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:
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