A quantitative MRCP-derived score for medium-term outcome prediction in primary sclerosing cholangitis

BACKGROUND

Magnetic resonance cholangiopancreatography (MRCP) is the gold standard for diagnosis of patients with primary sclerosing cholangitis (PSC). The semi-quantitative MRCP-derived Anali scores proposed for risk stratification, have poor-to-moderate inter-reader agreement.

AIMS

To evaluate the prognostic performance of quantitative MRCP metrics in PSC.

METHODS

This is a retrospective study of PSC patients undergoing MRCP. Images were processed using MRCP+ software (Perspectum Ltd, Oxford) that provides quantitative biliary features, semi-automatically extracted by artificial intelligence-driven analysis of MRCP-3D images. The prognostic value of biliary features has been assessed for all hepato-biliary complications.

RESULTS

87 PSC patients have been included in the analysis. Median follow-up from MRCP to event/censoring of 30.9 months (Q1-Q3=13.6-46.6). An adverse outcome occurred in 27 (31.0%) patients. The number of biliary strictures (HR=1.05 per unit, 95%CI 1.02-1.08, p < 0.0001), spleen length (HR=1.16 per cm, 95%CI 1.01-1.34, p = 0.039), adjusted for height, age at MRCP, and time from diagnosis to MRCP predicted higher risk of hepatobiliary complications. These were incorporated into a the quantitative MRCP-derived PSC (qMRCP-PSC) score (C-statistic=0.80). After 3-fold cross-validation, qMRCP-PSC outperformed the Anali score in our cohort (C-statistic of 0.78 vs 0.64) and enabled the discrimination of survival of PSC patients (log-rank p < 0.0001).

CONCLUSIONS

The qMRCP-PSC score identified patients at higher risk of hepatobiliary complications and outperformed the available radiological scores. It represents a novel quantitative biomarker for disease monitoring and a potential surrogate endpoint for clinical trials.

Rice: old or new food?

The aim of this paper is to focus the attention on the role of rice not only as food, but as a natural dietetic product. In fact, a regular intake of rice may contribute to the well-being of subjects due to the particular positive qualities of this food (high digeribility, high biological value of amino acids, high content of EFA, positive sodium/chloride rate, high content of selenium and silicium, antihypertensive effect) which have been scientifically confirmed. Stress is laid on the particular nutritional composition of rice, underlying the dietetic usefulness of this food and the new frontiers of rice as functional food.

Transverse-mode selection in apertured super-Gaussian resonators: an experimental and numerical investigation for a pulsed CO(2) Doppler lidar transmitter

A representative prototype of a high-energy, long-pulse, and narrow-bandwidth pulsed CO(2) laser suitable for a spaceborne Doppler wind lidar application has been developed. We obtained 10 J of output energy at greater than 8% efficiency in long, narrow-bandwidth, single-longitudinal, and transverse-mode pulses. We used a positive branch unstable resonator with a fourth-order super-Gaussian mirror as the output coupler. Experiments were carried out to assess the effect of intracavity hard apertures of different diameters that induce diffractive perturbation of the theoretical field and reduce the transverse-mode selectivity of the cavity. An upper limit to the choice of the mirror soft radius has been found, which allows optimization of the trade-off between laser efficiency and beam quality. We determined experimentally that a value of 0.75-0.8 for the ratio between the exp(-1) diameter of the beam intensity and the laser clear aperture gave a single-transverse-mode operation without significant loss of efficiency.