There is no characteristic autoantibody test that can be used in PSK. Blood tests show significant increases in serum alkaline phosphatase (AF) and gamma glutamyl trasferase (GGT) levels, while slight increases in aminotransferase levels (ALT and AST). In cases with jaundice, serum bilirubin levels are found to be high (See Liver function tests). Hypergammaglobulinemia (especially IgM) is seen in 1/3 of the cases. Antinuclear cytoplasmic antibody (ANCA) is positive in blood in 65-85% of cases.
The diagnosis is made by observing typical findings in a cholangiography to be performed in the presence of clinical and biochemical findings and by distinguishing other diseases that may produce similar findings. Cholangiography (radiological imaging of the biliary tract) is performed with the ERCP procedure and is the most valuable diagnostic method used in the diagnosis of PSC (See ERCP- Endoscopic Retrograde Cholangio Pancreatography). In cases where ERCP cannot be performed or is undesirable, MRCP is helpful in the diagnosis (MRCP- Magnetic Resonance Cholangio Pancreatography).
Since technological advances in recent years have enabled better quality images to be obtained with MRCP, MRCP has become the first choice method for diagnosis in many patients. ERCP and MRCP provide information about the extent of the disease and the location and degree of narrowing of the biliary tract. In PSC, both intrahepatic (intrahepatic) and extrahepatic (extrahepatic) bile ducts are commonly involved. In ERCP and MRCP, narrowing of the bile ducts, enlargement in the form of beads, and the appearance of dried-pruned trees are characteristic findings for PSK.
A liver biopsy (taking a tissue sample from the liver with a fine needle) is rarely needed for diagnosis. Biopsy is helpful in staging the disease and determining the prognosis. The most common characteristic finding in liver biopsy is fibrosis (connective tissue development) that resembles an ‘onion skin’ appearance around the bile ducts.
In up to 10% of patients without an abnormality in cholangiography, the appearance of onion skin can be detected in the small bile ducts in the liver biopsy. This condition is called small duct Primary sclerosing cholangitis (small-duct PSC). This type of the disease has a better prognosis than the classical type.