Imaging

Primary Sclerosing Cholangitis

Preliminary Diagnosis: Primary Sclerosing Cholangitis (PSC)

I. What imaging technique is first-line for this diagnosis?

Endoscopic retrograde cholangiopancreatography (ERCP) is the first line imaging modality for biliary tree assessment in primary sclerosing cholangitis (PSC).

II. Describe the advantages and disadvantages of this technique for diagnosing primary sclerosing cholangitis (PSC).

Advantages

  • Exquisite evaluation of the intrahepatic and extrahepatic biliary ducts (high spatial resolution).

  • Interventional procedures can be performed during the study (dilation, stenting, gallstone removal, and brushing).

Disadvantages

  • Invasive.

  • Exposure to ionizing radiation.

  • Post-ERCP pancreatitis.

III. What are the contraindications for the first-line imaging technique?

  • Known prior anaphylaxis toiodinated contrast agents.

  • Severe coagulopathy.

IV. What alternative imaging techniques are available?

Magnetic resonance cholangiopancreatography (MRCP)

V. Describe the advantages and disadvantages of the alternative techniques for diagnosing primary sclerosing cholangitis (PSC).

Advantages

  • Non invasive.

  • Does not require contrast.

  • No exposure to ionizing radiation.

Disadvantages

  • Expensive.

  • Time consuming.

  • Requires significant patient cooperation to minimize motion artifact.

VI. What are the contraindications for the alternative imaging techniques?

  • Contraindicated in patients with non-MR compatible metallic (ferromagnetic) hardware or foreign bodies.

  • Contraindicated in patients who are uncooperative or claustrophobic.

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