Sclerosing cholangitis: broad spectrum of radiographic features

The broad spectrum of radiographic appearance of sclerosing cholangitis is illustrated in 19 cases. A classification of intrahepatic and extrahepatic features is presented, based on extent of narrowing of bile ducts, severity of narrowing, contour abnormalities, and presence of postsclerotic dilatation. In 13 of 19 cases, both intra- and extrahepatic ducts were involved. The most common form of intrahepatic involvement (8/19) was irregular stenosis obliterating peripheral ducts leaving only the more central ducts filled with contrast material. The most common type of extrahepatic duct involvement was a well-defined segment of either smooth or irregular narrowing. The most extensive involvement of intrahepatic ducts was often associated with more well-defined, less extensive extrahepatic duct involvement. In 7 patients, radiographic features were evaluated over periods ranging from several months to several years. Intrahepatic duct involvement either remained unchanged or worsened, while extrahepatic features more often remained unchanged. Our classification of patterns of involvement was applied to previous reports and revealed frequency of type of duct involvement similar to our series.