Chronic cholangitis: Differential diagnosis and role of MRI.

Congress:

ECR 2019

Poster Number:

C-2183

Type:

Educational Exhibit

Keywords:

Cirrhosis, Cholangiography, MR-Diffusion/Perfusion, MR-Cholangiography, MR, Abdomen

Authors:

E. Cebada Chaparro¹, J. Lloret Del Hoyo¹, A. G. Ortiz Escobar², R. J. Méndez¹; ¹Madrid/ES, ²Bogota/CO

DOI:

10.26044/ecr2019/C-2183

DOI-Link:

https://dx.doi.org/10.26044/ecr2019/C-2183

Fig. 1: Figure 1. MRI-MRCP protocol for cholangiopathies.

Fig. 2: Figure 2. Advanced PSC: MRCP and MRI findings. This 36 years old man has signs...

Fig. 3: Figure 3. PSC subtle MRCP changes. When PSC is suspected, subtle MRCP features...

Fig. 4: Figure 4. PSC progression on MRCP images. These are axial thick MRCP slices of...

Learning objectives

a. To illustrate the clinical role of imaging in the diagnosis of idiopathic chronic cholangitis b. To describe the MR imaging findings in primary sclerosing cholangitis (PSC) and in other chronic cholangiopathies, including signs of ductal, hepatic and extrahepatic involvement.

Background

a. Patients with chronic cholangitis present elevated LFTs and nonspecific symptoms. Imaging studies are often necessary for diagnosis. b. PSC is probably an autoimmune disease that affects the biliary ducts, causing inflammation, fibrosis and strictures. c. IgG4 related cholangitis and secondary causes of cholangitis and chronic cholestasis should be ruled out in order to make the diagnosis of idiopathic chronic cholangiopathies.

Findings and procedure details

1. IDIOPATHIC CHRONIC CHOLANGIOPATIES 1) Primary Sclerosing Cholangitis (PSC) Primary sclerosing cholangitis is an idiopathic, chronic, fibrosing inflammatory disease of bile ducts that leads to bile duct obliteration, cholestasis and can progress to cirrhosis, end-stage liver disease. Patients have an increased risk of hepatobiliary and colorectal cancer and median survival after diagnosis is 20 years [4, 5]. Approximately 70% of patients with PSC also have inflammatory bowel disease (IBD), mainly ulcerative colitis, being the diagnosis of IBD typically made first. Up to 80% of patients...

Conclusion

Chronic cholangitis are a group of diseases with different etiologies and diverse therapeutic approach. MRCP is the best noninvasive technique for imaging intra and extrahepatic bile ducts. An optimized and tailored technique is necessary to obtain high quality studies. In a patient with chronic cholestasis and suspected PSC, MRCP is the preferred diagnostic technique to demonstrate bile duct abnormalities. Patients with IgG4-related cholangitis and chronic cholangitis related to secondary causes can also present strictures and dilatations of intra and extrahepatic bile ducts. The clinical background...

Personal information

Dr. Elena Cebada Radiology resident in training email: [email protected] Dr. Juan Lloret Radiology resident in training email: [email protected] Dr. Ramiro Mendez Abdominal Radiology Section [email protected] Department of Radiology, Hospital Clinico San Carlos of Madrid

References

Fig. 20 Fig. 21