Primary Sclerosing Cholangitis: Evaluation with MR Cholangiography—A Case-Control Study

Fulcher, Ann S.; Turner, Mary Ann; Franklin, K. J.; Shiffman, Mitchell L.; Sterling, Richard K.; Luketic, Velimir A.; Sanyal, Arun J.

doi:10.1148/radiology.215.1.r00ap2671

Cited by 183 publications

(94 citation statements)

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“…Although these results were not reproduced in living patients, minor ductal irregularities, crowding, pruning, and quick tapering of the intrahepatic biliary tree on ERCP were confirmed in 70% of cirrhotic patients by Altraif and Lewall. 24 More recently, Fulcher et al 12 pointed out that false-positive diagnoses of SC may occur on MRCP in patients with cirrhosis. The suggested mechanism for these biliary changes is the imprinting on the bile duct lumen by the distorted hepatic architecture due to mutilating fibrosis.…”

Section: Discussionmentioning

confidence: 99%

“…12 Indeed, the changes predominating in the third-and fourth-order bile ducts (diameter ranging from 500 to 390 m) are not always adequately analyzable, making it difficult to interpret peripheral duct abnormalities. These difficulties might explain in part the mild bile duct changes described in our study in two of the three AIH patients with no histological evidence of cirrhosis or advanced fibrosis, while the remaining patient, who had obvious features of cirrhosis on MRI, was likely to be underestimated by histological staging.…”

Section: Discussionmentioning

confidence: 99%

“…Sclerosing cholangitis was defined by the presence of multiple and diffuse intrahepatic and/or extrahepatic bile duct strictures with or without associated biliary dilatation in the absence of apparent cholangiocarcinoma. 12 A normal cholangiogram was defined by the absence of apparent stricture, irregularity, and bile duct dilatation. Evaluation of liver MRI abnormalities included changes in morphologic features (segmental enlargement or atrophy, irregularity of the liver contour), presence of confluent fibrosis, and existence of portal hypertension (splenomegaly and ascites or portosystemic collateral vessels).…”

Section: Patientmentioning

confidence: 99%

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Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: A prospective magnetic resonance imaging and histological study

et al. 2009

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The development of sclerosing cholangitis (SC) is observed in up to 50% of children followed up for autoimmune hepatitis (AIH). In adults, the prevalence is less known, although a recent study found evidence of SC in 10% of AIH patients using magnetic resonance cholangiopancreatography (MRCP). The aim of this study was to assess prospectively the prevalence of SC in adults with AIH. Fifty-nine consecutive patients with AIH diagnosed according to International Autoimmune Hepatitis Group score (women, 71%; mean age, 48 years; cirrhosis, 23%) underwent both MRCP and percutaneous liver biopsy. Twenty-seven patients with cirrhosis of nonbiliary or non-autoimmune etiology served as controls. Fourteen AIH patients (24%) showed mild MRCP abnormalities of intrahepatic bile ducts (IHBDs). None had abnormal common bile duct or convincing evidence of SC on MRCP or biopsy. A diagnosis of overlapping SC was nevertheless retained in one patient with MRCP abnormalities who subsequently developed symptomatic cholestasis despite corticosteroid therapy. Fibrosis score was the only independent parameter associated with bile duct abnormalities on MRCP (odds ratio 2.4; 95% confidence interval 1.4-4.7) and the percentage of patients with IHBD MRCP abnormalities was not different among F3-F4 AIH patients (n ‫؍‬ 24) and cirrhotic controls (46% versus 59%; NS). Conclusion: In this cohort of adult patients with AIH, the prevalence of SC was much lower than previously reported (1.7%). Mild MRCP abnormalities of IHBD were seen in a quarter of patients, but these abnormalities resulted from hepatic fibrosis and not SC. In the absence of cholestatic presentation, MRCP screening does not seem justified in adult-onset AIH. (HEPATOLOGY 2009;50:528-537.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patientmentioning

confidence: 99%

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Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: A prospective magnetic resonance imaging and histological study

et al. 2009

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“…7,8 Alternatively, magnetic resonance cholangiography (MRC) is a noninvasive, rapidly performed imaging modality that may be safely used in the evaluation of the biliary tree. Fulcher et al 9 recently reported that the sensitivity and specificity of MRC in the detection and localization of PSC were as high as 88% and 97%, respectively. 9 This study reports the results of a routine evaluation of the biliary tree via MRC in patients with a diagnosis of AIH.…”

mentioning

confidence: 99%

Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: Evaluating the role of routine magnetic resonance imaging

et al. 2007

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Large bile duct injury (that seen on cholangiography) is not usually considered a feature of autoimmune hepatitis (AIH) in adults but is present in up to 50% of children with AIH. The aim of this work was to study the prevalence of large bile duct abnormalities identified by magnetic resonance cholangiography (MRC) in adults given a diagnosis of AIH. Seventy-nine (n ‫؍‬ 79) patients given a diagnosis of AIH (mean AIH score: 15.1 ؎ 3.4) were screened with MRC for evidence of sclerosing cholangitis (SC). Results were reviewed by two radiologists. Clinical parameters were correlated with MRC findings. A histological review of available liver biopsies (n ‫؍‬ 29) was performed. Of the 79 patients surveyed, 8 (10%) had MRC findings consistent with primary sclerosing cholangitis (PSC). The interrater variability was excellent (kappa ‫؍‬ 0.87). Younger age at diagnosis (24.3 ؎ 11.9), higher baseline alkaline phosphatase (186.4 ؎ 98.3), higher bilirubin at time of MRC (45.8 ؎ 37.2), and greater lobular activity on initial liver biopsy were significantly associated with the detection of this overlap of SC with AIH (P ‫؍‬ 0.024, P ‫؍‬ 0.037, P ‫؍‬ 0.032, and P ‫؍‬ 0.041, respectively), but not alkaline phosphatase/aspartate aminotransferase ratio, time between the initial diagnosis of AIH and the MRC, or the presence of cirrhosis on initial liver histology. Two cases with a normal MRC had histological lesions typical of small duct PSC. Conclusion: The presence of SC detected by MRC and from liver histology in adult patients with AIH may not be clinically overt, and thus the prevalence of this AIH/SC overlap may be higher than previously recognized. Our data suggest that routine radiological evaluation of the biliary tree should be performed in adults given a diagnosis of AIH, as in children the presence of this overlap negatively impacts on survival. (HEPATOLOGY 2008;47:949-957.)

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“…As to the absence of first ductules, it is important for clinical practice for two reasons: the first as a sign of fibro-obliterative deseases [18][19][20][21][22][23][24][25][26] and the second considering minimum detectable duct caliber in imaging radiologic researches [27][28][29]. From LDLT point of view it is important in evaluation of age and functional-size-mass related liver parenchyma changes for donors and recipients.…”

Section: Discussionmentioning

confidence: 99%

Aberrant Confluence of Intrahepatic Biliary Ducts - A Case Report

Jurkovikj

Korneti-Pekevska

2013

Maced J Med Sci

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Aim: Besides the most frequent-modal type of confluent patterns intrahepatic biliary ducts, there are cases with aberrant type of confluence. The aim of this report is to present a case with aberrant confluence of intrahepatic biliary ducts. Material and Methods:Injection-corrosive method was used to obtain acrylic cast from biliary and portal systems of one human liver. Biliary ducts were followed parallel to the adjoint portal ramification from the initial part of segmental ductules.

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Primary Sclerosing Cholangitis: Evaluation with MR Cholangiography—A Case-Control Study

Abstract: MR cholangiography enables accurate detection and localization of PSC.

Cited by 183 publications

References 30 publications

Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: A prospective magnetic resonance imaging and histological study

Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: A prospective magnetic resonance imaging and histological study

Prevalence of sclerosing cholangitis in adults with autoimmune hepatitis: Evaluating the role of routine magnetic resonance imaging

Aberrant Confluence of Intrahepatic Biliary Ducts - A Case Report

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