Magnetic resonance imaging features in 283 patients with primary biliary cholangitis

Ilkay S. Idilman, Sandeep H. Venkatesh, John E. Eaton, Candice W. Bolan, Karim T. Osman, Daniel B. Maselli, Christine O. Menias, Sudhakar K. Venkatesh

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
JournalEuropean radiology
DOIs
StateAccepted/In press - Jan 1 2020

Keywords

  • Biliary cirrhosis
  • Fibrosis
  • Periportal halo sign
  • Portal hypertension
  • Splenomegaly

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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    Idilman, I. S., Venkatesh, S. H., Eaton, J. E., Bolan, C. W., Osman, K. T., Maselli, D. B., Menias, C. O., & Venkatesh, S. K. (Accepted/In press). Magnetic resonance imaging features in 283 patients with primary biliary cholangitis. European radiology. https://doi.org/10.1007/s00330-020-06855-0