Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis: challenging for experts to interpret

the International PSC Study Group (IPSCSG)

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: In patients with primary sclerosing cholangitis follow-up magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is performed by many centres, particularly for the early detection of biliary malignancies and strictures. Clinically meaningful MRI-based definitions of primary sclerosing cholangitis related complications are, however, lacking. Aim: To investigate how primary sclerosing cholangitis experts interpret follow-up MRI/MRCP with a focus on conclusions that may impact clinical decision-making in primary sclerosing cholangitis. Methods: Within the International Primary Sclerosing Cholangitis Study Group, an online survey on 16 real-life primary sclerosing cholangitis cases including clinical and biochemical information as well as a T2-weighted liver MRI/3D-MRCP was conducted. The interpretation of images and subsequent recommendations were assessed using a multiple-choice questionnaire. An inter-rater reliability calculation (Fleiss′ kappa) was performed and factors potentially affecting the interpretation of magnetic resonance images were analysed using generalised linear mixed-effect models. Results: Forty-four members/associates of the International Primary Sclerosing Cholangitis Study Group (median experience in the care of primary sclerosing cholangitis patients: 14 years) completed the survey. The MRI interpretation significantly varied among the participants. The lowest agreement was found with respect to the indication to perform subsequent endoscopic retrograde cholangiopancreatography (ERCP; Κ = 0.12, 95%CI 0.11-0.14). Elevated total bilirubin was the variable with the strongest effect on the rate of suspected dominant strictures, cholangiocarcinoma or ERCP recommendations. Liver cirrhosis did not prevent participants from recommending ERCP. Overall, the survey participants′ recommendations contrasted the real-life management and outcome. Conclusions: In primary sclerosing cholangitis, the interpretation of follow-up MRI/3D-MRCP significantly varies even among experts and seems to be primarily affected by bilirubin levels. Generally accepted MRI-based definitions of primary sclerosing cholangitis-related complications are urgently needed.

Original languageEnglish (US)
Pages (from-to)169-178
Number of pages10
JournalAlimentary Pharmacology and Therapeutics
Volume48
Issue number2
DOIs
StatePublished - Jul 1 2018

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Magnetic Resonance Cholangiopancreatography
Sclerosing Cholangitis
Magnetic Resonance Imaging
Endoscopic Retrograde Cholangiopancreatography
Bilirubin
Pathologic Constriction
Cholangiocarcinoma
Liver Cirrhosis
Magnetic Resonance Spectroscopy

ASJC Scopus subject areas

  • Pharmacology (medical)

Cite this

Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis : challenging for experts to interpret. / the International PSC Study Group (IPSCSG).

In: Alimentary Pharmacology and Therapeutics, Vol. 48, No. 2, 01.07.2018, p. 169-178.

Research output: Contribution to journalArticle

@article{072c3a3edf4e4781a16aac70b9e69211,
title = "Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis: challenging for experts to interpret",
abstract = "Background: In patients with primary sclerosing cholangitis follow-up magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is performed by many centres, particularly for the early detection of biliary malignancies and strictures. Clinically meaningful MRI-based definitions of primary sclerosing cholangitis related complications are, however, lacking. Aim: To investigate how primary sclerosing cholangitis experts interpret follow-up MRI/MRCP with a focus on conclusions that may impact clinical decision-making in primary sclerosing cholangitis. Methods: Within the International Primary Sclerosing Cholangitis Study Group, an online survey on 16 real-life primary sclerosing cholangitis cases including clinical and biochemical information as well as a T2-weighted liver MRI/3D-MRCP was conducted. The interpretation of images and subsequent recommendations were assessed using a multiple-choice questionnaire. An inter-rater reliability calculation (Fleiss′ kappa) was performed and factors potentially affecting the interpretation of magnetic resonance images were analysed using generalised linear mixed-effect models. Results: Forty-four members/associates of the International Primary Sclerosing Cholangitis Study Group (median experience in the care of primary sclerosing cholangitis patients: 14 years) completed the survey. The MRI interpretation significantly varied among the participants. The lowest agreement was found with respect to the indication to perform subsequent endoscopic retrograde cholangiopancreatography (ERCP; Κ = 0.12, 95{\%}CI 0.11-0.14). Elevated total bilirubin was the variable with the strongest effect on the rate of suspected dominant strictures, cholangiocarcinoma or ERCP recommendations. Liver cirrhosis did not prevent participants from recommending ERCP. Overall, the survey participants′ recommendations contrasted the real-life management and outcome. Conclusions: In primary sclerosing cholangitis, the interpretation of follow-up MRI/3D-MRCP significantly varies even among experts and seems to be primarily affected by bilirubin levels. Generally accepted MRI-based definitions of primary sclerosing cholangitis-related complications are urgently needed.",
author = "{the International PSC Study Group (IPSCSG)} and R. Zenouzi and T. Liwinski and J. Yamamura and C. Weiler-Normann and M. Sebode and S. Keller and Lohse, {A. W.} and C. Schramm and L. Aabakken and L. Arriv{\'e} and Christopher Bowlus and H. Bungay and {van Buuren}, {H. R.} and V. Cardinale and Carey, {E. J.} and O. Chazouill{\`e}res and A. Cheung and Culver, {E. L.} and Dufour, {J. F.} and Dumonceau, {J. M.} and Eaton, {J. E.} and Eddowes, {P. J.} and M. F{\"a}rkkil{\"a} and A. Floreani and I. Franceschet and Hohenester, {S. D.} and G. Kemmerich and M. Krawczyk and V. Zimmer and H. Lenzen and C. Levy and Marschall, {H. U.} and M. Marzioni and R. Motta and L. Muratori and Pereira, {S. P.} and Poley, {J. W.} and J. Rimola and Ringe, {K. I.} and S. Rushbrook and Simpson, {B. W.} and E. Schrumpf and Spina, {J. C.} and {Terziroli Beretta-Piccoli}, B. and M. Trauner and A. Tringali and Venkatesh, {S. K.} and M. Vesterhus and A. Villamil and Weism{\"u}ller, {T. J.}",
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month = "7",
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language = "English (US)",
volume = "48",
pages = "169--178",
journal = "Alimentary Pharmacology and Therapeutics",
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TY - JOUR

T1 - Follow-up magnetic resonance imaging/3D-magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis

T2 - challenging for experts to interpret

AU - the International PSC Study Group (IPSCSG)

AU - Zenouzi, R.

AU - Liwinski, T.

AU - Yamamura, J.

AU - Weiler-Normann, C.

AU - Sebode, M.

AU - Keller, S.

AU - Lohse, A. W.

AU - Schramm, C.

AU - Aabakken, L.

AU - Arrivé, L.

AU - Bowlus, Christopher

AU - Bungay, H.

AU - van Buuren, H. R.

AU - Cardinale, V.

AU - Carey, E. J.

AU - Chazouillères, O.

AU - Cheung, A.

AU - Culver, E. L.

AU - Dufour, J. F.

AU - Dumonceau, J. M.

AU - Eaton, J. E.

AU - Eddowes, P. J.

AU - Färkkilä, M.

AU - Floreani, A.

AU - Franceschet, I.

AU - Hohenester, S. D.

AU - Kemmerich, G.

AU - Krawczyk, M.

AU - Zimmer, V.

AU - Lenzen, H.

AU - Levy, C.

AU - Marschall, H. U.

AU - Marzioni, M.

AU - Motta, R.

AU - Muratori, L.

AU - Pereira, S. P.

AU - Poley, J. W.

AU - Rimola, J.

AU - Ringe, K. I.

AU - Rushbrook, S.

AU - Simpson, B. W.

AU - Schrumpf, E.

AU - Spina, J. C.

AU - Terziroli Beretta-Piccoli, B.

AU - Trauner, M.

AU - Tringali, A.

AU - Venkatesh, S. K.

AU - Vesterhus, M.

AU - Villamil, A.

AU - Weismüller, T. J.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Background: In patients with primary sclerosing cholangitis follow-up magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is performed by many centres, particularly for the early detection of biliary malignancies and strictures. Clinically meaningful MRI-based definitions of primary sclerosing cholangitis related complications are, however, lacking. Aim: To investigate how primary sclerosing cholangitis experts interpret follow-up MRI/MRCP with a focus on conclusions that may impact clinical decision-making in primary sclerosing cholangitis. Methods: Within the International Primary Sclerosing Cholangitis Study Group, an online survey on 16 real-life primary sclerosing cholangitis cases including clinical and biochemical information as well as a T2-weighted liver MRI/3D-MRCP was conducted. The interpretation of images and subsequent recommendations were assessed using a multiple-choice questionnaire. An inter-rater reliability calculation (Fleiss′ kappa) was performed and factors potentially affecting the interpretation of magnetic resonance images were analysed using generalised linear mixed-effect models. Results: Forty-four members/associates of the International Primary Sclerosing Cholangitis Study Group (median experience in the care of primary sclerosing cholangitis patients: 14 years) completed the survey. The MRI interpretation significantly varied among the participants. The lowest agreement was found with respect to the indication to perform subsequent endoscopic retrograde cholangiopancreatography (ERCP; Κ = 0.12, 95%CI 0.11-0.14). Elevated total bilirubin was the variable with the strongest effect on the rate of suspected dominant strictures, cholangiocarcinoma or ERCP recommendations. Liver cirrhosis did not prevent participants from recommending ERCP. Overall, the survey participants′ recommendations contrasted the real-life management and outcome. Conclusions: In primary sclerosing cholangitis, the interpretation of follow-up MRI/3D-MRCP significantly varies even among experts and seems to be primarily affected by bilirubin levels. Generally accepted MRI-based definitions of primary sclerosing cholangitis-related complications are urgently needed.

AB - Background: In patients with primary sclerosing cholangitis follow-up magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is performed by many centres, particularly for the early detection of biliary malignancies and strictures. Clinically meaningful MRI-based definitions of primary sclerosing cholangitis related complications are, however, lacking. Aim: To investigate how primary sclerosing cholangitis experts interpret follow-up MRI/MRCP with a focus on conclusions that may impact clinical decision-making in primary sclerosing cholangitis. Methods: Within the International Primary Sclerosing Cholangitis Study Group, an online survey on 16 real-life primary sclerosing cholangitis cases including clinical and biochemical information as well as a T2-weighted liver MRI/3D-MRCP was conducted. The interpretation of images and subsequent recommendations were assessed using a multiple-choice questionnaire. An inter-rater reliability calculation (Fleiss′ kappa) was performed and factors potentially affecting the interpretation of magnetic resonance images were analysed using generalised linear mixed-effect models. Results: Forty-four members/associates of the International Primary Sclerosing Cholangitis Study Group (median experience in the care of primary sclerosing cholangitis patients: 14 years) completed the survey. The MRI interpretation significantly varied among the participants. The lowest agreement was found with respect to the indication to perform subsequent endoscopic retrograde cholangiopancreatography (ERCP; Κ = 0.12, 95%CI 0.11-0.14). Elevated total bilirubin was the variable with the strongest effect on the rate of suspected dominant strictures, cholangiocarcinoma or ERCP recommendations. Liver cirrhosis did not prevent participants from recommending ERCP. Overall, the survey participants′ recommendations contrasted the real-life management and outcome. Conclusions: In primary sclerosing cholangitis, the interpretation of follow-up MRI/3D-MRCP significantly varies even among experts and seems to be primarily affected by bilirubin levels. Generally accepted MRI-based definitions of primary sclerosing cholangitis-related complications are urgently needed.

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U2 - 10.1111/apt.14797

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