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 25 February 2018

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News

Techniques for accurate diagnosis of primary sclerosing cholangitis

This month's Clinical Gastroenterology & Hepatology shows that magnetic resonance cholangiography and endoscopic retrograde cholangiography performed equally well in the accurate diagnosis of primary sclerosing cholangitis.

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Dr Audun Berstad and colleagues from Norway evaluated the accuracy, and interobserver variability of 2 techniques in the diagnosis of primary sclerosing cholangitis.

The research team compared magnetic resonance cholangiography with endoscopic retrograde cholangiography.

The team performed magnetic resonance cholangiography at 1.5 T with thin- and thick-slice breath-hold technique in 66 adult patients, of which 26 were women.

The median age of the patients was 44 years, and they presented with an appropriate spectrum of hepatobiliary diseases.

Maximum intensity projection images were reconstructed from the thin slices.

Endoscopic retrograde cholangiography was performed within 48 hours of the magnetic resonance examination.

The reference standard of primary sclerosing cholangitis diagnosis was based on a combination of clinical features and cholestatic biochemical profile.

The team used typical abnormal findings of endoscopic retrograde cholangiography and/or magnetic resonance cholangiography.

These were supported by liver histology findings.

The images were retrospectively analyzed by 2 independent reviewers who were unaware of the final diagnoses.

Endoscopic retrograde cholangiography had an accuracy of 85%
Clinical Gastroenterology & Hepatology

The researchers diagnosed primary sclerosing cholangitis in 59% of patients.

Magnetic resonance cholangiography provided comparable and poorer depiction than endoscopic retrograde cholangiography of extrahepatic and intrahepatic ducts, respectively.

However, the the team noted that diagnostic accuracy of endoscopic retrograde cholangiography and magnetic resonance cholangiography were comparable.

In the magnetic resonance cholangiography detection of primary sclerosing cholangitis, the average sensitivity of 2 independent readers was 80%.

The research team noted that with magnetic resonance, specificity was 87%, and the accuracy was 83%.

The corresponding values for endoscopic retrograde cholangiography were a sensitivity of 89%, a specificity of 80%, and an accuracy of 85%.

The researchers found that interobserver agreement for the diagnosis of primary sclerosing cholangitis was good for magnetic resonance cholangiography.

Interobserver agreement for endoscopic retrograde cholangiography was excellent.

Dr Berstad's team concluded, “Primary sclerosing cholangitis can be diagnosed with high accuracy and good interobserver agreement.”

“Magnetic resonance cholangiography and endoscopic retrograde cholangiography performed equally well in the diagnosis of primary sclerosing cholangitis when used blinded to clinical information.”

Clin Gastroenterol Hepatol 2006: 4(4): 514-20
19 April 2006

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