Background:
Given the strong association of inflammatory bowel disease (IBD) and primary sclerosing cholangitis (PSC), we aimed to investigate the clinical relevance of abnormal hepatobiliary findings on magnetic resonance enterography (MRE) of IBD patients considering the risk of over-or underestimation of PSC at MRE.
Methods:
Using the MRE dataset of patients referring to a Tertiary hospital and the national registry of Crohn’s and colitis, 69 Mres, including 23 IBD-PSC, 23 IBD without PSC, and 23 healthy controls, were retrospectively reviewed by two experienced radiologists blinded to the clinical data to evaluate hepatobiliary abnormalities. Sensitivity, specificity, and likelihood ratios were calculated.
Results:
Bile Duct irregularities were the most common finding in the IBD-PSC group, with a frequency of 91%. intra- and extrahepatic Bile Duct (IHBD And EHBD) irregularities were observed in 87% and 78% of PSC patients, respectively. Higher frequency of IHBD and EHBD wall thickening, Bile Duct dilation, EHBD stricture, and periportal edema were observed in the IBD-PSC group. Peribiliary T2-Weighted hyperintensities and contrast-enhancement were significantly more common in the IBD-PSC than IBD and HC groups (48% And 35%, Respectively) (P-Value<0.001). Detection of Biliary irregularities on MRE had a specificity of 94% (95% CI= 82% To 99%), a sensitivity of 91% (72% To 99%), and a positive likelihood ratio of 14.0 (95%CI= 4.7 To 42.1) for the PSC diagnosis.
Conclusions:
This study emphasizes the importance of assessing and reporting hepatobiliary abnormalities visible in MRE of patients with IBD to avoid a delayed diagnosis of PSC.