Title: ESGAR Consensus Statement on MR Imaging in PSC
Background: 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.
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 Research: A consensus panel of MRI experts from Europe and the U.S. in collaboration with The European Society of Gastrointestinal and Abdominal Radiology
Key Results: These key findings establish MRCP as the most effective imaging tool for the clinical management of PSC. 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; ERCP should not be performed for the diagnosis of PSC
- MRCP must be performed before any interventions and biliary stent placement
- MRCP must be considered the first-line imaging modality for acute cholangitis attacks
- Standardized language was established in reporting biliary strictures
- A standardized template of results reporting was developed for consistent communication among clinicians to improve quality of care
Impact on PSC Community:
- Establishing MRCP as the diagnostic/monitoring procedure of choice in PSC would reduce variability in interpretation and lead to more reliable and faster PSC diagnosis and improve monitoring of PSC-related complications and cholangiocarcinoma
- This would also discourage overuse of more invasive procedures like ERCP and biopsy as standard of care
- MRCP standardization improves the consistency of result reporting across different centers and hopefully improve the overall quality of care
