MRCP Screening Reveals Unsuspected PSC in Nearly 1 in 10 Newly Diagnosed IBD Patients: CGH | September 2026

Introduction:

PSC is strongly associated with IBD, but screening is usually prompted by abnormal liver biochemistry. The Copenhagen IBD inception cohort examined how often systematic MRCP at IBD diagnosis identifies previously unsuspected PSC.

Why was this study needed?

PSC may remain clinically silent for years.

Current practice relies heavily on abnormal liver enzymes to trigger investigation.

The true prevalence of subclinical PSC in newly diagnosed IBD is uncertain.

Key Findings:

389 newly diagnosed IBD patients underwent systematic MRCP.

Radiological PSC was identified in 8.0%.

Another 1.8% had PSC-like lesions, giving an overall radiological burden of 9.8%.

Only 51.6% of patients with radiological PSC had abnormal liver biochemistry.

Thus, reliance on liver tests alone would have missed many cases.

During approximately 2 years of follow-up, radiological PSC was associated with more IBD-related hospitalization and greater biologic use.

The long-term significance of incidentally detected radiological PSC remains uncertain.

Universal MRCP screening cannot yet be recommended without data on prognosis, false positives, and cost-effectiveness.

Bottom Line:

Systematic MRCP identified unexpectedly frequent subclinical PSC in newly diagnosed IBD, often despite normal liver tests. The findings challenge LFT-based case finding but do not yet justify universal MRCP screenin