Hepatology communications · 2025
Spatial heterogeneity in liver stiffness does not predict clinical outcomes in patients with primary sclerosing cholangitis.
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Cruz Grave Erick, Chan Connie, Corwin Michael T, Dean Richard, Dhaliwal Sandeep, Yazdanfar Maryam, Bowlus Christopher L
Аннотация
BACKGROUND: Primary sclerosing cholangitis (PSC) is a cholestatic liver disease that can cause uneven fibrosis throughout the liver. Spatial heterogeneity in liver stiffness (LS) by magnetic resonance elastography (MRE) was compared in patients with PSC and metabolic dysfunction-associated steatotic liver disease (MASLD).
METHODS: Variability of LS was defined as the difference between the maximum and minimum LS divided by the maximum LS. The coefficient of variation (CoV) was calculated as the SD of LS divided by the mean of LS. MREs were classified as homogenous or heterogenous if the variability of LS was less than or greater than the mean variability, respectively.
RESULTS: A total of 105 patients (PSC: n=66, MASLD: n=39) were included. In both PSC and MASLD, the variability of LS increased with increasing mean LS (r=0.31, p=0.01 and r=0.57, p=0.0002, respectively). CoV correlated with mean LS in patients with MASLD (r=0.34, p=0.03), but not PSC (r=0.19, p=0.12). Among patients with PSC, neither variability nor CoV of LS were predictors of transplant-free survival (TFS) or hepatic decompensation (HD). Mean LS was a significant predictor of TFS (HR 1.52, p=0.004) and HD (HR 1.94, p<0.0001), independent of LS variability or CoV.
CONCLUSIONS: Spatial heterogeneity of LS increases with progressive disease but is not associated with clinical outcomes in PSC. Mean LS predicts clinical outcomes in patients with PSC independent of LS spatial heterogeneity.
METHODS: Variability of LS was defined as the difference between the maximum and minimum LS divided by the maximum LS. The coefficient of variation (CoV) was calculated as the SD of LS divided by the mean of LS. MREs were classified as homogenous or heterogenous if the variability of LS was less than or greater than the mean variability, respectively.
RESULTS: A total of 105 patients (PSC: n=66, MASLD: n=39) were included. In both PSC and MASLD, the variability of LS increased with increasing mean LS (r=0.31, p=0.01 and r=0.57, p=0.0002, respectively). CoV correlated with mean LS in patients with MASLD (r=0.34, p=0.03), but not PSC (r=0.19, p=0.12). Among patients with PSC, neither variability nor CoV of LS were predictors of transplant-free survival (TFS) or hepatic decompensation (HD). Mean LS was a significant predictor of TFS (HR 1.52, p=0.004) and HD (HR 1.94, p<0.0001), independent of LS variability or CoV.
CONCLUSIONS: Spatial heterogeneity of LS increases with progressive disease but is not associated with clinical outcomes in PSC. Mean LS predicts clinical outcomes in patients with PSC independent of LS spatial heterogeneity.