Primary sclerosing cholangitis: MR imaging features

OBJECTIVE. The purpose of this study was to evaluate the spectrum of MR imaging features of primary sclerosing cholangitis. MATERIALS AND METHODS. A retrospective review was performed of MR imaging findings including MR cholangiography and multiphasic contrast-enhanced dynamic sequences in 22 patients with primary sclerosing cholangitis. MR imaging analysis included abnormalities of intra- and extrahepatic bile ducts, abnormalities of liver parenchyma, changes in liver morphology, and lymphadenopathy. RESULTS. Abnormal findings of bile ducts were seen in all 22 patients; the most common finding was intrahepatic bile duct dilatation (77%), followed by intrahepatic bile duct stenosis (64%), extrahepatic bile duct wall enhancement (67%), extrahepatic bile duct wall thickening (50%), extrahepatic bile duct stenosis (50%), and intrahepatic bile duct beading (36%). Increased enhancement of the liver parenchyma on dynamic arterial-phase images, predominantly in the peripheral areas of the liver, was identified in 56% of patients. Other findings included periportal lymphadenopathy (77%), periportal high signal intensity on T2-weighted images (68%), hypertrophy of the caudate lobe (68%), and abnormal hyperintensity of the liver parenchyma on T1-weighted images (23%). CONCLUSION. On MR imaging, primary sclerosing cholangitis showed several characteristic features, including bile duct abnormalities and increased enhancement of the liver parenchyma. MR cholangiography and contrast-enhanced dynamic MR techniques are useful for revealing intra- and extrahepatic signs of primary sclerosing cholangitis.