Quantitative Magnetic Resonance Imaging in Biliary Disease: Health Economics Study

Biliary diseases are hard to diagnose and monitor, resulting in patient anxiety. There is an increasing incidence of biliary diseases, due in part to increasing levels of obesity, leading to increasing incidence of mortality. To date, there are no biomarkers for biliary diseases. We aim to redress this situation via a novel quantitative imaging technology, MRCP+.


Chronic inflammation of the biliary ducts leads to hardening, obstruction, and eventual destruction, particularly in primary sclerosing cholangitis (PSC), a chronic, immune-mediated biliary disease. Currently, liver transplantation is the only proven life-extending intervention. PSC is designated an "orphan" disease (low incidence), however drug development has proved unsuccessful to date due to a lack of a reliable clinical endpoint. Post-transplant biliary complications remain a major cause of morbidity and mortality for all liver transplantations (approximately 14,000 per year in US/Europe).


Currently, an invasive endoscopic procedure, ERCP, is a recommended modality for assessment of biliary disease, though ERCP is invasive and associated with significant risks of morbidity. This has encouraged take-up of MRI-based MRCP, which is non-invasive. Unfortunately, the advantages of MRCP are frustrated by its current limitations, a situation that this project aims to transform.


A position statement from the International PSC Study Group outlines areas of unmet need for imaging techniques in PSC, including (1) early detection of disease, (2) the determination of disease stage, activity and prognosis, (3) a clinically meaningful definition of dominant bile duct stenosis, and (4) the early detection of cholangiocarcinoma. A recent survey by PSC Support highlighted that patients experience significant anxiety due to the uncertainties surrounding the prognostics limitations. Thus, there is a clear need for effective, non-invasive staging and monitoring of disease progression in PSC and related biliary diseases.


Perspectum was spun out of the University of Oxford with the express aim to develop and commercialise technology for liver disease applications and its flagship product, LiverMultiScan, has been successfully adopted worldwide. Its newer product, MRCP+, is the only image processing software to enhance and quantify MRCP images. We aim to gather evidence in support of MRCP+ to enable it to be deployed clinically throughout the world.