Follow‐up magnetic resonance imaging/3D‐magnetic resonance cholangiopancreatography in patients with primary sclerosing cholangitis: challenging for experts to interpret

Abstract

In primary sclerosing cholangitis, the interpretation of follow-up MRI/3D-MRCP significantly varies even among experts and seems to be primarily affected by bilirubin levels. Generally accepted MRI-based definitions of primary sclerosing cholangitis-related complications are urgently needed.

Magnetic Resonance Imaging in Primary Sclerosing Cholangitis—Current State and Future Directions

“…The so-called "dominant stricture" is a term derived from ERCP studies and defines strictures of the common bile duct of less than 1.5 mm and of the left or right or common hepatic duct of less than 1 mm. 40 Due to lower resolution of MRCP compared with ERCP and significant inter-observer variability in "dominant stricture" detection, 41 this definition may not be directly applicable to MRCP and an improved terminology that can be readily applied to MRCP exams is needed. Approximately 10 to 62% of patients with PSC develop a dominant stricture over time.…”

“…However, most high-volume PSC centers have taken a pragmatic approach and advocate for screening, typically with MRI/MRCP annually or every other year. 2,5,8,13,14,41 Indeed there is retrospective evidence that suggests that screening is associated with an improved survival. 57 However, this study was not designed to determine if there was any difference between US-or MRI/MRCPbased screening regimens.…”

Inter-reader agreement of interpretation of radiological course of bile duct changes between serial follow-up magnetic resonance imaging/3D magnetic resonance cholangiopancreatography of patients with primary sclerosing cholangitis

“…A recent study performed by Zenouzi et al [14] showed that inter-reader agreement between experienced clinicians of the interpretation of MRI/MRCP of PSC patients is low posing a challenge in utilization of MRI/MRCP as follow-up and/ or surveillance method. In this study, the reviewers were asked to evaluate a short liver MRI protocol composed of a T2-weighted image of the liver and a 3 D MRCP.…”

Longitudinal analysis of CA19‐9 reveals individualised normal range and early changes before development of biliary tract cancer in patients with primary sclerosing cholangitis

“…Single‐operator cholangioscopy with targeted biopsy seems the most promising approach thus far, among the endoscopy‐based screening strategies . As follow‐up imaging in PSC, it has been shown interpretation of magnetic resonance cholangiography remains challenging even among experts …”