MRCP scan- PSC or not?

Hi all,

I just had an MRCP and the conclusion suggests PSC but my specialist doesn’t agree. He said it might be cholangitis caused by something else. I’ve detailed the MRCP conclusion at the bottom of this message and would like to know if the results are similar to anyone else with a PSC diagnosis. Perhaps small duct PSC?

I had my gallbladder removed in December 2017 - although the MRCP shows something unclear in that region.
I have mild Chron’s disease

My LFTs have been abnormal for 2.5 years but normalise (apart from GGT) with urso. I recently stopped urso and went on vancomycin 3 weeks ago. My latest LFTs are:
ALT: 132 (normal: 5 - 30)
AST: 64 (normal 10 - 30)
ALP: 251 (normal 20 to 90)
GGT: 460 (normal 10 to 35)

My MRCP concludes:
Some smooth dilatation of the small bile ducts in the liver periphery, with some subtle irregularity of the central ducts about the porta hepatis. The central ducts are also showing some delayed contrast enhancement in their walls.

No focal bile duct dilatation, no calculi detected.

Difficult to see the gallbladder but there is a probable calculus in the region of the expected neck of the gallbladder (15 mm)

The appearances favour cholangitis affecting the central bile ducts about the porta hepatis and are more in keeping with PSC than pyogenic cholangitis. IgG4 cholangitis may also need to be considered.

More detail on the report:
Biliary Tree:

There is some peripheral small duct dilatation within the hepatic parenchyma. These ducts are smooth walled.

However in the region of the porta hepatis and main right and left hepatic ducts there is some subtle ductal irregularity

The common bile duct is not dilated. It is smooth in contour.

No focal bile duct dilatation, no intraductal calculi or filling defect seen.

No enhancing hepatic mass lesion seen in either the arterial or portal venous phases of contrast enhancement

There is some subtle enhancement in the walls of the bile ducts about the porta hepatis on the delayed phase following contrast

Common Bile duct = 5 mm.

No evidence of intra-ductal calculi or bile duct strictures.


The liver is normal in overall size and contour with no nodularity of the liver surface. No focal segmental atrophy.

No liver parenchymal signal abnormality or mass lesion.

Any help would be appreciated. Thanks! Emma

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After my son had his 1st MRCP, that also suggested “probable PSC”, he then had a liver biopsy to confirm. After the biopsy my son was then “officially” diagnosed with PSC. Because he was young, 17, and didn’t have the “usual” problems that seem to come along w/PSC; i.e.- UC, Chron’s, etc., the Dr treated him for “Autoimmune Sclerosing Cholangitis” first. They put him on an immune suppressant called Azathioprine. If your liver reacts by your lab numbers coming down, then you have the Autoimmune, ASC…if you have the Primary, PSC, then your labs don’t react at all to this medicine. He’s been on this drug for almost 3 years and it has helped his liver tremendously!!! Although, shuting your immune system down can create an entirely different set of problems. For example, 4 months into taking this medication he ended up being hospitalized for 6 days w/pneumonia that they had trouble getting under control! To date though, that’s been the only time he’s gotten so sick due to the medication. He’s never been on the Vanco or Urso, just the immune suppressant. I’m not sure how the Dr determined that his was being caused by his immune system vs. just having this bad gene. I think the Dr just decided to see if his liver would react to the medication.
Sorry, I don’t know if this was any help or not, but it’s worth asking your Dr about. From what I was told, if you have to have PSC, the Autoimmune one is “easier” to treat and keep under control, then the Primary.
Take care,

Hi Lisa, thanks this is helpful. Is it possible you are talking about IgG4 sclerosing? I’m a bit frustrated as I’m still unsure about my diagnosis and the health system takes ages. I had a stent put into my common bile duct last May but it now seems that I may have had post-cholecysectomy syndrome. We still haven’t discovered the initial cause of my abnormal liver functions tests that existed before the cholecystectomy (gallbladder removal) and seem to persist 2.5 years later. It could be small duct psc or not. I am on vanco at the moment but so far it has not had an impact so will up the dose and continue for another month. Urso worked for me. I’m really grateful for this group. :-).