This article is more than 5 years old. Information may no longer be current.

MRI biomarker identifies clinical endpoints in PSC

Researchers identified a potential prognostic biomarker for patients with primary sclerosing cholangitis using magnetic imaging resonance-measured relative enhancement with a hepatocyte-specific contrast agent, according to a recently published study.

“Biomarkers that reflect PSC disease severity in an individual patient are desperately needed for both, daily clinical practice, and as surrogate endpoints and stratification tools in clinical trials,” Jennifer Schulze, from the Hannover Medical School in Germany, and colleagues wrote. “With the advance of hepatocyte-specific contrast agents, namely Gd-EOB-DTPA (gadoxetate disodium), it recently has been discussed that quantitative MRI may have the potential to provide valuable prognostic information in patients with PSC, providing important structural as well as functional information.”

To evaluate the potential of hepatobiliary phase MRI as a novel prognostic biomarker in patients with PSC, Schulze and colleagues enrolled 111 patients with PSC, all of whom except one had large duct PSC.

Liver function tests correlated significantly with signal intensity and with relative enhancement of liver parenchyma at hepatobiliary phase imaging 20 minutes (HBP1) and 120 minutes after contrast injection (HBP2).

The strongest correlations were between relative enhancement at HBP1 and the following surrogate parameters for PSC clinical outcome: alkaline phosphatase (r = –0.636; P < .0001), bilirubin (r = –0.646; P < .0001), albumin (r = 0.538; P < .0001) and international normalized ratio (r = –0.456; P < .0001).

Additionally, the researchers observed a significant negative correlation of relative enhancement at both HBP1 and HBP2 with MELD score (r = –0.587 and r = –0.51, respectively; P < .0001 for both) and relative enhancement with Mayo risk score (r = –0.535 and r = –0.501, respectively; P < .0001 for both).

During a mean follow-up of 547 days, 21 patients presented clinical endpoints including cholangiocarcinoma, liver transplantation and liver-related death. Relative enhancement at HBP1 correlated significantly with all three clinical endpoints (P < .05). Relative enhancement at HBP2 correlated with liver transplantation (P = .003). A relative enhancement cutoff of 0.65 identified patients with clinical endpoints with 73.9% sensitivity and 92.9% specificity (AUROC = 0.901; P < .0001).

“We demonstrated that MRI in the hepatobiliary phase allows for calculation of quantitative liver parenchyma parameters after injection of a hepatocyte-specific contrast agent,” Schulze and colleagues wrote. “Its role as a long-term prognostic biomarker needs to be addressed in future studies.” – by Talitha Bennett

Disclosure: Schulze reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.