Year: 2026
Type: preprint
Study design: Observational Study
Abstract: BACKGROUND Primary sclerosing cholangitis (PSC) is characterized by multifocal biliary strictures on MRI/MRCP. However, we have observed that young PSC patients often displayed a marked intrahepatic bile duct visibility, sometimes with gallbladder enlargement, before developing biliary strictures. This study aimed to evaluate whether this imaging pattern was associated with subsequent diagnosis of PSC. PATIENTSAND METHODS This retrospective two-center study included patients younger than 21 years who had a baseline liver MRI/MRCP, without biliary strictures. The endpoint was a definite diagnosis of large duct PSC during follow-up. The association of baseline imaging findings with the endpoint was evaluated by multivariable logistic regression, Cox models, and Kaplan-Meier analyses. RESULTS 94 patients were included: 54% women, mean age of 16, 36% with IBD. Over a mean follow-up of 7.75 years, 21 patients were subsequently diagnosed with large duct PSC after a median time of 5.60 years. Marked intrahepatic bile duct visibility and gallbladder enlargement displayed good performance to predict the subsequent diagnosis of PSC (AUC, 0.77 and 0.69, respectively). The presence of both signs displayed a specificity of 1.00. In multivariable analyses, marked intrahepatic bile duct visibility and gallbladder enlargement were independently associated with subsequent PSC diagnosis (OR, 13.35; 95% CI, 3.00– 59.41; p < 0.001 and OR, 12.36; 95% CI, 1.93–79.09; p = 0.008, respectively) and shorter time to diagnosis (HR, 6.42; 95% CI, 1.99–20.75; p = 0.002 and HR, 3.36; 95% CI, 1.22–9.27; p = 0.019, respectively). Survival analyses confirmed the association between these two imaging signs and subsequent PSC diagnosis (HR, 7.78; 95% CI, 2.62–23.16; p < 0.001 and HR, 3.85; 95% CI, 1.64–9.08; p < 0.001, respectively). CONCLUSIONS In young patients without biliary strictures, marked intrahepatic bile duct visibility and gallbladder enlargement on MRI/MRCP were strongly associated with subsequent diagnosis of large duct PSC. IMPACT AND IMPLICATIONS Diagnosis of PSC relies on the presence of multifocal biliary strictures. However, early diagnosis of PSC is crucial since it could trigger earlier and more effective therapeutic interventions. In young patients without biliary strictures, we identified two imaging signs significantly associated with the subsequent diagnosis of large duct PSC: marked intrahepatic bile duct visibility and gallbladder enlargement. These findings should encourage closer monitoring of young patients who display these imaging patterns. HIGHLIGHTS Marked intrahepatic bile duct visibility can predict the subsequent diagnosis of large duct PSC. Gallbladder enlargement can predict the subsequent diagnosis of large duct PSC. These two signs were significantly associated with subsequent diagnosis of large duct PSC.
Source: medRxiv
Institutions: Université Paris-Saclay, Sorbonne Université, Assistance Publique – Hôpitaux de Paris, Hôpital Saint-Antoine, CentraleSupélec, Inserm, Fédération Hospitalo-Universitaire, Paris Center for Microbiome Medicine, Centre de Recherche Saint-Antoine, Fondation pour l’innovation en Cadiométabolisme et Nutrition, Hôpital Paul-Brousse, Université Paris Sciences et Lettres, Institut Curie, Centre National de la Recherche Scientifique, Laboratoire d’Imagerie Biomédicale
Language: English
Topic: Liver Diseases and Immunity
Subfield: Hepatology
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7215040192