Pancreatic changes in primary sclerosing cholangitis: evaluation with MR imaging

The purpose of this study was to determine the frequency and the spectrum of MR imaging findings of pancreatic abnormalities in patients with primary sclerosing cholangitis.

MR images in 24 patients with primary sclerosing cholangitis were retrospectively reviewed for evidence of pancreatic abnormalities, including abnormalities of signal intensity; changes in size and morphology; abnormalities of pancreatic ducts; presence of focal lesions, pseudocysts, and peripancreatic edema or fluid; and contrast-enhancement pattern if dynamic studies were available.

Eleven patients with pancreatic abnormalities on MR images (case patients) and 13 patients with normal MR findings of the pancreas (cohort patients) were identified. The most common finding in case patients was increased signal intensity of the pancreas on T2-weighted images (73%), followed by decreased signal intensity on T1-weighted images (55%) and decreased enhancement on arterial-phase contrast-enhanced images (50%). Other findings included marked enlargement of the pancreas (27%), narrowing of pancreatic ducts (27%), and peripancreatic edema or fluid (27%). The mean value of the anteroposterior diameter of the pancreatic head in the case patients was significantly greater than that in the cohort patients (p = .039). The mean signal-intensity ratio on the T2-weighted images was significantly higher in the case patients than in the cohort patients (p = .007).

Increased signal on T2-weighted images, decreased signal on T1-weighted images, enlargement of the pancreas, and decreased contrast-enhancement were MR findings of pancreatic disease associated with primary sclerosing cholangitis.