Diagnostic Tests in Primary Sclerosing Cholangitis: Serology, Elastography, Imaging, and Histology

Clin Liver Dis. 2024 Feb;28(1):157-169. doi: 10.1016/j.cld.2023.07.007. Epub 2023 Aug 12.

Abstract

Primary sclerosing cholangitis (PSC) is a chronic cholestatic liver disease characterized by progressive inflammation and fibrosis of the biliary tree leading to biliary strictures, cholangitis, and cirrhosis. Early in presentation, patients may have normal liver tests, though over time develop a cholestatic pattern of liver injury. Diagnosis is made radiographically with magnetic resonance or endoscopic cholangiography. While several autoantibodies are associated with PSC, none have proven to have adequate diagnostic utility. Liver biopsy is rarely recommended unless to evaluate for small-duct PSC or overlap syndrome. Elastography, in various forms, is an effective, non-invasive modality to evaluate liver fibrosis in PSC.

Keywords: Cholangiogram; Cholangiopathy; Cholestasis; Diagnosis; Elastography; Pathology; Primary sclerosing cholangitis.

Publication types

  • Review

MeSH terms

  • Cholangitis, Sclerosing* / complications
  • Cholestasis* / complications
  • Diagnostic Tests, Routine
  • Elasticity Imaging Techniques* / methods
  • Humans
  • Liver Cirrhosis / complications