title: Discrimination between sclerosing cholangitis-associated autoimmune pancreatitis and primary sclerosing cholangitis, cancer using intraductal ultrasonography.
abstract: OBJECTIVE
  Differentiation of sclerosing cholangitis-associated autoimmune pancreatitis (SC-AIP), primary sclerosing cholangitis (PSC) and cancer of the hilar part of the bile duct (CHB) has been challenging. The aim of the present study was to evaluate characteristic intraductal ultrasonography (IDUS) features that could be used to discriminate SC-AIP from PSC and CHB.
  
  
  METHODS
  Six patients with SC-AIP, 10 patients with PSC and 12 patients with CHB were identified. We reviewed the following bile duct features observed using IDUS to determine their usefulness for differentiating SC-AIP from PSC and CHB: presence of symmetrical wall thickness, wall thickness, presence of homogeneous internal foci and presence of lateral mucosal lesions continuous to the hilar.
  
  
  RESULTS
  IDUS results (SC-AIP, PSC, CHB) were as follows: wall thickness (mm), 3.7±0.9, 2.6 ±0.9, 2.8±0.0.6; presence of symmetrical wall thickness, 100% (6/6), 20% (2/10), 8.3% (1/12); presence of homogeneous internal foci, 100% (6/6), 10% (1/10), 8.3% (1/12); and presence of lateral mucosal lesions continuous to the hilar, 83.3% (5/6), 40%(4/10), 25% (3/12). Symmetrical wall thickness of the bile duct, homogeneous internal foci and lateral mucosal lesions continuous to the hilar were detected significantly more often among the patients with SC-PSC than among the patients with PSC or CHB (P<0.05).
  
  
  CONCLUSIONS
  IDUS findings, such as symmetrical wall thickness, presence of homogeneous internal foci and presence of lateral mucosal lesions continuous to the hilar can facilitate the differential diagnosis of SC-AIP from PSC and CHB.
authors.affiliation: Division of Gastroenterology, Yokohama City University, Graduate School of Medicine, Yokohama, Japan. kubotak@yokohamacu.ac.jp
authors.forename: Kensuke
authors.initials: K
authors.lastname: Kubota
authors.forename: Shingo
authors.initials: S
authors.lastname: Kato
authors.forename: Takashi
authors.initials: T
authors.lastname: Uchiyama
authors.forename: Seitaro
authors.initials: S
authors.lastname: Watanabe
authors.forename: Yuich
authors.initials: Y
authors.lastname: Nozaki
authors.forename: Koji
authors.initials: K
authors.lastname: Fujita
authors.forename: Masato
authors.initials: M
authors.lastname: Yoneda
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inamori
authors.forename: Takeshi
authors.initials: T
authors.lastname: Shimamura
authors.forename: Yasunobu
authors.initials: Y
authors.lastname: Abe
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kirikoshi
authors.forename: Noritoshi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Satoru
authors.initials: S
authors.lastname: Saito
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakajima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D015209:Cholangitis, Sclerosing / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000000981:diagnostic imaging* / Q000276:immunology*