Magnetic resonance imaging features in 283 patients with primary biliary cholangitis
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Published on: November 27, 2016
Ilkay S Idilman1,2, Sandeep H Venkatesh2,3, John E Eaton4
1Department of Radiology, School of Medicine, Hacettepe University, Ankara, Turkey.
Objectives:
To evaluate magnetic resonance imaging (MRI) features of the liver in primary biliary cholangitis (PBC).
Methods:
We conducted a multicenter retrospective review on 283 patients with PBC who underwent an MRI between 2007 and 2018. Patients with overlap syndromes were excluded. MRI studies were independently reviewed by two abdominal radiologists for liver morphology, signal intensity, postcontrast enhancement, and decompensation. Liver and spleen volumes and normalized liver apparent diffusion coefficient (nlADC) were also calculated. MRI features were correlated with fibrosis stage among a subset of patients who had a liver biopsy within 6 months (n = 72).
Results:
The study population was comprised of 283 patients (89% females) and a mean ± SD age of 59.4 ± 11.8 years. Lymphadenopathy (78.1%), periportal hyperintensity (36.7%), and periportal halo sign (27.6%) were the most common features. A positive correlation was found between fibrosis stage and spleen size (r = 0.457, p < 0.001), spleen volume (r = 0.557, p < 0.001) and portal vein diameter (r = 0.287, p = 0.013), and a negative correlation with nlADC (r = - 0.332, p = 0.011). Fibrosis stage also correlated with the presence of surface nodularity (p < 0.001), periportal halo sign (p = 0.04), collaterals (p = 0.033), and splenomegaly (p = 0.002). No significant differences in nlADC values were found in different fibrosis stages. Spleen size and volume were significantly higher in patients with ascites and collaterals (< 0.001). The periportal halo sign was present only in patients with significant fibrosis. None of the MRI features significantly correlated with inflammation grade.
Conclusions:
In PBC, presence of periportal halo sign correlates with significant fibrosis. Heterogeneous T2W intensity, heterogeneous postcontrast enhancement, collaterals, spleen size, and spleen volume correlate with fibrosis stage and may be useful for predicting advanced fibrosis.
Key Points:
• The presence of periportal halo sign is indicative for significant fibrosis in primary biliary cholangitis. • Liver parenchymal heterogeneous T2 signal intensity, heterogeneous postcontrast enhancement, collaterals, spleen size, and spleen volume correlate with fibrosis stages in PBC and may be useful for predicting advanced fibrosis.
Insights
Magnetic resonance imaging (MRI) can identify advanced fibrosis in primary biliary cholangitis (PBC). Features like the periportal halo sign and increased spleen size correlate with significant fibrosis, aiding in disease staging.
Area of Science:
- Hepatology
- Radiology
- Medical Imaging
Background:
- Primary biliary cholangitis (PBC) is a chronic liver disease characterized by autoimmune destruction of intrahepatic bile ducts.
- Accurate staging of liver fibrosis is crucial for prognosis and management of PBC.
- Magnetic resonance imaging (MRI) offers non-invasive assessment of liver morphology and characteristics.
Purpose of the Study:
- To evaluate the utility of various magnetic resonance imaging (MRI) features in assessing liver fibrosis in patients with primary biliary cholangitis (PBC).
- To correlate specific MRI findings with the stage of liver fibrosis in a cohort of PBC patients.
Main Methods:
- A multicenter retrospective review of 283 patients with PBC who underwent liver MRI between 2007 and 2018.
- Exclusion of patients with overlap syndromes.
- Independent review of MRI studies by two abdominal radiologists assessing liver morphology, signal intensity, enhancement, and decompensation.
- Calculation of liver and spleen volumes and normalized liver apparent diffusion coefficient (nlADC).
- Correlation of MRI features with fibrosis stage in a subset of 72 patients with liver biopsy data.
Main Results:
- Common MRI findings included lymphadenopathy (78.1%), periportal hyperintensity (36.7%), and periportal halo sign (27.6%).
- Significant positive correlations were observed between fibrosis stage and spleen size, spleen volume, and portal vein diameter.
- A negative correlation was found between fibrosis stage and normalized liver apparent diffusion coefficient (nlADC).
- Fibrosis stage correlated with surface nodularity, periportal halo sign, collaterals, and splenomegaly.
- The periportal halo sign was exclusively present in patients with significant fibrosis.
Conclusions:
- The periportal halo sign on MRI is indicative of significant fibrosis in primary biliary cholangitis.
- Heterogeneous T2W intensity, heterogeneous postcontrast enhancement, collaterals, spleen size, and spleen volume correlate with fibrosis stage.
- These MRI features may serve as valuable non-invasive markers for predicting advanced fibrosis in PBC, aiding clinical management.
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