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European Radiology

, Volume 22, Issue 11, pp 2502–2513 | Cite as

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

  • Jin Hee Kim
  • Jae Ho Byun
  • So Jung Lee
  • Seong Ho Park
  • Hyoung Jung Kim
  • Seung Soo Lee
  • Myung-Hwan Kim
  • Jihun Kim
  • Moon-Gyu Lee
Hepatobiliary-Pancreas

Abstract

Objectives

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.

Key Points

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.

Keywords

Sclerosing cholangitis with autoimmune pancreatitis Periductal infiltrating common bile duct cancer Dynamic computed tomography Endoscopic retrograde cholangiography Magnetic resonance cholangiography 

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Copyright information

© European Society of Radiology 2012

Authors and Affiliations

  • Jin Hee Kim
    • 1
  • Jae Ho Byun
    • 1
  • So Jung Lee
    • 1
  • Seong Ho Park
    • 1
  • Hyoung Jung Kim
    • 1
  • Seung Soo Lee
    • 1
  • Myung-Hwan Kim
    • 2
  • Jihun Kim
    • 3
  • Moon-Gyu Lee
    • 1
  1. 1.Department of Radiology and Research Institute of RadiologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  2. 2.Department of Internal MedicineUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea
  3. 3.Department of Diagnostic PathologyUniversity of Ulsan College of Medicine, Asan Medical CenterSeoulKorea

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