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Primary Biliary Cirrhosis

MR Imaging Findings and Description of MR Imaging Periportal Halo Sign

¹ Department of Radiology, Baylor University Medical Center-Dallas, 3500 Gaston Ave., Dallas, TX 75246.
² Department of Pathology, Baylor University Medical Center-Dallas, Dallas, TX 75246.
³ Institute of Transplantation Services, Baylor University Medical Center, Dallas, TX 75246.

View larger version (64K): [in a new window]   Fig. 1. —39-year-old woman primary biliary cirrhosis. T2-weighted single-shot fast spin-echo MR image reveals round areas of low signal intensity encircling portal veins (arrows).

View larger version (60K): [in a new window]   Fig. 2. —39-year-old woman with primary biliary cirrhosis. T1-weighted MR image obtained 3 min after infusion shows conspicuous areas of low signal intensity around portal veins (arrows).

View larger version (101K): [in a new window]   Fig. 3A. —44-year-old woman with primary biliary cirrhosis. T1-weighted MR image obtained 45 sec after infusion reveals halos of low signal intensity around portal veins (arrows).

View larger version (98K): [in a new window]   Fig. 3B. —44-year-old woman with primary biliary cirrhosis. T1-weighted MR image again shows halos of low signal intensity around portal veins (arrows).

View larger version (105K): [in a new window]   Fig. 4. —T1-weighted MR image of 46-year-old woman with hepatitis B cirrhosis shows numerous small regenerating nodules (arrows) in hepatic parenchyma.

View larger version (143K): [in a new window]   Fig. 5A. —Pathologic difference was consistent throughout primary biliary cirrhosis cohort in regard to visibility of MR imaging periportal halo sign. Photomicrographs of liver tissue from 41-year-old woman with primary biliary cirrhosis with positive MR finding for periportal halo sign (A) and from 37-year-old woman with primary biliary cirrhosis with negative MR finding for periportal halo sign (B). Stellate areas of hepatocellular parenchymal extinction (arrows, A) around portal triads can be seen in A but not in B. Larger and more variably sized regenerating nodules encircle fibrotic portal triads in patient with MR finding for periportal halo sign (A). Scale = 1-cm section. (H and E, x20)

View larger version (159K): [in a new window]   Fig. 5B. —Pathologic difference was consistent throughout primary biliary cirrhosis cohort in regard to visibility of MR imaging periportal halo sign. Photomicrographs of liver tissue from 41-year-old woman with primary biliary cirrhosis with positive MR finding for periportal halo sign (A) and from 37-year-old woman with primary biliary cirrhosis with negative MR finding for periportal halo sign (B). Stellate areas of hepatocellular parenchymal extinction (arrows, A) around portal triads can be seen in A but not in B. Larger and more variably sized regenerating nodules encircle fibrotic portal triads in patient with MR finding for periportal halo sign (A). Scale = 1-cm section. (H and E, x20)

View larger version (157K): [in a new window]   Fig. 6A. —Patients with MR imaging periportal halo sign have more diffuse periportal hepatocellular parenchymal extinction than patients with cirrhosis from other causes. Photomicrographs of liver tissue from 41-year-old woman with primary biliary cirrhosis with MR imaging periportal halo sign (A) and from 56-year-old man with cirrhosis not caused by primary biliary cirrhosis (B) show no conspicuous difference around portal triads (arrows) between two patients. Scale = 1-cm section. (Masson trichrome, x 20)

View larger version (152K): [in a new window]   Fig. 6B. —Patients with MR imaging periportal halo sign have more diffuse periportal hepatocellular parenchymal extinction than patients with cirrhosis from other causes. Photomicrographs of liver tissue from 41-year-old woman with primary biliary cirrhosis with MR imaging periportal halo sign (A) and from 56-year-old man with cirrhosis not caused by primary biliary cirrhosis (B) show no conspicuous difference around portal triads (arrows) between two patients. Scale = 1-cm section. (Masson trichrome, x 20)

View larger version (157K): [in a new window]   Fig. 7A. —Lack of diffuse nature of periportal hepatocellular parenchymal extinction may result in nonvisualization of MR imaging periportal halo sign in patients with cirrhosis not caused by primary biliary cirrhosis. Photomicrograph of liver tissue from 46-year-old woman with cirrhosis not caused by primary biliary cirrhosis reveals some areas of liver show little parenchymal extinction (arrows). Scale = 1-cm section. (Masson trichrome, x 20)

View larger version (140K): [in a new window]   Fig. 7B. —Lack of diffuse nature of periportal hepatocellular parenchymal extinction may result in nonvisualization of MR imaging periportal halo sign in patients with cirrhosis not caused by primary biliary cirrhosis. Photomicrograph of liver tissue from 39-year-old woman with primary biliary cirrhosis with MR imaging periportal halo sign (arrows) reveals other areas of liver show severe parenchymal extinction. Scale = 1-cm section. (Masson trichrome, x 20)

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