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Evaluation highlights potential of new tool to transform diagnosis and monitoring of patients with rare chronic liver disease

Overall summary

Primary sclerosing cholangitis (PSC) is a rare disease with a high risk of complications and a leading cause of liver transplant. It is difficult to differentiate PSC from other biliary diseases. Accurate diagnosis is critical to ensure patients receive the right care and avoid invasive and expensive alternative investigations.

Perspectum’s MRCP+ software uses AI technology to calculate quantitative 3D biliary system models, providing a non-invasive, objective and reproducible means of assessing biliary health.

A feasibility study carried out by the Oxford AHSN showed that MRCP+ had strong potential to improve the diagnostic pathway of PSC in the NHS in England.

What is the challenge?

PSC is a disease with a highly variable and unpredictable natural history. People with PSC currently have no effective curative treatment aside from a liver transplant.

The treatment of patients is highly variable and individualised and the mean time between diagnosis to liver transplant or death is thought to be 10-22 years.

Current magnetic resonance cholangiopancreatography (MRCP) used in the standard pathway does not provide an objective assessment of the biliary tree (a system of bile ducts from the liver, gallbladder and pancreas) and as a result there are often differences of opinion when interpreting the images.  Accurate assessment of the status of a patient’s biliary system is essential in diagnosis and monitoring of hepatobiliary diseases such as PSC. It is also integral in preparing for liver transplant and post-transplant monitoring.

MRCP+ is an innovation that produces a 3D MRCP image of the biliary tree and pancreatic duct and a quantitative report including the whole tree’s metrics and single duct metrics enabling more precise and objective identification of biliary irregularities.

What did we do?

The Oxford AHSN conducted a feasibility study to review the current landscape, care pathway and unmet needs in the clinical pathway for patients with PSC. The study involved gaining perspectives from clinicians, where the potential utility and value of MRCP+ may lie in the PSC pathway as well as other indications in the NHS in England.

Secondary research was conducted to understand the clinical pathway and the current diagnostic and treatment paradigms used to manage and monitor patients with PSC. Key stakeholders were interviewed to evaluate the acceptability, clinical utility, potential value and barriers to adoption surrounding MRCP+.

What has been achieved?

The Oxford AHSN feasibility study evaluated the technology’s utility in the current care pathway. Stakeholders who were interviewed agreed that the MRCP+ technology has strong potential to improve diagnosis of PSC.

Additionally, the study highlighted that the technology could be used in other pathways,  including post-surgical liver transplant monitoring, planning endoscopic treatments and other biliary tree indications.

The Oxford AHSN study indicated that implementing MRCP+ technology may lead to significant cost savings in diagnosing and managing PSC.

What people said

“MRCP+ provides a non-invasive, objective, quantitative and reproducible means of assessing biliary health. Accurate diagnosis is critical to ensure patients with rare disease such as PSC receive the right care and avoid invasive and expensive alternative investigations. The Oxford AHSN was instrumental in providing us with feedback from clinicians and stakeholders within the NHS. As a result, we now know that MRCP+ has strong potential to improve the diagnostic pathway of PSC in the NHS in England.”

Sarah Finnegan – Senior Clinical Research Scientist & Product Specialist

What next?

The Oxford AHSN is working with Perspectum on an economic impact report with real world data on use of MRCP+ in the PSC pathway.


Mamta Bajre, Lead Health Economist & Methodologist: [email protected]