CT and MRI features of primary sclerosing cholangitis
What is primary sclerosing cholangitis (PSC), and what are its CT and MR imaging features?
PSC is a chronic idiopathic fibroinflammatory biliary disease that is typically seen in young adults, more commonly in men than in women, and is associated with ulcerative colitis in up to 70% of patients. It can lead to cirrhosis and is associated with an increased risk of cholangiocarcinoma.
On CT and MRI, multifocal segmental areas of bile duct dilation and stenosis are typically seen, leading to a beaded appearance of the biliary tree. Pruning of the peripheral intrahepatic bile ducts and intraductal calculi may also be encountered. Bile duct wall thickening and increased enhancement are often seen, sometimes with surrounding edema or patchy increased enhancement in the surrounding liver parenchyma. Cirrhosis, characteristically with atrophy of the lateral and posterior segments, and reactively enlarged periportal and portacaval lymph nodes can also be visualized.
