Primary sclerosing cholangitis: evaluation with MR cholangiography-a case-control study.
OBJECTIVE
To determine the accuracy of magnetic resonance (MR) cholangiography for detection of primary sclerosing cholangitis (PSC) and localization of PSC in the biliary tract.


METHODS
In a prospective case-control study involving 102 patients, the MR cholangiograms obtained in 34 patients with PSC established with endoscopic retrograde cholangiopancreatography (ERCP) were compared with the MR cholangiograms obtained in 68 age-matched control patients with hepatobiliary diseases other than PSC. Two abdominal radiologists conducted an independent, blinded random review of the MR cholangiograms to assess for the presence or absence of PSC and determine the location of PSC in the biliary tract, and then compared the findings with those at ERCP.


RESULTS
MR cholangiography was found to be accurate in detecting PSC and in defining the extent of disease. In the detection of PSC, the sensitivities were 88% and 85%; specificities, 97% and 92%; positive predictive values, 94% and 85%; and negative predictive values, 94% and 93% for readers 1 and 2, respectively. Interobserver agreement was excellent (kappa = 0.79). In the localization of extrahepatic PSC, the sensitivities were 83% and 89%; and specificities, 83% and 83% for readers 1 and 2, respectively. Interobserver agreement was good (kappa = 0.62). In the localization of intrahepatic PSC, the sensitivity was 87% for both readers; interobserver agreement was good (kappa = 0.71).


CONCLUSIONS
MR cholangiography enables accurate detection and localization of PSC.
Fulcher
A S
AS
Department of Radiology, Medical College of Virginia of Virginia Commonwealth University, Main Hospital, Richmond, VA 23298, USA. asfulche@hsc.vcu.edu
Turner
M A
MA
Franklin
K J
KJ
Shiffman
M L
ML
Sterling
R K
RK
Luketic
V A
VA
Sanyal
A J
AJ
D000328:Adult; D000368:Aged; D001649:Bile Duct Diseases / Q000175:diagnosis; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D001659:Biliary Tract / Q000473:pathology; D016022:Case-Control Studies; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000175:diagnosis*; D002779:Cholestasis / Q000175:diagnosis; D016001:Confidence Intervals; D005260:Female; D006526:Hepatitis C / Q000175:diagnosis; D019693:Hepatitis, Autoimmune / Q000175:diagnosis; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008103:Liver Cirrhosis / Q000175:diagnosis; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis; D008107:Liver Diseases / Q000175:diagnosis; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D016037:Single-Blind Method