Early Cholangiocarcinoma Detection with Magnetic Resonance Imaging in Primary Sclerosing Cholangitis
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.
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