title: MR imaging of primary sclerosing cholangitis: additional value of diffusion-weighted imaging and ADC measurement.
abstract: BACKGROUND
  Primary sclerosing cholangitis (PSC) is a cholestatic liver disease with chronic inflammation and progressive destruction of biliary tree. Magnetic resonance (MR) examination with diffusion-weighted imaging (DWI) allows analysis of morphological liver parenchymal changes and non-invasive assessment of liver fibrosis. Moreover, MR cholangiopancreatography (MRCP), as a part of standard MR protocol, provides insight into bile duct irregularities.
  
  
  OBJECTIVE
  To evaluate MR and MRCP findings in patients with primary sclerosing cholangitis and to determine the value of DWI in the assessment of liver fibrosis.
  
  
  METHODS
  The following MR findings were reviewed in 38 patients: abnormalities in liver parenchyma signal intensity, changes in liver morphology, lymphadenopathy, signs of portal hypertension, and irregularities of intra- and extrahepatic bile ducts. Apparent diffusion coefficient (ADC) was calculated for six locations in the liver for b = 800 s/mm(2).
  
  
  RESULTS
  T2-weighted hyperintensity was seen as peripheral wedge-shaped areas in 42.1% and as periportal edema in 28.9% of patients. Increased enhancement of liver parenchyma on arterial-phase imaging was observed in six (15.8%) patients. Caudate lobe hypertrophy was present in 10 (26.3%), while spherical liver shape was noted in 7.9% of patients. Liver cirrhosis was seen in 34.2% of patients; the most common pattern was micronodular cirrhosis (61.5%). Other findings included lymphadenopathy (28.9%), signs of portal hypertension (36.7%), and bile duct irregularities (78.9%). The mean ADCs (x10(-3)mm(2)/s) were significantly different at stage I vs. stages III and IV, and stage II vs. stage IV. No significant difference was found between stages II and III. For prediction of stage ≥II and stage ≥III, areas under receiver-operating characteristic curves were 0.891 and 0.887, respectively.
  
  
  CONCLUSIONS
  MR with MRCP is a necessary diagnostic procedure for diagnosis of PSC and evaluation of disease severity. Moreover, DWI could be used in continuation with standard MR sequences for the evaluation of liver fibrosis stage and distribution.
authors: Center for Radiology and Magnetic Resonance Imaging, Clinical Center Serbia, Belgrade, Serbia. jelenadjokic2003@yahoo.co.uk
authors: Jelena Djokić
authors: JD
authors: Kovač
authors: Rada
authors: R
authors: Ješić
authors: Dejana
authors: D
authors: Stanisavljević
authors: Bojan
authors: B
authors: Kovač
authors: Ružica
authors: R
authors: Maksimovic
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015209:Cholangitis, Sclerosing / Q000473:pathology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity