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Reporting standards for primary sclerosing cholangitis using MRI and MR cholangiopancreatography: guidelines from MR Working Group of the International Primary Sclerosing Cholangitis Study Group

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A Correction to this article was published on 04 October 2021

This article has been updated

Abstract

Primary sclerosing cholangitis (PSC) is a chronic inflammatory disorder affecting the bile ducts and is characterized by biliary strictures, progressive liver parenchymal fibrosis, and an increased risk of hepatobiliary malignancies primarily cholangiocarcinoma (CCA). PSC may lead to portal hypertension, liver decompensation, and liver failure with the need for liver transplantation. Magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) are considered the imaging standard for diagnosis and follow-up in patients with PSC. Currently, there are no universally accepted reporting standards and definitions for MRI/MRCP features. Controversies exist about the definition of a high-grade stricture and there is no widely agreed approach to their management. The members of the MRI working group of the International Primary Sclerosing Cholangitis Study Group (IPSCSG) sought to define terminologies and reporting standards for describing MRI/MRCP features that would be applied to diagnosis and surveillance of disease progression, and potentially for evaluating treatment response in clinical trials. In this extensive review, the technique of MRI/MRCP and assessment of image quality for the evaluation of PSC is briefly described. The definitions and terminologies for severity and length of strictures, duct wall thickening and hyperenhancement, and liver parenchyma signal intensity changes are outlined. As CCA is an important complication of PSC, standardized reporting criteria for CCA developing in PSC are summarized. Finally, the guidelines for reporting important changes in follow-up MRI/MRCP studies are provided.

Key Points

• Primary sclerosing cholangitis is a chronic inflammatory disorder affecting the bile ducts, causing biliary strictures and liver fibrosis and an increased risk of cholangiocarcinoma.

• This consensus document provides definitions and suggested reporting standards for MRI and MRCP features of primary sclerosing cholangitis, which will allow for a standardized approach to diagnosis, assessment of disease severity, follow-up, and detection of complications.

• Standardized definitions and reporting of MRI/MRCP features of PSC will facilitate comparison between studies, promote longitudinal assessment during management, reduce inter-reader variability, and enhance the quality of care and communication between health care providers.

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Change history

Abbreviations

CCA :

Cholangiocarcinoma

DS:

Dominant stricture

EHD:

Extrahepatic ducts

ERCP :

Endoscopic retrograde cholangiopancreatography

IBD :

Inflammatory bowel disease

IHD:

Intrahepatic ducts

IPSCSG:

International Primary Sclerosing Cholangitis Study Group

LD-PSC:

Large duct primary sclerosing cholangitis

MRCP:

Magnetic resonance cholangiopancreatography

MRI:

Magnetic resonance imaging

PSC:

Primary sclerosing cholangitis

SD-PSC:

Small duct primary sclerosing cholangitis

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Acknowledgements

The authors would like to thank the members of the IPSCSG for their comments and suggestions for the manuscript

Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Division of Abdominal Imaging, Department of Radiology, Mayo Clinic, 200, First Street SW, Rochester, MN, 55905, USA

    Sudhakar K. Venkatesh & Christopher L. Welle

  2. Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Frank H. Miller

  3. Joint Department of Medical Imaging, University Health Network, University of Toronto, Toronto, ON, Canada

    Kartik Jhaveri

  4. Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany

    Kristina I. Ringe

  5. Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA

    John E Eaton

  6. Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Helen Bungay

  7. Department of Radiology, Saint-Antoine Hospital, APHP Sorbonne University, Paris, France

    Lionel Arrivé

  8. Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria

    Ahmed Ba-Ssalamah

  9. Department of Abdominal Radiology, Karolinska University Hospital, Stockholm, Sweden

    Aristeidis Grigoriadis

  10. 1st Department of Medicine, Martin Zeitz Center for Rare Diseases, and Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Christoph Schramm

  11. Department of Radiology, Virginia Commonwealth University, Richmond, VA, USA

    Ann S Fulcher

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  1. Sudhakar K. Venkatesh
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IPSCSG

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Correspondence to Sudhakar K. Venkatesh.

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The scientific guarantor of this publication is Sudhakar K. Venkatesh.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

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Venkatesh, S.K., Welle, C.L., Miller, F.H. et al. Reporting standards for primary sclerosing cholangitis using MRI and MR cholangiopancreatography: guidelines from MR Working Group of the International Primary Sclerosing Cholangitis Study Group. Eur Radiol 32, 923–937 (2022). https://doi.org/10.1007/s00330-021-08147-7

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