title: Diagnosis of sclerosing cholangitis in children: blinded, comparative study of magnetic resonance versus endoscopic cholangiography.
abstract: BACKGROUND
  Magnetic resonance cholangiography (MRC) has been validated as comparable to endoscopic retrograde cholangiography (ERC) for the diagnosis of sclerosing cholangitis (SC) in adult patients. In children, MRC is widely used based mainly on non-comparative studies.
  
  
  METHODS
  ERCs and MRCs of seven children (median age 9, range: 7-20 years) with SC and 17 controls (median age 6, range: 2 months-20 years) with other chronic liver diseases were reviewed in a blinded, random and independent way. All patients underwent both examinations within a 6-months slot. All ERCs and 17 MRCs were performed under general anesthesia. One radiologist evaluated both ERCs and MRCs and one interventional endoscopist independently reviewed only ERCs. Reviewers did not receive any clinical information. Diagnosis of SC, established on the basis of history, laboratory data, radiological examinations and clinical course, was used as gold standard to compare ERC and MRC diagnostic accuracy.
  
  
  RESULTS
  Overall image quality was graded as very good in 57% of MRC and in 71% of ERC cases; difference was not statistically significant (P=0.24) although the probability for MRC to be diagnostic increased with patient's age. Depiction of first, second and fourth-order intrahepatic bile duct was better in ERC (P=0.004, 0.02 and 0.023, respectively); depiction of the extrahepatic bile duct was comparable (P=0.052). Diagnostic accuracy of MRC and ERC was very high, without statistically significant difference (P=0.61).
  
  
  CONCLUSIONS
  Despite an overall better depiction of the biliary tree by ERC, MRC is comparable for the diagnosis of SC in children. These data support MRC as the first imaging approach in children with suspected SC.
authors.affiliation: Department of Clinical and Experimental Medicine, Pediatric Gastroenterology, University of Pisa, Pisa, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Rossi
authors.forename: Marco
authors.initials: M
authors.lastname: Sciveres
authors.forename: Luigi
authors.initials: L
authors.lastname: Maruzzelli
authors.forename: Gabriele
authors.initials: G
authors.lastname: Curcio
authors.forename: Silvia
authors.initials: S
authors.lastname: Riva
authors.forename: Mario
authors.initials: M
authors.lastname: Traina
authors.forename: Fabio
authors.initials: F
authors.lastname: Tuzzolino
authors.forename: Angelo
authors.initials: A
authors.lastname: Luca
authors.forename: Bruno
authors.initials: B
authors.lastname: Gridelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Maggiore
mesh_terms: D000293:Adolescent; D017734:Bile Ducts, Extrahepatic / Q000473:pathology; D001653:Bile Ducts, Intrahepatic / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: ERC; Endoscopic retrograde cholangiography; MRC; Magnetic resonance cholangiography; ROC; Receiver operating curves; SC; Sclerosing cholangitis