Do hepatic and biliary functional data from gadoxetate-enhanced MRI add value in predicting outcomes in primary sclerosing cholangitis (PSC)?

Objectives : We wanted to evaluate if hepatic and biliary functional information from gadoxetate disodium-enhanced MRI is useful in assessing prognosis in PSC. Methods : In this retrospective case-controlled study, 73 patients with PSC and gadoxetate-enhanced MRI were enrolled. Four radiologists independently assessed the qualitative and quantitative MRI features. The value of these features in predicting adverse events (liver-related death, hepatic decompensation from grade III/IV hepatic encephalopathy, variceal bleeding, spontaneous bacterial peritonitis as well as need for liver transplantation) within two years of MRI were compared with radiological scores (ANALI non-gadolinium score and FLIS) as well as clinical scoring systems (Mayo Risk Score, Amsterdam-Oxford model and UK PSC score), using multivariate logistic regression and receiver operating characteristic curve analysis. Results : The cohort consisted of 42 males, 31 females with mean age of 41.9 years. In the two-year period after MRI, 26 patients had adverse evets, 8 had liver transplantation and 6 died. On multivariate analysis, only Mayo Risk Score (p=0.001), and relative enhancement of proximal extrahepatic bile ducts (REPD) (p=0.035) were significant in predicting adverse outcomes. REPD of < 4.64 had 70% sensitivity and 63% specificity in such an event. The only variable that significantly predicted liver transplantation was ANALI non-gadolinium score (p=0.0003). ANALI score of > 3 had sensitivity of 87.5% and specificity of 74.2% for predicting need for liver transplantation. Conclusions : Relative enhancement ratio of extrahepatic bile ducts at 20 minutes after gadoxetate disodium provides useful information in predicting adverse events in PSC patients and is complementary or superior to the currently-used clinical scoring systems.