Development of a prognostic MRCP-score (DiStrict) for individuals with large-duct primary sclerosing cholangitis.

Autor:	Grigoriadis A; Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge (MedH), Karolinska Institutet, Stockholm, Sweden.; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden., Imeen Ringe K; Hannover Medical School, Department of Diagnostic and Interventional Radiology, Hannover, Germany., Bengtsson J; Department of Clinical Sciences/Division of Radiology, Lund University, Lund, Sweden.; Center for Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden., Baubeta E; Diagnostic Radiology, Department of Translational Medicine, Lund University, Skåne University Hospital, Lund, Sweden., Forsman C; Medical Imaging Centre, Uppsala University Hospital, Uppsala, Sweden., Korsavidou-Hult N; Radiology & Nuclear Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden., Rorsman F; Department of Gastroenterology and Hepatology, Uppsala University Hospital, Uppsala, Sweden., Nilsson E; Division of Gastroenterology and Hepatology, Skåne University Hospital, Lund, Sweden., Kartalis N; Department of Radiology, Karolinska University Hospital, Stockholm, Sweden.; Division of Radiology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden., Bergquist A; Unit of Gastroenterology and Rheumatology, Department of Medicine Huddinge (MedH), Karolinska Institutet, Stockholm, Sweden.; Division of Hepatology, Department of Upper GI Disease, Karolinska University Hospital, Stockholm, Sweden.
Jazyk:	angličtina
Zdroj:	JHEP reports : innovation in hepatology [JHEP Rep] 2022 Sep 22; Vol. 4 (12), pp. 100595. Date of Electronic Publication: 2022 Sep 22 (Print Publication: 2022).
DOI:	10.1016/j.jhepr.2022.100595
Abstrakt:	Background & Aims: Magnetic resonance cholangiopancreatography (MRCP) is used for the diagnosis and follow-up of individuals with primary sclerosing cholangitis (PSC). The aim of our study is to develop an MRCP-score based on cholangiographic findings previously associated with outcomes and assess its reproducibility and prognostic value in PSC. Methods: The score (DiStrict score) was developed based on the extent and severity of cholangiographic changes of intrahepatic and extrahepatic bile ducts (range 0-8) on 3D-MRCP. In this retrospective, multicentre study, three pairs of radiologists with different levels of expertise from three tertiary centres applied the score independently. MRCP examinations of 220 consecutive individuals with PSC from a prospectively collected PSC-cohort, with median follow-up of 7.4 years, were reviewed. Inter-reader and intrareader agreements were assessed via intraclass correlation coefficient (ICC). After consensus, the prognostic value of the score was assessed using Cox-regression and outcome-free survival rates were assessed via Kaplan-Meier estimates. Harrell's C-statistic was calculated. Results: Forty patients developed outcomes (liver transplantation or liver-related death). Inter-reader agreement between experienced radiologists was good (ICC 0.82; 95% CI 0.74-0.87, and ICC 0.81; 95% CI 0.70-0.87, respectively) and better than the agreement for the pair of experienced/less-experienced radiologists (ICC 0.48; 95% CI 0.05-0.72). Agreement between radiologists from the three centres was good (ICC 0.76; 95% CI 0.57-0.89). Intrareader agreement was good to excellent (ICC 0.85-0.93). Harrell's C was 0.78. Patients with a DiStrict score of 5-8 had 8.2-fold higher risk (hazard ratio 8.2; 95% CI 2.97-22.65) of developing outcomes, and significantly worse survival ( p <0.001), compared to those with a DiStrict score of 1-4. Conclusions: The novel DiStrict score is reproducible and strongly associated with outcomes, indicating its prognostic value for individuals with PSC in clinical practice. Impact and Implications: The diagnosis of primary sclerosing cholangitis (PSC) is based on magnetic resonance cholangiopancreatography (MRCP). However, the role of MRCP in the prognostication of PSC is still unclear. We developed a novel, simple, and reproducible risk-score, based on MRCP findings, that showed a strong association with prognosis in individuals with PSC (DiStrict score). This score can be easily used in clinical practice and thus has the potential to be useful in clinical trials and in patient counselling and management. Competing Interests: Kristina Imeen Ringe received an honorarium from Bayer Healthcare. Fredrik Rorsman: advisory board for Norgine, Intercept; speaker fee from Norgine, Gore; research support from Norgine, Antaros Medical, Boehringer Ingelheim Pharma GmbH & Co. Annika Bergquist has received a research grant from Gilead. Nikolaos Kartalis is a consultant speaker for Bayer. Please refer to the accompanying ICMJE disclosure forms for further details. (© 2022 The Author(s).)
Databáze:	MEDLINE
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