OBJECTIVE: The purpose of this study was
to evaluate MR imaging findings of primary sclerosing cholangitis, to compare
them with histopathologic findings, and to determine if these findings
help differentiate primary sclerosing cholangitis from other disorders
that result in end-stage liver disease. MATERIALS AND METHODS: MR imaging
was performed in 40 patients (27 men, 13 women; age range, 13-72 years;
mean, 47 years) with primary sclerosing cholangitis over a 9-year period.
In 16 patients who underwent orthotopic hepatic transplantation and in
seven patients who underwent needle biopsy, correlation was made between
MR imaging and pathologic findings. RESULTS: Focal signal changes in the
liver parenchyma were seen on T2-weighted images as peripheral wedge-shaped
zones of increased signal intensity in 29 patients (72%), as a reticular
pattern in 15 patients (38%), and as periportal edema in 16 patients (40%).
Lobar atrophy involved the right lobe in three patients (8%) and the left
lobe in 11 patients (28%); hypertrophy of the caudate lobe was seen in
nine patients (23%). Features of portal hypertension were seen in 14 patients
(35%). Histologic assessment showed zones of segmental atrophy and scarring
on the periphery of the liver. CONCLUSION: Peripheral wedge-shaped areas
of high T2 signal intensity and dilatation of bile ducts are characteristic
MR features of primary sclerosing cholangitis. Pathologic correlation suggests
that these features may be related to underlying perfusion changes and
bile duct inflammation in patients with primary sclerosing cholangitis.
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