OBJECTIVE. The purpose of this study was to evaluate MR imaging findings of
primary sclerosing cholangitis, to compare them with histopathologic findi
ngs, and to determine if these findings help differentiate primary sclerosi
ng cholangitis from other disorders that result in end-stage liver disease.
MATERIALS AND METHODS. MR imaging was performed in 40 patients (27 men, 13
women; age range, 13-72 years; mean, 47 years) with primary sclerosing chol
angitis over a 9-year period. In 16 patients who underwent orthotopic hepat
ic transplantation and in seven patients who underwent needle biopsy, corre
lation was made between MR imaging and pathologic findings.
RESULTS. Focal signal changes in the liver parenchyma were seen on T2-weigh
ted images as peripheral wedge-shaped zones of increased signal intensity i
n 29 patients (72%), as a reticular pattern in 15 patients (38%), and as pe
riportal edema in 16 patients (40%). Lobar atrophy involved the right lobe
in three patients (8%) and the left lobe in 11 patients (28%); hypertrophy
of the caudate lobe was seen in nine patients (23%). Features of portal hyp
ertension were seen in 14 patients (35%). Histologic assessment showed zone
s of segmental atrophy and scarring on the periphery of the liver.
CONCLUSION. Peripheral wedge-shaped areas of high T2 signal intensity and d
ilatation of bile ducts are characteristic MR features of primary sclerosin
g cholangitis. Pathologic correlation suggests that these features may be r
elated to underlying perfusion changes and bile duct inflammation in patien
ts with primary sclerosing cholangitis.