Magnetic resonance cholangiography may have less accuracy for the diagnosis of the severity of primary sclerosing cholangitis than endoscopic retrograde cholangiography.
Dr Stephen Moff determined the diagnostic accuracy and interobserver agreement of both techniques in primary sclerosing cholangitis.
The team assessed 36 patients with primary sclerosing cholangitis and 51 controls.
The patients were evaluated in an independent, blinded, and random fashion by 2 magnetic resonance radiologists, and 2 interventional endoscopists.
These readers had no access to clinical history, laboratory results, or patient mix.
|Visualizations were excellent in 86% of 74% of endoscopic retrograde cholangiographies|
The team found that extrahepatic ductal and intrahepatic ductal visualization was excellent in 64% of 66% of magnetic resonance cholangiographies.
The researchers found these visualizations were excellent in 86% of 74% of endoscopic retrograde cholangiographies.
Sensitivity for diagnosis of primary sclerosing cholangitis for readers 1 to 4 were 91% and 85%, 88% and 90%, respectively.
The team noted that the specificity for diagnosing primary sclerosing cholangitis for readers 1 to 4 were 81% and 96%, and 83% and 96%. respectively.
Receiver operating curve values were excellent for all readers.
Interobserver agreement for diagnosising primary sclerosing cholangitis and identifying the presence of intrahepatic ductal strictures was good for both modalities.
Only endoscopic retrograde cholangiography was good for the presence and the severity of extrahepatic ductal strictures.
When assessment of disease severity was limited to patients with primary sclerosing cholangitis, interobserver agreement was very poor for techniques.
The team reported that the retrospective case-control study made it difficult to assess the impact of the diagnosis on patient management.
Dr Moff's team concludes, “Endoscopic retrograde cholangiography and magnetic resonance cholangiography were comparable for diagnosing primary sclerosing cholangitis.”
“There was very good interobserver agreement for the diagnosis of primary sclerosing cholangitis and intrahepatic ductal strictures.”
Only endoscopic retrograde cholangiography had good agreement for extrahepatic ductal strictures.”
“Interobserver agreement was very poor for both magnetic resonance cholangiography and endoscopic retrograde cholangiography when disease severity of primary sclerosing cholangitis was assessed.”