Radiomics-Based Prognostication in Primary Sclerosing Cholangitis: A Proof-of-Concept Study

IF 5.2 2区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Liver International Pub Date : 2025-09-27 DOI:10.1111/liv.70348

Laura Cristoferi, Cesare Maino, Davide Paolo Bernasconi, Ilaria Ripamonti, Miki Scaravaglio, Alberto Savino, Eugenia Pesatori, Alessio Gerussi, Eugenia Nofit, Olga Falco, Daphne D'Amato, Francesca Gallivanone, Chiara Alberzoni, Raffaella Viganò, Chiara Mazzarelli, Luca Saverio Belli, Marco Emilio Dinelli, Massimiliano Mutignani, Maria Grazia Valsecchi, Rocco Corso, Pietro Invernizzi, Marco Carbone, Davide Ippolito, Elisabetta De Bernardi

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Abstract

Background and Aim

Risk assessment in primary sclerosing cholangitis (PSC) by magnetic resonance imaging (MRI) relies on semi-quantitative analysis, which can result in interpretation variability. Radiomics may offer a quantitative approach for risk stratification. This study aims to explore and validate MRI-derived radiomic features to identify high-risk PSC patients.

Methods

In this prospective study (January 2019–December 2022), consecutive PSC patients undergoing routine gadoxetate disodium-enhanced MRI were recruited. Using PyRadiomics, whole liver parenchyma features were extracted from five MRI sequences according to the Image Biomarker Standardisation Initiative (IBSI). Patients were categorised into risk groups based on the Mayo risk score (MRS) and liver stiffness measurement (LSM). Features associated with high-risk patients were selected and validated in an independent cohort. A survival analysis was conducted in the combined cohort to assess the prognostic value of the radiomic features for clinical events.

Results

One hundred and two PSC patients were enrolled in this study. Five radiomics features were associated with high risk in the training cohort. In the validation setting, GLRLM-Run Entropy in the fat-saturation T2 weighted imaging (FS-T2W) sequence was the only significant feature, with an odds ratio of 3.90 (CI 1.46–10.42, p = 0.007) for MRS and 2.97 (CI 1.33–6.66, p = 0.008) for LSM. Its prognostic potential on clinical outcome was confirmed by Cox regression analysis in the combined cohort (hazard ratio per 0.1 increase = 1.480, CI 1.226–1.786), showing excellent predictive performance (C-index = 0.857).

Conclusions

GLRLM-Run Entropy in FS-T2W is a novel radiomics-based biomarker for risk stratification in PSC patients. It is quantitative, standardised, easy to compute and cost-free, positioning it as a potential key innovation in PSC radiology-based biomarkers.

Trial Registration

Clinicaltrial.gov ID: NC705618145

Abstract Image

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基于放射学的原发性硬化性胆管炎预后：一项概念验证研究

背景与目的磁共振成像（MRI）对原发性硬化性胆管炎（PSC）的风险评估依赖于半定量分析，这可能导致解释的差异。放射组学可以为风险分层提供定量方法。本研究旨在探索和验证mri衍生的放射学特征，以识别高危PSC患者。方法在这项前瞻性研究（2019年1月- 2022年12月）中，招募了连续接受常规加多赛特二钠增强MRI检查的PSC患者。使用PyRadiomics，根据图像生物标志物标准化倡议（IBSI）从五个MRI序列中提取全肝实质特征。根据梅奥风险评分（MRS）和肝硬度测量（LSM）将患者分为风险组。选择与高危患者相关的特征，并在独立队列中进行验证。在联合队列中进行了生存分析，以评估放射学特征对临床事件的预后价值。结果共纳入102例PSC患者。5个放射组学特征与训练队列中的高风险相关。在验证设置中，脂肪饱和T2加权成像（FS-T2W）序列的GLRLM-Run熵是唯一显著特征，MRS的比值比为3.90 (CI 1.46-10.42, p = 0.007)， LSM的比值比为2.97 （CI 1.33-6.66, p = 0.008）。联合队列Cox回归分析证实了其对临床预后的预测潜力（每增加0.1风险比= 1.480,CI 1.226 ~ 1.786），具有良好的预测效果（C-index = 0.857）。结论FS-T2W的glrlm运行熵是一种新的基于放射组学的PSC患者风险分层生物标志物。它是定量的、标准化的、易于计算和免费的，将其定位为PSC放射学生物标志物的潜在关键创新。临床试验注册。gov ID: NC705618145

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来源期刊

Liver International 医学-胃肠肝病学

CiteScore

13.90

自引率

4.50%

发文量

348

审稿时长

2 months

期刊介绍： Liver International promotes all aspects of the science of hepatology from basic research to applied clinical studies. Providing an international forum for the publication of high-quality original research in hepatology, it is an essential resource for everyone working on normal and abnormal structure and function in the liver and its constituent cells, including clinicians and basic scientists involved in the multi-disciplinary field of hepatology. The journal welcomes articles from all fields of hepatology, which may be published as original articles, brief definitive reports, reviews, mini-reviews, images in hepatology and letters to the Editor.