Primary sclerosing cholangitis other imaging findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

Other Imaging Findings

ERCP

ERCP has been regarded as the gold standard for diagnosis because it allows good visualization of the biliary system and the pancreas. However, MRCP is currently preferred due to its noninvasive nature.^[1] Common findings include:^[2]

Multiple segmental strictures
Biliary dilatation: may be present in ~85% of cases
Biliary diverticula
Mural irregularities
Distortion of the biliary tree due to associated cirrhosis

MRCP

MRCP is preferred over ERCP due to several reasons, which include:^[1]

Non-invasive nature
No use of radiation
No need for antibiotic prophylaxis
Cost-effectiveness

Imaging findings on MRCP are similar to those seen on ERCP.

Images

Coronal thick-section MRCP showing a high-grade hilar stricture (straight arrow) with proximal dilatation, multifocal intrahepatic strictures and dilatation and a beaded appearance of the anterior right hepatic duct (curved arrow). Adapted from RadioGraphics http://pubs.rsna.org/doi/full/10.1148/radiographics.20.4.g00jl04959. Accessed on Dec 12, 2016.
This ERCP image shows several strictures of the anterior right hepatic duct alternating with areas of dilatation, thus producing a beaded appearance (arrows). Adapted from RadioGraphics http://pubs.rsna.org/doi/full/10.1148/radiographics.20.4.g00jl04959. Accessed on Dec 12, 2016.