Early Cholangiocarcinoma Detection with Magnetic Resonance Imaging in Primary Sclerosing Cholangitis

Oct 5, 2020 | Konstantinos N. Lazaridis, M.D. | @klazaridis

Early detection of perihilar cholangiocarcinoma (CCA) among patients with primary sclerosing cholangitis (PSC) is important to identify those patients eligible for curative therapy. In a recent study published in Hepatology, Eaton et al., examined the diagnostic performances and prognostic implications of MRI and ultrasound based CCA detection. The study included 266 adults with PSC (CCA n=120) who underwent both an ultrasound and MRI within 3 months. Images were re-examined by radiologists who were blinded to the clinical information. Respectively, MRI had a higher area under the curve compared to ultrasound for CCA detection: 0.87 vs 0.70 entire cohort; 0.81 vs 0.59 asymptomatic; 0.88 vs 0.71 listed for CCA transplant protocol. Among those with asymptomatic CCA, MRI detection (compared to ultrasound) was associated with reduction in both mortality (hazard ratio [HR], 0.10; 95% CI, 0.01-0.96) and CCA progression after transplant listing (HR 0.10; 95%CI, 0.01-0.90). These benefits continued among patients who had annual monitoring and PSC for more than 1 year before CCA was diagnosed. The authors concluded that MRI is superior to ultrasound for the detection of early stage CCA in patients with PSC.