title: MR imaging features of primary sclerosing cholangitis: patterns of cirrhosis in relationship to clinical severity of disease.
abstract: OBJECTIVE
  To evaluate the spectrum of magnetic resonance (MR) imaging appearances of the liver in primary sclerosing cholangitis (PSC) and to examine their correlation with clinical stage of disease.
  
  
  METHODS
  Fifty-two patients (25 female, 27 male; mean age, 43 years; age range, 11-87 years) with PSC underwent nonenhanced and gadolinium-enhanced MR imaging. Two abdominal radiologists retrospectively reviewed all images (independently and then in consensus) for the imaging pattern of the liver parenchyma, presence and grade of intrahepatic biliary ductal dilatation, and presence of areas of parenchymal atrophy or abnormal signal intensity and/or gadolinium enhancement. Imaging findings were correlated with Child class, Child-Turcotte-Pugh score, and Mayo end-stage liver disease (MELD) score. Statistical analyses (kappa scoring for interobserver agreement, McNemar test, Mann-Whitney U test, multiple regression analysis, Spearman correlation) were performed.
  
  
  RESULTS
  Of 52 patients, seven (13%) had no imaging findings of cirrhosis, 17 (33%) had a diffuse pattern of cirrhosis, and 28 (54%) had a large macronodular pattern (with nodules >or=3 cm) (kappa = 0.84). Intrahepatic biliary ductal dilatation was observed in 44 (85%) patients and was general in 18 (35%) and segmental in 26 (50%). Peripheral wedge-shaped areas of parenchyma were observed with atrophy in 23 (44%) and 25 (48%) patients by the two readers (kappa = 0.76) and without atrophy in 18 (35%) patients by both readers (kappa = 1.00). No correlation was found between imaging findings and clinical scores (P >.05, multiple regression analysis; P =.25-.75, Mann-Whitney U test; Spearman correlation coefficients between -0.33 and 0.33).
  
  
  CONCLUSIONS
  The spectrum of MR imaging appearances of PSC is diverse and comprises distinct patterns that do not appear to correlate with severity of disease. Large regenerative nodules are a frequent finding and may help to establish the diagnosis.
authors.affiliation: Departments of Radiology and Internal Medicine, University of North Carolina at Chapel Hill, 101 Manning Dr, CB 7510, Chapel Hill, NC 27599-7510, USA.
authors.forename: Till R
authors.initials: TR
authors.lastname: Bader
authors.forename: Kimberly L
authors.initials: KL
authors.lastname: Beavers
authors.forename: Richard C
authors.initials: RC
authors.lastname: Semelka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D002648:Child; D015209:Cholangitis, Sclerosing / Q000473:pathology*; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage; D006801:Humans; D008103:Liver Cirrhosis / Q000473:pathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA