Primary sclerosing cholangitis: MR cholangiopancreatography and T2-weighted MR imaging findings.

OBJECTIVE

To present MR cholangiopancreatography (MRCP) findings and to determine the hepatic morphological changes of primary sclerosing cholangitis (PSC) seen on T2-weighted fast spin echo (FSE) images.

METHODS

Twenty-three patients (15 women, 8 men) with ages ranging from 17 to 80 years (median, 45.1 years) were included in the study. MR imaging was performed on a 1 Tesla MR unit using a phased-array coil. Heavily T2-weighted images were obtained with single-shot fast spin echo technique for MRCP. Morphological changes encountered in livers were evaluated with coronal and axial T2-weighted fast spin echo images.

RESULTS

Irregularities, multifocal strictures, and dilatations in different levels of the biliary channels were seen in all patients. T2-weighted images showed lobulated hepatic contours in 21.73%, atrophy in both anterior and posterior segments of the right lobe in 21.73%, atrophy in the anterior segment in 13.04%, atrophy in both medial and lateral segments of the left lobe in 17.39%, atrophy in the medial segment in 8.69%, atrophy in the lateral segment in 4.34%, hypertrophy in the posterior segment of the right lobe in 4.34%, global hypertrophy in the left lobe in 4.34%, hypertrophy in the lateral segment of the left lobe in 4.34%, and caudate lobe hypertrophy in 21.73% of the patients. In addition, periportal edema was noted in 39.13%, increased parenchymal signal on T2-weighted images in 26.08%, periportal and/or portocaval lymphadenopathy in 34.78%, and portal hypertension in 34.78% of our patients. In one patient (4.34%), the liver had a round shape characteristic of PSC.

CONCLUSIONS

MR imaging is a useful method for establishing the changes in biliary ducts specific to PSC, and for identifying long-standing cases complicated with cirrhosis.