Diagnosing PSC

How PSC is diagnosed and the tests used to make the right diagnosis

How is PSC diagnosed?

There is no single diagnostic blood test for PSC.

This means that your doctors need to piece together clues from your medical history, blood tests, symptoms and scans to make a diagnosis.

 

Dr James Ferguson explains how PSC is diagnosed:

The diagnosis often comes unexpectedly after your routine blood tests for IBD suggest bile duct injury 10. In other cases, people suffer with fatigue or feel generally unwell, or may show signs of liver disease such as itch or jaundice, which triggers investigations to identify the cause.

Where there is any doubt about your PSC diagnosis, you should ask to be referred to a hospital or doctor with experience or an interest in PSC.

 

Blood tests

Investigations often begin following liver blood test results showing a pattern of damage indicating injury to the biliary tree 52.

However, because liver blood tests look normal in some people with PSC 2,10, blood tests alone cannot be used to diagnose it or rule it out.

Medical history

Your doctor will also consider other factors, such as whether or not you have inflammatory bowel disease (IBD) or other autoimmune diseases. Around 70%-80% of people with PSC have IBD, and its presence is a strong indicator to check for PSC 1,52. Furthermore, nearly a quarter will have or develop another autoimmune condition 46.

 

Imaging

If your doctor suspects PSC, you will be asked to have a type of MRI scan called an MRCP scan. An MRCP looks closely at your bile ducts. It is the gold standard and the test of choice for diagnosing PSC 2,59. If you have PSC, MRCP will typically show an irregular biliary tree, with a beaded appearance characterised by strictures and dilatations.

Liver biopsy (if necessary)

Where the MRCP shows a typical appearance for PSC, a liver biopsy is rarely undertaken. However, occasionally a biopsy is taken when small duct PSC, IgG4-sclerosing cholangitis or autoimmune hepatitis is suspected 10,106.

Just diagnosed?

Now you will undergo routine care and monitoring to look after you and manage any symptoms you may have.

Is it definitely PSC?

Once PSC is diagnosed, your doctor will check blood tests to rule out IGg4-associated cholangitis 1,59 and sometimes cholangiocarcinoma as these can mimic and/or complicate PSC 10.

Next steps

Just diagnosed?

10 things you need to know first about PSC

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