Differential diagnosis of sclerosing cholangitis with autoimmune pancreatitis and periductal infiltrating cancer in the common bile duct at dynamic CT, endoscopic retrograde cholangiography and MR cholangiography.
OBJECTIVE
To compare findings at dynamic computed tomography (CT), endoscopic retrograde cholangiography (ERC) and magnetic resonance cholangiography (MRC) in patients with sclerosing cholangitis with autoimmune pancreatitis (SC-AIP) and periductal infiltrating cancer in the common bile duct (CBD), and to evaluate the diagnostic performance of ERC and MRC in differentiating between the two diseases.


METHODS
Bile duct changes at dynamic CT, ERC and MRC were compared in 58 patients with SC-AIP and CBD involvement and 93 patients with periductal infiltrating CBD cancer. Two radiologists rated their confidence in differentiating between the two diseases and the diagnostic performances of ERC and MRC were compared.


RESULTS
At CT, SC-AIP was more frequently associated with intrapancreatic CBD involvement, thinner CBD walls, concentric wall thickening, smooth outer margins, and lower degrees of upstream ductal dilatation and contrast enhancement (P ≤ 0.05) than CBD cancer. At ERC and MRC, SC-AIP was more frequently associated with smooth margins, gradual and symmetric narrowing, multifocal involvement and hourglass appearance (P ≤ 0.027) than CBD cancer. MRC showed good diagnostic performance comparable to ERC.


CONCLUSIONS
Dynamic CT, ERC and MRC can be helpful in distinguishing SC-AIP from periductal infiltrating CBD cancer. MRC may be a useful diagnostic alternative to ERC in differentiating between the two diseases.


CONCLUSIONS
• SC-AIP often mimics periductal infiltrating ductal cancer.                                  • Imaging findings of SC-AIP and periductal infiltrating CBD cancer can be similar.                                  • Dynamic CT, ERC and MRC help differentiate between these two diseases.                                  • MRC may be a useful diagnostic alternative to ERC.
Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Asanbyeongwon-gil 86, Songpa-Gu, Seoul, 138-736, Korea.
Jin Hee
JH
Kim
Jae Ho
JH
Byun
So Jung
SJ
Lee
Seong Ho
SH
Park
Hyoung Jung
HJ
Kim
Seung Soo
SS
Lee
Myung-Hwan
MH
Kim
Jihun
J
Kim
Moon-Gyu
MG
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001327:Autoimmune Diseases / Q000175:diagnosis*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods*; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D015209:Cholangitis, Sclerosing / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003135:Common Bile Duct / Q000000981:diagnostic imaging* / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010195:Pancreatitis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*