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Abstract：
OBJECTIVE: To explore the feasibility of pretreatment nonenhanced magnetic resonance imaging (MRI) in predicting insufficient biochemical response to ursodeoxycholic acid (UDCA) in patients with primary biliary cholangitis (PBC).
METHODS: From January 2009 to April 2022, consecutive PBC patients who were treated with UDCA and underwent nonenhanced MRI within 30 days before treatment were retrospectively enrolled. All MR images were independently evaluated by two blinded radiologists. Uni- and multivariable logistic regression analyses were performed to develop a predictive model for 12-month insufficient biochemical response. Model performances were evaluated by computing the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.
RESULTS: A total of 74 patients (50.6 ± 11.9 years; 62 females) were included. Three pretreatment MRI features, including hepatomegaly (odds ratio [OR]: 4.580; p = 0.011), periportal hyperintensity on T2-weighted imaging (T2WI) (OR: 4.795, p = 0.008), and narrowing of the bile ducts (OR: 3.491; p = 0.027) were associated with 12-month insufficient biochemical response in the multivariable analysis. A predictive model based on the above indicators had an AUC of 0.781, sensitivity of 85.4%, and specificity of 61.5% for predicting insufficient biochemical response.
CONCLUSIONS: A noninvasive model based on three pretreatment MRI features could accurately predict 12-month insufficient biochemical response to UDCA in patients with PBC. Early identification of PBC patients at increased risk for insufficient response can facilitate the timely initiation of additional treatment.
CONCLUSIONS: A noninvasive predictive model constructed by incorporating three pretreatment MRI features may help identify patients with primary biliary cholangitis at high risk of insufficient biochemical response to ursodeoxycholic acid and facilitate the timely initiation of additional treatment.
CONCLUSIONS: • Noninvasive imaging features based on nonenhanced pretreatment MRI may predict an insufficient biochemical response to UDCA in PBC patients. • A combined model based on three MRI features (hepatomegaly, periportal hyperintensity on T2-weighted imaging, and narrowing of the bile ducts) further improved the predictive efficacy for an insufficient biochemical response to UDCA in PBC patients, with high sensitivity and specificity. • The nomogram of the combined model showed good calibration and predictive efficacy for an insufficient biochemical response to UDCA in PBC patients. In particular, the calibration curve visualised the clinical applicability of the prediction model.
METHODS: From January 2009 to April 2022, consecutive PBC patients who were treated with UDCA and underwent nonenhanced MRI within 30 days before treatment were retrospectively enrolled. All MR images were independently evaluated by two blinded radiologists. Uni- and multivariable logistic regression analyses were performed to develop a predictive model for 12-month insufficient biochemical response. Model performances were evaluated by computing the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity.
RESULTS: A total of 74 patients (50.6 ± 11.9 years; 62 females) were included. Three pretreatment MRI features, including hepatomegaly (odds ratio [OR]: 4.580; p = 0.011), periportal hyperintensity on T2-weighted imaging (T2WI) (OR: 4.795, p = 0.008), and narrowing of the bile ducts (OR: 3.491; p = 0.027) were associated with 12-month insufficient biochemical response in the multivariable analysis. A predictive model based on the above indicators had an AUC of 0.781, sensitivity of 85.4%, and specificity of 61.5% for predicting insufficient biochemical response.
CONCLUSIONS: A noninvasive model based on three pretreatment MRI features could accurately predict 12-month insufficient biochemical response to UDCA in patients with PBC. Early identification of PBC patients at increased risk for insufficient response can facilitate the timely initiation of additional treatment.
CONCLUSIONS: A noninvasive predictive model constructed by incorporating three pretreatment MRI features may help identify patients with primary biliary cholangitis at high risk of insufficient biochemical response to ursodeoxycholic acid and facilitate the timely initiation of additional treatment.
CONCLUSIONS: • Noninvasive imaging features based on nonenhanced pretreatment MRI may predict an insufficient biochemical response to UDCA in PBC patients. • A combined model based on three MRI features (hepatomegaly, periportal hyperintensity on T2-weighted imaging, and narrowing of the bile ducts) further improved the predictive efficacy for an insufficient biochemical response to UDCA in PBC patients, with high sensitivity and specificity. • The nomogram of the combined model showed good calibration and predictive efficacy for an insufficient biochemical response to UDCA in PBC patients. In particular, the calibration curve visualised the clinical applicability of the prediction model.
摘要：
目的：探讨预处理非增强磁共振成像(MRI)预测原发性胆汁性胆管炎(PBC)患者熊去氧胆酸(UDCA)生化反应不足的可行性。
方法：2009年1月至2022年4月，回顾性纳入接受UDCA治疗并在治疗前30天内接受非增强MRI检查的连续PBC患者。所有MR图像均由两名盲放射科医生独立评估。进行了单变量和多变量逻辑回归分析，以建立12个月生化反应不足的预测模型。通过计算受试者工作特征曲线下面积（AUC）评估模型性能，灵敏度,和特异性。
结果：共纳入74例患者（50.6±11.9岁；62例女性）。三种预处理MRI特征，包括肝肿大（比值比[OR]：4.580；p=0.011），T2加权成像（T2WI）上的门静脉高压（OR：4.795，p=0.008），在多变量分析中,胆管狭窄(OR:3.491;p=0.027)与12个月生化反应不足相关.基于上述指标的预测模型的AUC为0.781，灵敏度为85.4%，预测生化反应不足的特异性为61.5%。
结论：基于三种预处理MRI特征的无创性模型可以准确预测PBC患者对UDCA的12个月生化反应不足。早期识别反应不足风险增加的PBC患者可以促进及时开始额外的治疗。
结论：通过结合三种预处理MRI特征构建的非侵入性预测模型可能有助于识别对熊去氧胆酸生化反应不足的高风险原发性胆汁性胆管炎患者，并促进及时开始额外治疗。
结论：•基于非增强预处理MRI的非侵入性成像特征可预测PBC患者对UDCA的生化反应不足。•基于三个MRI特征的组合模型(肝肿大，T2加权成像上的门静脉周围高强度，和胆管变窄）进一步改善了PBC患者对UDCA的生化反应不足的预测功效，具有较高的敏感性和特异性。•组合模型的列线图显示对于PBC患者中对UDCA的不足的生化反应的良好校准和预测功效。特别是,校准曲线显示了预测模型的临床适用性。
方法：2009年1月至2022年4月，回顾性纳入接受UDCA治疗并在治疗前30天内接受非增强MRI检查的连续PBC患者。所有MR图像均由两名盲放射科医生独立评估。进行了单变量和多变量逻辑回归分析，以建立12个月生化反应不足的预测模型。通过计算受试者工作特征曲线下面积（AUC）评估模型性能，灵敏度,和特异性。
结果：共纳入74例患者（50.6±11.9岁；62例女性）。三种预处理MRI特征，包括肝肿大（比值比[OR]：4.580；p=0.011），T2加权成像（T2WI）上的门静脉高压（OR：4.795，p=0.008），在多变量分析中,胆管狭窄(OR:3.491;p=0.027)与12个月生化反应不足相关.基于上述指标的预测模型的AUC为0.781，灵敏度为85.4%，预测生化反应不足的特异性为61.5%。
结论：基于三种预处理MRI特征的无创性模型可以准确预测PBC患者对UDCA的12个月生化反应不足。早期识别反应不足风险增加的PBC患者可以促进及时开始额外的治疗。
结论：通过结合三种预处理MRI特征构建的非侵入性预测模型可能有助于识别对熊去氧胆酸生化反应不足的高风险原发性胆汁性胆管炎患者，并促进及时开始额外治疗。
结论：•基于非增强预处理MRI的非侵入性成像特征可预测PBC患者对UDCA的生化反应不足。•基于三个MRI特征的组合模型(肝肿大，T2加权成像上的门静脉周围高强度，和胆管变窄）进一步改善了PBC患者对UDCA的生化反应不足的预测功效，具有较高的敏感性和特异性。•组合模型的列线图显示对于PBC患者中对UDCA的不足的生化反应的良好校准和预测功效。特别是,校准曲线显示了预测模型的临床适用性。
