Primary sclerosing cholangitis: Evaluation with MR cholangiography - A case-control study

PURPOSE: To determine the accuracy of magnetic resonance (MR) cholangiograp hy for detection of primary sclerosing cholangitis (PSC) and localization o f PSC in the biliary tract. MATERIALS AND METHODS: In a prospective case-control study involving 102 pa tients, the MR cholangiograms obtained in 34 patients with PSC established with endoscopic retrograde cholangiopancreatography (ERCP) were compared wi th the MR cholangiograms obtained in 68 age-matched control patients with h epatobiliary diseases other than PSC. Two abdominal radiologists conducted an independent, blinded random review of the MR cholangiograms to assess fo r the presence or absence of PSC and determine the location of PSC in the b iliary tract, and then compared the findings with those at ERCP. RESULTS: MR cholangiography was found to be accurate in detecting PSC and i n defining the extent of disease. In the detection of PSC, the sensitivitie s 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%; a nd specificities, 83% and 83% for readers 1 and 2, respectively. Interobser ver 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). CONCLUSION: MR cholangiography enables accurate detection and localization of PSC.