An Imaging Biomarker for Assessing Hepatic Function in Patients With Primary Sclerosing Cholangitis

Area of Science:

• Hepatobiliary imaging
• Magnetic Resonance Imaging (MRI)
• Hepatocellular function assessment

Background:

• Primary sclerosing cholangitis (PSC) is a chronic liver disease affecting bile ducts.
• Assessing hepatocellular function is crucial for managing PSC and predicting outcomes.
• Hepatobiliary phase MRI offers a potential non-invasive method to evaluate liver function.

Purpose of the Study:

• To evaluate hepatobiliary phase MRI using gadoxetate disodium as a parameter for assessing hepatocellular function in PSC patients.
• To correlate MRI-derived relative enhancement values with liver function tests and clinical outcomes.

Main Methods:

• 111 PSC patients underwent MRI with gadoxetate disodium before and after contrast injection.
• Signal intensities and relative enhancement values were measured in liver segments.
• Correlations were performed with liver function tests, prognostic scores (MELD, Mayo, Amsterdam-Oxford), and clinical endpoints.

Main Results:

• Relative enhancement values showed significant correlations with liver function tests (alkaline phosphatase, bilirubin, albumin, INR) and prognostic scores (MELD, Mayo, Amsterdam-Oxford).
• MRI-measured relative enhancement correlated with clinical endpoints including cholangiocarcinoma, liver transplantation, and liver-related death.
• A cutoff relative enhancement value of 0.65 demonstrated 73.9% sensitivity and 92.9% specificity in identifying patients with clinical endpoints.

Conclusions:

• Hepatobiliary phase MRI with gadoxetate disodium is a valuable tool for assessing hepatocellular function and predicting clinical outcomes in PSC patients.
• The study highlights the potential of MRI-measured relative enhancement as a sensitive and specific marker for PSC progression.
• Further long-term, multicenter studies are recommended to validate this imaging marker.