Title: ESGAR Consensus Statement on MR Imaging in Primary Sclerosing Cholangitis
Objective: To provide a consensus statement and recommendations on MR imaging in PSC relying on strong evidence on when and how to perform MRCP in PSC
Type of Study: A consensus study conducted by a panel of MRI experts from The European Society of Gastrointestinal and Abdominal Radiology
Research Institution: D. Ippolito (University of Milan, Italy; Fondazione IRCCS San Gerardo dei Tintori, Italy), C. Maino (Fondazione IRCCS San Gerardo dei Tintori); M. A. Bali (Hôpital Universitaire de Bruxelles, Belgium)
Key Results: The latest guidelines for diagnosing and monitoring PSC lack consensus on the use of MRCP in PSC. Though the advantages of using non-invasive MRCP for detecting large bile-duct changes and for cholangiocarcinoma screening have been demonstrated, systematic studies on MRCP in PSC are missing.
This critical study, which establishes MRCP as a most effective tool for PSC, was conducted by a panel of European and US PSC experts. Following a rigorous process, the authors extracted a comprehensive set of statements on the use of MRCP in PSC from existing literature and expert experience. The panel reached complete agreement on a core set of statements including the following fundamental ones:
- “MRCP is the recommended imaging modality in patients with suspected or confirmed PSC”
- “MRCP must be performed before any interventions and biliary stent placement”
- “ERCP should not be performed for the diagnosis of PSC”; and “MRCP must be considered the first-line imaging modality … for cholangitis [attacks].”
- Standardized language was established in reporting biliary strictures, such as “localized/diffused” and “low/high-grade” to describe strictures.
- An important study result is a template to regulate communication among physicians and researchers and improve quality of care.
Impact on PSC Community:
Establishing MRCP as the diagnostic/monitoring procedure of choice in PSC would reduce variability in interpretation, lead to more reliable and faster diagnosis, discourage overuse of more invasive procedures like ERCP and biopsy, enhance monitoring for cholangiocarcinoma and other PSC-related complications, and possibly lead to more confident patients receiving consistent care regardless of where they are being treated.
Practical Applications: The standardization of MRCP for PSC would allow for more consistent data collection across different centers, which can accelerate the development of new treatments and improve understanding of the disease.
