Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease marked by inflammation, fibrosis, and narrowing of the bile ducts, leading to cholestasis. Magnetic resonance cholangiopancrea-tography (MRCP) is the gold standard for the diagnosis of PSC allowing insight into biliary duct changes. The typical presentation of PSC includes multifocal anular and short-segmental strictures alternating with normal or slightly dilatated biliary ducts. Besides cholangio-graphic findings, magnetic resonance (MR) allows the assessment of liver parenchymal changes which might indicate the severity of the disease. The scoring systems based on MR findings, such as the ANA-LI score, and new computer-based software analysis termed MRCP+, provide a prediction of the course of disease and identify high-risk patients. Thus, Mr with MRCP is a promising diagnostic tool for the integrative evaluation of PSC patients allowing not only initial diagnosis and detection of complications but also has prognostic significance.