Reason: Evaluate for cholangiocarcinoma, HCC screening History: PSC ? CirrhosisAdditional history per electronic medical record: 65 year old female with PSC with a CBD dominant stricture negative for malignancy on most recent ERCP (2015).July 2015 MRCP - Intrahepatic ducts show mild narrowing some discontinuity most likely due to areas narrowing and this is c/w with sclerosing cholangitis. The CBD is difficult to visualize suggesting it may be narrowed. The liver parenchyma shows no gross abnormality. ABDOMEN:LIVER, BILIARY TRACT: The liver is smooth in contour with a somewhat abnormal morphology with hypertrophy of the left lobe. The hepatic parenchyma demonstrates normal signal intensity and enhancement. No suspicious hepatic lesions are identified.The hepatic vasculature appears patent. Upper abdominal varices are noted.Status post cholecystectomy. There is moderate irregularity of the intrahepatic bile ducts with scattered short segments of stenosis with intervening dilation (for example series 701, image 60), overall not grossly changed (although precise comparison difficult due to differences in technique). The common hepatic duct is narrowed down to approximately 1-2 mm. There is irregularity and saccular dilation in the expected location of the cystic duct remnant. The common bile duct measures up to 6 mm. There is mild narrowing of the midportion of the common bile duct down to approximately 4 mm without high-grade stenosis, somewhat improved compared to the prior examination. There is also mild irregularity and wall thickening of the common bile duct likely reflecting chronic inflammatory changes. SPLEEN: No significant abnormality noted.PANCREAS: The pancreas demonstrates diffusely decreased parenchymal T1 signal which may reflect prior pancreatitis. The pancreas enhances normally. The pancreatic duct is not significantly dilated, and the pancreatic duct describes a normal variant looped course proximally. There several subcentimeter cystic lesions within the pancreatic body and tail. The largest appears to communicate with the main pancreatic duct and most likely represents a sidebranch IPMN, not significantly changed in size and with reference measurements below.ADRENAL GLANDS: Mild thickening of the left adrenal gland, not significant changed.KIDNEYS, URETERS: Multiple subcentimeter renal cysts, not significant changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Loss of haustration of the distal partially visualized likely reflects chronic inflammatory changes.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.INDEX LESION MEASUREMENTS (Current exam date/time: 9/16/2016 12:00:00)PANCREATIC BODY CYSTIC LESION: 0.7 x 0.5 cm (Image 25, Series 1001).
1.Findings compatible with reported history of primary sclerosing cholangitis, not significantly changed (though precise comparison difficult due to differences in technique). Common hepatic duct again narrowed down to approximately 1-2 mm. Common bile duct mildly narrowed but without high-grade stenosis, somewhat improved from prior.2.Subcentimeter cystic lesion within the pancreatic body compatible with a sidebranch IPMN, not significantly changed.3.Cirrhotic liver morphology.4.No suspicious hepatic lesions to suggest hepatocellular carcinoma.5.Partially visualized findings suggestive of chronic colitis.