Diagnostic yield of MRI/MRCP surveillance in detecting hepato-biliary cancer in
patients with primary sclerosing cholangitis.
Background and Aims: Primary sclerosing cholangitis (PSC) is a chronic
cholestatic disease associated with an increased risk of hepato-biliary malignancy.
Bi-annual or annual MRI / MRCP have been recommended as a surveillance strategy
in these patients however the benefit of this is unclear. Therefore we wished to
determine the diagnostic yield of six-monthly/annual MRI/ MRCP surveillance scans
in patients with PSC and examine the relationship between MRI/ MRCP results and
bilirubin/ CA-19.9 levels.
Methods: A retrospective cohort study of 89 PSC patients identified via Sir Charles
Gairdner Hospital hepatology unit and a private gastroenterologist clinical database.
Medical records and imaging results were reviewed to collect data on patient
demographics, malignancy risk factors, laboratory results and imaging surveillance
strategies.
Results: A cohort of 89 patients were included in the study, and followed up for an
average of 6.3 years. The mean age of patients was 57 years and 48% (n=43) of
these were male. A total of 52% (n=46) had inflammatory bowel disease and 58%
(n=52) were being treated with Ursodeoxycholic acid. 29% (n=26) underwent liver
transplants in the course of their follow up. 42% (n=36) of the PSC patients enrolled
in the study underwent regular MRI/MRCP surveillance scans. Four patients (4.5%)
in the non-surveillance group were diagnosed with cholangiocarcinoma (7.5%)
(table 1). At the time of diagnosis of cholangiocarcinoma on MRI, this was
associated with an elevated bilirubin and CA19.9. One patient in the surveillance
cohort was diagnosed with an enhancing gall-bladder polyp on MRI which
demonstrated with high-grade dysplasia on removal.
Age
Gender (males)
Bilirubin at diagnosis
Alkaline phosphatase
Duration of follow up
Inflammatory bowel disease
Liver Transplants
Ursodeoxycholic acid
Cholangiocarcinoma
Colorectal carcinoma
Gall bladder polyp (HGD)
MRI/MRCP
surveillance (n=36)
No surveillance
(n=53)
P value
42 (17) years
47% (n=18)
33 (44)
337 (240)
6.4 (5) years
53 % (n=19)
33% (n=12)
80% (n=29)
n=0
n=0
n = 1 (3%)
46 (17) years
50% (n=25)
25 (42)
337 (425)
6.2 (4.8)
51% (n=27)
26% (n =14)
43 % (n=23)
n = 4 (7.5%)
n = 2 (3.6%)
n=0
0.3
0.6
0.4
0.9
0.8
0.9
0.6
<0.05
0.1
0.5
0.4
Table 1: Patient demographics and MRI results in surveillance group versus none.
Variables presented as mean (standard deviation) or percentage (number).
Conclusion: A MRI/MRCP surveillance strategy for hepato-biliary cancer in PSC
patients was not associated with improved detection of malignancy.