Magnetic resonance imaging features of small-duct primary sclerosing cholangitis
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HEPATOBILIARY
Magnetic resonance imaging features of small‑duct primary sclerosing cholangitis Kazuto Kozaka1,2 · Shannon P. Sheedy1 · John E. Eaton3 · Sudhakar K. Venkatesh1 · Jay P. Heiken1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose To evaluate the biliary tree and hepatic parenchymal findings on magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) in small-duct primary sclerosing cholangitis (SD-PSC). Methods Thirty-nine patients with biopsy-proven primary sclerosing cholangitis (PSC) without any bile duct abnormality on MRCP (n = 15) or ERCP (n = 24) at the time of diagnosis were identified. Follow-up MRCP was available in 36/39 patients (12/15 Baseline MRCP group and 24 Baseline ERCP group). Two radiologists in consensus assessed the MRI/MRCP findings. The baseline MRI/MRCP of 15 SD-PSC patients was compared with MRI/MRCP of 15 normal healthy potential liver donors (Control group). Comparisons were made between SD-PSC patients and the Control group, and between baseline and follow-up MRI/MRCP findings in the SD-PSC patients. Results In the 15 Baseline MRCP SD-PSC subjects, the biliary tree was normal with a trend of larger bile ducts compared to the Control group. Periductal enhancement (arterial phase: 70%, 7/10; delayed phase: 90%, 9/10), heterogeneous parenchymal signal on T2-weighted (53%, 8/15) and post contrast-enhanced images (70%, 7/10), and enlarged periportal lymph nodes (73%, 11/15) were frequently present in patients with SD-PSC. Eight (33%) of 24 SD-PSC patients who had normal MRCP at baseline MRCP or initial follow-up MRCP after normal baseline ERCP showed large-duct PSC (LD-PSC) features on follow-up and the 10-year cumulative incidence for progression to LD-PSC rate was 8.5%. Conclusion SD-PSC patients have a normal biliary tree but frequently have peribiliary enhancement, abnormal parenchymal signal intensity, and periportal lymphadenopathy. One-third shows progression to LD-PSC on follow-up. Keywords Bile duct dilation · Parenchyma heterogeneity · Magnetic resonance cholangiopancreatography · Small-duct primary sclerosing cholangitis * Jay P. Heiken [email protected] Kazuto Kozaka k‑[email protected]‑u.ac.jp Shannon P. Sheedy [email protected] John E. Eaton [email protected] Sudhakar K. Venkatesh [email protected] 1
Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN 55905, USA
2
Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
3
Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic College of Medicine, Mayo Clinic, 200, First Street SW, Rochester, MN 55905, USA
Abbreviations PSC Primary sclerosing cholangitis SD-PSC Small-duct primary sclerosing cholangitis LD-PSC Large-duct primary sclerosing cholangitis MRI Magnetic resonance imaging MRCP Magnetic resonance cholangiopancreatography
Introduction Primary sclerosing cholangitis
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