 80 and 83% ± 4%.
  
  
  CONCLUSIONS
  A majority of PSC patients develop radiologic aggravation upon MRI over 4 years. Two simple scores can predict radiologic progression.
authors.affiliation: APHP, Service de radiologie, Hôpital Saint Antoine, Paris, France and Université Pierre et Marie Curie (UPMC, Paris VI), Paris, France.
authors.forename: Ana
authors.initials: A
authors.lastname: Ruiz
authors.forename: Sara
authors.initials: S
authors.lastname: Lemoinne
authors.forename: Fabrice
authors.initials: F
authors.lastname: Carrat
authors.forename: Christophe
authors.initials: C
authors.lastname: Corpechot
authors.forename: Olivier
authors.initials: O
authors.lastname: Chazouillères
authors.forename: Lionel
authors.initials: L
authors.lastname: Arrivé
mesh_terms: D000328:Adult; D000465:Algorithms; D001659:Biliary Tract / Q000473:pathology*; D015209:Cholangitis, Sclerosing / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D005682:Gadolinium; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D012189:Retrospective Studies
chemical_list: D005682:Gadolinium