Diagnostic Accuracy of Magnetic Resonance and Endoscopic Retrograde Cholangiography in Primary Sclerosing Cholangitis

Berstad, A; Aabakken, Lars; Smith, Hans‐Jørgen; Aasen, Steinar; Boberg, Kirsten Muri; Schrumpf, E.

doi:10.1016/j.cgh.2005.10.007

Cited by 133 publications

(62 citation statements)

References 17 publications

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“…Conversely, the negative findings on MRCP might not completely exclude early-stage SC, because MRCP is considered by some authors of lower sensitivity than ERCP for the diagnosis of proximal bile duct lesions, even if this has not been clearly demonstrated in the field of PSC. 25,26 Bilaj et al 27 have recently documented the MRI appearance of AIH, and this report is consistent with our data. The authors observed mild IHBD dilatation in 12% of AIH patients (4/32 patients).…”

Section: Discussionsupporting

confidence: 93%

Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis

et al. 2009

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The development of sclerosing cholangitis (SC) is observed in up to 50% of children followed up for autoimmune hepatitis (AIH). In adults, the prevalence is less known, although a recent study found evidence of SC in 10% of AIH patients using magnetic resonance cholangiopancreatography (MRCP). The aim of this study was to assess prospectively the prevalence of SC in adults with AIH. Fifty-nine consecutive patients with AIH diagnosed according to International Autoimmune Hepatitis Group score (women, 71%; mean age, 48 years; cirrhosis, 23%) underwent both MRCP and percutaneous liver biopsy. Twenty-seven patients with cirrhosis of nonbiliary or non-autoimmune etiology served as controls. Fourteen AIH patients (24%) showed mild MRCP abnormalities of intrahepatic bile ducts (IHBDs). None had abnormal common bile duct or convincing evidence of SC on MRCP or biopsy. A diagnosis of overlapping SC was nevertheless retained in one patient with MRCP abnormalities who subsequently developed symptomatic cholestasis despite corticosteroid therapy. Fibrosis score was the only independent parameter associated with bile duct abnormalities on MRCP (odds ratio 2.4; 95% confidence interval 1.4-4.7) and the percentage of patients with IHBD MRCP abnormalities was not different among F3-F4 AIH patients (n ‫؍‬ 24) and cirrhotic controls (46% versus 59%; NS). Conclusion: In this cohort of adult patients with AIH, the prevalence of SC was much lower than previously reported (1.7%). Mild MRCP abnormalities of IHBD were seen in a quarter of patients, but these abnormalities resulted from hepatic fibrosis and not SC. In the absence of cholestatic presentation, MRCP screening does not seem justified in adult-onset AIH. (HEPATOLOGY 2009;50:528-537.)

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Section: Discussionsupporting

confidence: 93%

Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis

et al. 2009

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“…Two recent reports compared these two modalities head-to-head. Berstad et al [28] thought that the diagnostic accuracy of ERC and MRC were comparable, despite MRC providing a slightly poorer depiction than ERC of extrahepatic and intrahepatic ducts. They reported independent reader sensitivity and specificity rates of 80% and 87%, with an accuracy of 83% for MRC, compared to 89%, 80% and 85 % for ERC.…”

Section: Radiographymentioning

confidence: 99%

Primary sclerosing cholangitis - What is the difference between east and west?

Shorbagi¹,

Bayraktar²

2008

WJG

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Primary sclerosing cholangitis (PSC) is a chronic, progressive, cholestatic liver disease characterized by inflammation and fibrotic obliteration of the hepatic biliary tree. It is commonly associated with inflammatory bowel disease (IBD). A number of complications can occur which require special consideration, the most important of which is the development of cholangiocellular carcinoma (CCC). Unfortunately, no medical therapy is currently available for the underlying liver disease. Liver transplantation is an effective, lifeextending option for patients with advanced PSC. Geographical variations between East and West include a second peak for age with a lower association with IBD in a Japanese population and female predominance in a lone study from Turkey. The clinical and biochemical Mayo criteria may not be universally applicable, as different patients show variations regarding the initial presentation and natural course of the disease. Directing research towards explaining these geographical differences and understanding the pathogenesis of PSC is required in order to develop better therapies for this devastating disease.

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“…Although ERCP has been regarded as the standard of reference in diagnosing PSC, MRC is now recommended as first line non-invasive imaging method for patients with suspected PSC, offering comparable accuracy (except in in early stage of PSC restricted into intrahepatic bile ducts and the rare cases of contraindications to MRC) (8)(9)(10)(11)(12). A meta-analysis based on six studies using ERCP as a reference method concluded that MRC has high sensitivity and specificity (0.86 and 0.94, respectively) for the diagnosis of PSC (13).…”

Section: Esge/easl Recommend That As the Primary Diagnostic Modalitymentioning

confidence: 99%