MR Cholangiopancreatography in Patients with Primary Sclerosing Cholangitis: Interobserver Variability and Comparison with Endoscopic Retrograde Cholangiopancreatography
K. M. Vitellas1,
A. El-Dieb1,
K. K. Vaswani1,
W. F. Bennett1,
M. Tzalonikou2,
C. Mabee3,
R. Kirkpatrick4 and
J. G. Bova1
1 Department of Radiology, The Ohio State University Medical Center, 171 Means
Hall, 1654 Upham Dr., Columbus, OH 43210-1250.
2 Alexander S. Onasis Public Benefit Foundation, Athens, Greece.
3 Ohio Gastroenterology Group, Inc., Columbus, OH.
4 Department of Digestive Diseases, The Ohio State University Medical Center,
Columbus, OH 43230.
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Fig. 1A. —38-year-old man with primary sclerosing cholangitis.
Endoscopic retrograde cholangiogram shows multiple strictures of extrahepatic
bile duct. Intrahepatic bile ducts could not be opacified because of diffuse
disease.
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Fig. 1B. —38-year-old man with primary sclerosing cholangitis. MR
cholangiopancreatogram shows multiple strictures (arrows) in
intrahepatic bile duct that could not be seen on ERCP (A) because
intrahepatic ducts were not opacified. Signal voids at left and right central
intrahepatic ducts represent high-grade strictures responsible for inability
to opacify ducts on ERCP. In addition, although strictures of extra-hepatic
bile duct (arrowheads) are shown, they are better visualized on ERCP
because of distention of duct by contrast material.
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Fig. 2A. —55-year-old woman with primary sclerosing cholangitis.
Endoscopic retrograde cholangiogram shows multifocal strictures and
irregularities of extrahepatic and central intrahepatic bile ducts.
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Fig. 2B. —55-year-old woman with primary sclerosing cholangitis.
Central intrahepatic bile duct strictures (arrows) that prevented
opacification on ERCP (A) produce dilatation and allow better
visualization of right peripheral intrahepatic bile ducts on this MR
cholangiopancreatogram. Multifocal strictures of peripheral right intrahepatic
bile ducts are shown. Because of diffuse disease of left intrahepatic bile
ducts, they cannot be visualized.
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Fig. 3A. —54-year-old man with primary sclerosing cholangitis.
Endoscopic retrograde cholangiopancreatogram shows multifocal strictures,
irregularity, and webs (arrows) of extrahepatic bile duct.
Intrahepatic bile ducts could not be opacified because of strictures in
central ducts.
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Fig. 3B. —54-year-old man with primary sclerosing cholangitis. MR
cholangiopancreatogram shows multifocal strictures and irregularities
(arrows) of extrahepatic bile duct that are compatible with
sclerosing cholangitis. However, extrahepatic bile duct is more visible on
endoscopic retrograde cholangiogram (A) because strictures of
intrahepatic and extrahepatic bile ducts have resulted in decreased volume of
bile. Diffuse strictures of left central and peripheral intrahepatic bile
ducts (arrowheads), which could not be opacified on ERCP, can be
seen. Right intrahepatic bile ducts could not be visualized because of diffuse
disease.
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Fig. 4A. —46-year-old man with primary sclerosing cholangitis.
Endoscopic retrograde cholangiogram reveals multiple strictures of
intrahepatic and extrahepatic bile ducts. Strictures of extrahepatic bile duct
(arrows) are better shown on ERCP than on MR cholangiopancreatography
(B) because of distention produced by infusion of contrast
material.
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Fig. 4B. —46-year-old man with primary sclerosing cholangitis. MR
cholangiopancreatogram shows multiple strictures of intrahepatic and
extrahepatic bile ducts (arrow).
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Fig. 5A. —39-year-old woman with primary sclerosing cholangitis and
cirrhosis. Endoscopic retrograde cholangiogram shows multiple strictures of
right intrahepatic bile ducts. Note smooth narrowing of portions of right
central and peripheral intrahepatic ducts caused by cirrhosis.
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Fig. 5B. —39-year-old woman with primary sclerosing cholangitis and
cirrhosis. MR cholangiopancreatogram shows extrahepatic bile duct
(arrowheads) well, but central ducts (arrows) are difficult
to see and peripheral intrahepatic bile ducts cannot be seen. Although diffuse
intrahepatic bile duct strictures can produce similar appearance, cirrhosis
was cause of cholangiographic appearance in this patient.
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Fig. 6A. —36-year-old man with primary sclerosing cholangitis.
Endoscopic retrograde cholangiogram shows intrahepatic and extrahepatic bile
duct strictures and irregularities.
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Fig. 6B. —36-year-old man with primary sclerosing cholangitis. MR
cholangiopancreatogram shows good correlation with endoscopic retrograde
cholangiopancreatogram (A) for detection of strictures and
irregularities in intrahepatic and extrahepatic ducts. Stricture at common
hepatic duct (arrows) is overestimated on MR cholangiopancreatogram
because signal intensity is decreased as a result of decreased quantity of
bile at stricture site.
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Fig. 7A. —72-year-old woman with primary sclerosing cholangitis.
Endoscopic retrograde cholangiogram shows intrahepatic and extrahepatic bile
duct strictures (long arrow). Extrahepatic duct (short
arrows) is dilated.
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Fig. 7B. —72-year-old woman with primary sclerosing cholangitis. MR
cholangiopancreatogram shows good correlation with endoscopic retrograde
cholangiopancreatogram (A) for detection of strictures in intrahepatic
and extrahepatic bile ducts. Extrahepatic bile duct (short arrows) is
dilated proximal to stricture in distal common bile duct (long
arrow). In addition, dilatation of intrahepatic ducts is prevented by
multiple intrahepatic bile duct strictures.
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Copyright © 2002 by the American Roentgen Ray Society.
