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Radiologic Manifestations of Sclerosing Cholangitis with Emphasis on MR Cholangiopancreatography¹

¹ From the Department of Radiology, Ohio State University Medical Center, S-209 Rhodes Hall, 450 W 10th Ave, Columbus, OH 43210 (K.M.V.); the Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (M.T.K.); the Departments of Radiology (K.S.F., C.E.S., R.C.N.) and Gastroenterology (J.M.B.), Duke University Medical Center, Durham, NC; and the Department of Gastroenterology, Saint Paul Medical Center, Vancouver, British Columbia, Canada (R.A.E.). Recipient of a Certificate of Merit award for a scientific exhibit at the 1998 RSNA scientific assembly. Received April 21, 1999; revision requested June 14 and received December 17; accepted December 20. Address correspondence to K.M.V.

Magnetic resonance cholangiopancreatography (MRCP) is a relatively new, noninvasive cholangiographic technique that is comparable with invasive endoscopic retrograde cholangiopancreatography (ERCP) in the detection and characterization of extrahepatic bile duct abnormalities. The role of MRCP in evaluation of the intrahepatic bile ducts, especially in patients with primary or secondary sclerosing cholangitis, is under investigation. The key cholangiographic features of primary sclerosing cholangitis are randomly distributed annular strictures out of proportion to upstream dilatation. As the fibrosing process worsens, strictures increase and the ducts become obliterated, and the peripheral ducts cannot be visualized to the periphery of the liver at ERCP. In addition, the acute angles formed with the central ducts become more obtuse. With further progression, strictures of the central ducts prevent peripheral ductal opacification at ERCP. Cholangiocarcinoma occurs in 10%–15% of patients with primary sclerosing cholangitis; cholangiographic features that suggest cholangiocarcinoma include irregular high-grade ductal narrowing with shouldered margins, rapid progression of strictures, marked ductal dilatation proximal to strictures, and polypoid lesions. Secondary sclerosing and nonsclerosing processes can mimic primary sclerosing cholangitis at cholangiography. These processes include ascending cholangitis, oriental cholangiohepatitis, acquired immunodeficiency syndrome–related cholangitis, chemotherapy-induced cholangitis, ischemic cholangitis after liver transplantation, eosinophilic cholangitis, and metastases.

Index Terms: Bile ducts, diseases, 76.288 • Bile ducts, MR, 76.12149 • Bile ducts, neoplasms, 76.321 • Cholangitis, 76.288

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RadioGraphics 2000 20: 939-957. [Abstract] [Full Text] [PDF]

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