The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis

Nora Cazzagon; Sara Lemoinne; Sanaâ El Mouhadi; Palak J Trivedi; Farid Gaouar; Astrid Kemgang; Karima Ben Belkacem; Annarosa Floreani; Gideon Hirschfield; Yves Chretien; Chantal Housset; Raffaella Motta; Francesco P Russo; Olivier Chazouillères; Lionel Arrivé; Christophe Corpechot

doi:10.14309/ajg.0000000000000461

The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis

Nora Cazzagon
, Sara Lemoinne
, Sanaâ El Mouhadi
, Palak J Trivedi
, Farid Gaouar
, Astrid Kemgang
, Karima Ben Belkacem
, Annarosa Floreani
, Gideon Hirschfield
, Yves Chretien
, Chantal Housset
, Raffaella Motta
, Francesco P Russo
, Olivier Chazouillères
, Lionel Arrivé
, Christophe Corpechot

Immunology and Immunotherapy

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

Abstract

OBJECTIVES: Magnetic resonance (MR) risk scores and liver stiffness (LS) have individually been shown to predict clinical outcomes in primary sclerosing cholangitis (PSC). The aim of this study was to assess their complementary prognostic value.

METHODS: Patients with PSC from 3 European centers with a 3-dimensional MR cholangiography available for central reviewing and a valid LS measurement assessed by vibration-controlled transient elastography by FibroScan performed within a 6-month interval were included in a longitudinal retrospective study. The MR score (Anali) without gadolinium (Gd) was calculated according to the formula: (1 × dilatation of intrahepatic bile ducts) + (2 × dysmorphy) + (1 × portal hypertension). The primary end point was survival without liver transplantation or cirrhosis decompensation. The prognostic values of LS and Anali score without Gd were assessed using Cox proportional hazard models.

RESULTS: One hundred sixty-two patients were included. Over a total follow-up of 753 patient-years, 40 patients experienced an adverse outcome (4 liver transplantations, 6 liver-related deaths, and 30 cirrhosis decompensations). LS and Anali score without Gd were significantly correlated (ρ = 0.51, P < 0.001) and were independently associated with the occurrence of an adverse outcome. Optimal prognostic thresholds were 10.5 kPa for LS and 2 for the Anali score without Gd. Hazard ratios (95% confidence interval) were 2.07 (1.06-4.06) and 3.78 (1.67-8.59), respectively. The use in combination of these 2 thresholds allowed us to separate patients into low-, medium-, and high-risk groups for developing adverse outcomes. The 5-year cumulative rates of adverse outcome in these 3 groups were 8%, 16%, and 38% (P < 0.001), respectively.

DISCUSSION: The combined use of MRI and vibration-controlled transient elastography permits easy risk stratification of patients with PSC.

Original language	English
Pages (from-to)	1878-1885
Number of pages	8
Journal	The American Journal of Gastroenterology
Volume	114
Issue number	12
DOIs	https://doi.org/10.14309/ajg.0000000000000461
Publication status	Published - 31 Dec 2019

Keywords

Adult
Cholangiocarcinoma/epidemiology
Cholangiography
Cholangitis/mortality
Cholangitis, Sclerosing/diagnostic imaging
Comorbidity
Elasticity Imaging Techniques
Female
Humans
Inflammatory Bowel Diseases/epidemiology
Liver/diagnostic imaging
Liver Cirrhosis, Biliary/diagnostic imaging
Liver Transplantation
Magnetic Resonance Imaging
Male
Middle Aged
Prognosis
Progression-Free Survival
Risk Assessment
Shock, Septic/mortality
Vibration

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10.14309/ajg.0000000000000461Licence: None: All rights reserved

Cite this

Cazzagon, N., Lemoinne, S., El Mouhadi, S., Trivedi, P. J., Gaouar, F., Kemgang, A., Ben Belkacem, K., Floreani, A., Hirschfield, G., Chretien, Y., Housset, C., Motta, R., Russo, F. P., Chazouillères, O., Arrivé, L., & Corpechot, C. (2019). The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis. The American Journal of Gastroenterology, 114(12), 1878-1885. https://doi.org/10.14309/ajg.0000000000000461

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title = "The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis",

abstract = "OBJECTIVES: Magnetic resonance (MR) risk scores and liver stiffness (LS) have individually been shown to predict clinical outcomes in primary sclerosing cholangitis (PSC). The aim of this study was to assess their complementary prognostic value.METHODS: Patients with PSC from 3 European centers with a 3-dimensional MR cholangiography available for central reviewing and a valid LS measurement assessed by vibration-controlled transient elastography by FibroScan performed within a 6-month interval were included in a longitudinal retrospective study. The MR score (Anali) without gadolinium (Gd) was calculated according to the formula: (1 × dilatation of intrahepatic bile ducts) + (2 × dysmorphy) + (1 × portal hypertension). The primary end point was survival without liver transplantation or cirrhosis decompensation. The prognostic values of LS and Anali score without Gd were assessed using Cox proportional hazard models.RESULTS: One hundred sixty-two patients were included. Over a total follow-up of 753 patient-years, 40 patients experienced an adverse outcome (4 liver transplantations, 6 liver-related deaths, and 30 cirrhosis decompensations). LS and Anali score without Gd were significantly correlated (ρ = 0.51, P < 0.001) and were independently associated with the occurrence of an adverse outcome. Optimal prognostic thresholds were 10.5 kPa for LS and 2 for the Anali score without Gd. Hazard ratios (95\% confidence interval) were 2.07 (1.06-4.06) and 3.78 (1.67-8.59), respectively. The use in combination of these 2 thresholds allowed us to separate patients into low-, medium-, and high-risk groups for developing adverse outcomes. The 5-year cumulative rates of adverse outcome in these 3 groups were 8\%, 16\%, and 38\% (P < 0.001), respectively.DISCUSSION: The combined use of MRI and vibration-controlled transient elastography permits easy risk stratification of patients with PSC.",

keywords = "Adult, Cholangiocarcinoma/epidemiology, Cholangiography, Cholangitis/mortality, Cholangitis, Sclerosing/diagnostic imaging, Comorbidity, Elasticity Imaging Techniques, Female, Humans, Inflammatory Bowel Diseases/epidemiology, Liver/diagnostic imaging, Liver Cirrhosis, Biliary/diagnostic imaging, Liver Transplantation, Magnetic Resonance Imaging, Male, Middle Aged, Prognosis, Progression-Free Survival, Risk Assessment, Shock, Septic/mortality, Vibration",

author = "Nora Cazzagon and Sara Lemoinne and \{El Mouhadi\}, Sana{\^a} and Trivedi, \{Palak J\} and Farid Gaouar and Astrid Kemgang and \{Ben Belkacem\}, Karima and Annarosa Floreani and Gideon Hirschfield and Yves Chretien and Chantal Housset and Raffaella Motta and Russo, \{Francesco P\} and Olivier Chazouill{\`e}res and Lionel Arriv{\'e} and Christophe Corpechot",

year = "2019",

month = dec,

day = "31",

doi = "10.14309/ajg.0000000000000461",

language = "English",

volume = "114",

pages = "1878--1885",

journal = "The American Journal of Gastroenterology",

issn = "0002-9270",

publisher = "Nature Publishing Group",

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Cazzagon, N, Lemoinne, S, El Mouhadi, S, Trivedi, PJ, Gaouar, F, Kemgang, A, Ben Belkacem, K, Floreani, A, Hirschfield, G, Chretien, Y, Housset, C, Motta, R, Russo, FP, Chazouillères, O, Arrivé, L & Corpechot, C 2019, 'The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis', The American Journal of Gastroenterology, vol. 114, no. 12, pp. 1878-1885. https://doi.org/10.14309/ajg.0000000000000461

The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis. / Cazzagon, Nora; Lemoinne, Sara; El Mouhadi, Sanaâ et al.
In: The American Journal of Gastroenterology, Vol. 114, No. 12, 31.12.2019, p. 1878-1885.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis

AU - Cazzagon, Nora

AU - Lemoinne, Sara

AU - El Mouhadi, Sanaâ

AU - Trivedi, Palak J

AU - Gaouar, Farid

AU - Kemgang, Astrid

AU - Ben Belkacem, Karima

AU - Floreani, Annarosa

AU - Hirschfield, Gideon

AU - Chretien, Yves

AU - Housset, Chantal

AU - Motta, Raffaella

AU - Russo, Francesco P

AU - Chazouillères, Olivier

AU - Arrivé, Lionel

AU - Corpechot, Christophe

PY - 2019/12/31

Y1 - 2019/12/31

N2 - OBJECTIVES: Magnetic resonance (MR) risk scores and liver stiffness (LS) have individually been shown to predict clinical outcomes in primary sclerosing cholangitis (PSC). The aim of this study was to assess their complementary prognostic value.METHODS: Patients with PSC from 3 European centers with a 3-dimensional MR cholangiography available for central reviewing and a valid LS measurement assessed by vibration-controlled transient elastography by FibroScan performed within a 6-month interval were included in a longitudinal retrospective study. The MR score (Anali) without gadolinium (Gd) was calculated according to the formula: (1 × dilatation of intrahepatic bile ducts) + (2 × dysmorphy) + (1 × portal hypertension). The primary end point was survival without liver transplantation or cirrhosis decompensation. The prognostic values of LS and Anali score without Gd were assessed using Cox proportional hazard models.RESULTS: One hundred sixty-two patients were included. Over a total follow-up of 753 patient-years, 40 patients experienced an adverse outcome (4 liver transplantations, 6 liver-related deaths, and 30 cirrhosis decompensations). LS and Anali score without Gd were significantly correlated (ρ = 0.51, P < 0.001) and were independently associated with the occurrence of an adverse outcome. Optimal prognostic thresholds were 10.5 kPa for LS and 2 for the Anali score without Gd. Hazard ratios (95% confidence interval) were 2.07 (1.06-4.06) and 3.78 (1.67-8.59), respectively. The use in combination of these 2 thresholds allowed us to separate patients into low-, medium-, and high-risk groups for developing adverse outcomes. The 5-year cumulative rates of adverse outcome in these 3 groups were 8%, 16%, and 38% (P < 0.001), respectively.DISCUSSION: The combined use of MRI and vibration-controlled transient elastography permits easy risk stratification of patients with PSC.

AB - OBJECTIVES: Magnetic resonance (MR) risk scores and liver stiffness (LS) have individually been shown to predict clinical outcomes in primary sclerosing cholangitis (PSC). The aim of this study was to assess their complementary prognostic value.METHODS: Patients with PSC from 3 European centers with a 3-dimensional MR cholangiography available for central reviewing and a valid LS measurement assessed by vibration-controlled transient elastography by FibroScan performed within a 6-month interval were included in a longitudinal retrospective study. The MR score (Anali) without gadolinium (Gd) was calculated according to the formula: (1 × dilatation of intrahepatic bile ducts) + (2 × dysmorphy) + (1 × portal hypertension). The primary end point was survival without liver transplantation or cirrhosis decompensation. The prognostic values of LS and Anali score without Gd were assessed using Cox proportional hazard models.RESULTS: One hundred sixty-two patients were included. Over a total follow-up of 753 patient-years, 40 patients experienced an adverse outcome (4 liver transplantations, 6 liver-related deaths, and 30 cirrhosis decompensations). LS and Anali score without Gd were significantly correlated (ρ = 0.51, P < 0.001) and were independently associated with the occurrence of an adverse outcome. Optimal prognostic thresholds were 10.5 kPa for LS and 2 for the Anali score without Gd. Hazard ratios (95% confidence interval) were 2.07 (1.06-4.06) and 3.78 (1.67-8.59), respectively. The use in combination of these 2 thresholds allowed us to separate patients into low-, medium-, and high-risk groups for developing adverse outcomes. The 5-year cumulative rates of adverse outcome in these 3 groups were 8%, 16%, and 38% (P < 0.001), respectively.DISCUSSION: The combined use of MRI and vibration-controlled transient elastography permits easy risk stratification of patients with PSC.

KW - Adult

KW - Cholangiocarcinoma/epidemiology

KW - Cholangiography

KW - Cholangitis/mortality

KW - Cholangitis, Sclerosing/diagnostic imaging

KW - Comorbidity

KW - Elasticity Imaging Techniques

KW - Female

KW - Humans

KW - Inflammatory Bowel Diseases/epidemiology

KW - Liver/diagnostic imaging

KW - Liver Cirrhosis, Biliary/diagnostic imaging

KW - Liver Transplantation

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Progression-Free Survival

KW - Risk Assessment

KW - Shock, Septic/mortality

KW - Vibration

UR - https://www.scopus.com/pages/publications/85076123195

U2 - 10.14309/ajg.0000000000000461

DO - 10.14309/ajg.0000000000000461

M3 - Article

C2 - 31738286

SN - 0002-9270

VL - 114

SP - 1878

EP - 1885

JO - The American Journal of Gastroenterology

JF - The American Journal of Gastroenterology

IS - 12

ER -

The complementary value of magnetic resonance imaging and vibration-controlled transient elastography for risk stratification in primary sclerosing cholangitis

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Keywords

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