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However, high inter-observer variability limits their utility. We introduce the \u201cpotential functional stricture\u201d (PFS)\u00a0on T1-weighted hepatobiliary-phase images of gadoxetic acid-enhanced MR cholangiography (T1-MRC) to assess inter-reader agreement on diagnosis, location, and prognostic value of PFS on T1-MRC vs. DS or HGS on T2-MRCP in PSC patients, using ERCP as the gold standard.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Six blinded readers independently reviewed 129\u00a0MRIs to diagnose and locate stricture, if present. DS\/HGS was determined on T2-MRCP. On\u00a0T1-MRC, PFS was diagnosed if no GA excretion was seen in the CBD, hilum or distal RHD, or LHD.\u00a0If excretion was normal, \u201cno functional stricture\u201d (NFS) was diagnosed. T1-MRC diagnoses (NFS\u2009=\u200987; PFS\u2009=\u200942) were correlated with ERCP, clinical scores, labs, splenic volume, and\u00a0clinical events. Statistical analyses included Kaplan\u2013Meier curves and Cox regression.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Interobserver agreement was almost perfect\u00a0for NFS vs. PFS diagnosis, but fair to moderate for DS and HGS. Forty-four ERCPs in 129 patients (34.1%) were performed, 39 in PFS (92.9%), and, due to clinical suspicion, five in NFS (5.7%) patients. PFS and NFS diagnoses had 100% PPV and 100% NPV, respectively. Labs and clinical scores were significantly worse for PFS vs. NFS. PFS patients underwent more diagnostic and therapeutic ERCPs, experienced more clinical events, and reached significantly more endpoints (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001) than those with NFS.\u00a0Multivariate analysis identified PFS as an independent risk factor for liver-related events.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>T1-MRC was superior to T2-MRCP for stricture diagnosis, stricture location, and prognostication.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical relevance statement<\/jats:title>\n                <jats:p>Because half of PSC patients will develop clinically-relevant strictures over the course of the disease, earlier more confident diagnosis and correct localization of functional stricture on gadoxetic acid-enhanced MRI may optimize management and improve prognostication.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Key Points<\/jats:title>\n                <jats:p>\u2022 <jats:italic>There is no consensus regarding biliary stricture imaging features in PSC that have clinical relevance.<\/jats:italic><\/jats:p>\n                <jats:p>\u2022 <jats:italic>Twenty-minute T1-weighted MRC images correctly classified PSC patients with potential (PFS) vs with no functional stricture (NFS).<\/jats:italic><\/jats:p>\n                <jats:p>\u2022 <jats:italic>T1-MRC diagnoses may reduce the burden of diagnostic ERCPs.<\/jats:italic><\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1007\/s00330-023-09915-3","type":"journal-article","created":{"date-parts":[[2023,7,20]],"date-time":"2023-07-20T13:01:43Z","timestamp":1689858103000},"page":"9022-9037","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Diagnosis of functional strictures in\u00a0patients with primary sclerosing cholangitis using hepatobiliary contrast-enhanced MRI: a proof-of-concept study"],"prefix":"10.1007","volume":"33","author":[{"given":"Sarah","family":"Poetter-Lang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alina","family":"Messner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nina","family":"Bastati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina I.","family":"Ringe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maxime","family":"Ronot","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhakar K.","family":"Venkatesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Ambros","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"Kristic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aida","family":"Korajac","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregor","family":"Dovjak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Zalaudek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline. 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Hepatology 58:2045\u20132055","journal-title":"Hepatology"}],"container-title":["European Radiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-023-09915-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00330-023-09915-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00330-023-09915-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,23]],"date-time":"2023-11-23T17:15:43Z","timestamp":1700759743000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00330-023-09915-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,20]]},"references-count":45,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["9915"],"URL":"https:\/\/doi.org\/10.1007\/s00330-023-09915-3","relation":{},"ISSN":["1432-1084"],"issn-type":[{"value":"1432-1084","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,20]]},"assertion":[{"value":"30 September 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 April 2023","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 May 2023","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"20 July 2023","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The scientific guarantor of this publication is Dr. Ahmed Ba-Ssalamah.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Guarantor"}},{"value":"The authors of this manuscript declare relationships with the following companies:Sarah Poetter-Lang: nothing to discloseAlina Messner: nothing to discloseNina Bastati: nothing to discloseKristina I. Ring: nothing to discloseMaxime Ronot: is a member of the European Radiology Scientific Editorial Board and has not taken part in the review or selection process of this article.Sudhakar K Venkatesh: nothing to discloseRaphael Ambros: nothing to discloseAntonia Kristic: nothing to discloseAida Korajac: nothing to discloseGregor Dovjak: nothing to discloseMartin Zalaudek: nothing to discloseJacqueline C. Hodge: nothing to discloseChristoph Schramm: nothing to discloseEmina Halilbasic: nothing to discloseMichael Trauner: received grant support from Albireo, Cymabay, Falk, Gilead, Intercept, MSD, and Takeda, honoraria for consulting from BiomX, Boehringer Ingelheim, Falk, Genfit, Gilead, Intercept, Janssen, MSD, Novartis, Phenex, and Regulus, speaker fees from BMS, Falk, Gilead, Intercept, and MSD, as well as travel support from Abbvie, Falk, Gilead, and Intercept.Ahmed Ba-Ssalamah: honoraria for consulting from Bayer, speaker fees from Bayer and Siemens and SanofiNone of the fund listed for Ahmed Ba-Ssalamah and Michael Trauner pertained to this manuscript.The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}},{"value":"Dr. Michael Weber kindly provided statistical advice for this manuscript.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Statistics and biometry"}},{"value":"Retrospective analysis, informed consent waived by IRB.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Institutional Review Board approval was obtained.Ethics commission (EC), Nr: 2249\/2016 Radiologic Diagnosis of Cholestatic Liver Disease; A Retrospective Data Analysis.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"No study subjects or cohorts overlap.","order":7,"name":"Ethics","group":{"name":"EthicsHeading","label":"Some study subjects or cohorts overlap"}},{"value":"\u2022 retrospective\u2022 diagnostic or prognostic study\u2022 performed at one institution","order":8,"name":"Ethics","group":{"name":"EthicsHeading","label":"Methodology"}}]}}