The Prognostic Utility of Quantitative Magnetic Resonance Cholangiopancreatography in Patients With PSC: A Systematic Review With Structured Evidence Synthesis

BACKGROUND: Magnetic resonance cholangiopancreatography (MRCP) is used in the diagnosis and management of primary sclerosing cholangitis (PSC). However, MRCP is subjective, and guidelines state that there is insufficient evidence to recommend MRCP as a prognostic tool. EASL-PSC guidelines have identified quantitative MRCP (MRCP+) as having promising utility for risk assessment and prediction of clinical outcomes. We conducted a systematic review to determine the clinical utility of MRCP+ metrics for the management of patients with PSC. METHODS: We systematically searched PubMed and MEDLINE for cohort studies reporting on MRCP+ metrics associated with risk prediction, clinical outcomes, and disease progression published between January 2019 and May 2024. Studies reporting on adults with diagnosed PSC with paired MRCP were selected. There were no limitations on the type of study (retrospective/prospective). Studies reporting on only qualitative assessment of MRCP were excluded. RESULTS: Six manuscripts with 512 subjects met the study criteria. For risk prediction and disease progression, 4 articles reported 21 unique MRCP+ metrics, which were significantly associated with the Amsterdam-Oxford model and the MAYO risk score. MRCP+ metrics had AUC ranging 0.65 to 0.87 and hazard ratios ranging 0.96 to 17.79 for the prediction of adverse outcomes, including liver transplantation, death, hepatic decompensation, biliary complications, and cholangiocarcinoma. Associations between biochemical markers of liver function (alkaline phosphatase, bilirubin, aspartate aminotransferase, gamma glutamyl transferase, and albumin) ranged -0.42≤ R ≤0.48. CONCLUSION: MRCP+ metrics have clinical utility to support patient management alongside addressing key gaps, including standardising MRCP assessment, early detection of disease, and quantification of risk.