Female; 54 years old. Reason: PSC History: Pruritus. LIVER, BILIARY TRACT: Extensive areas of focal dilatation and stricturing involving the intrahepatic biliary tree with pruning. Areas of beading are most pronounced near the origin of the left hepatic duct (series 701, image 73). Irregularity of the common bile duct appears more prominent than on prior MRI.Right percutaneous biliary catheter is noted, with new and significant soft tissue thickening seen along its course which demonstrates increased signal on T2 and diffusion weighted images. Associated diffuse circumferential thickening of the CBD and intrahepatic bile ducts which enhances on arterial and delayed phase images is also present, most pronounced in the right hepatic lobe. No discrete intraductal or hepatic masses identified. Small hemangiomas in segments 6 and 7 are not significantly changed. Gallstone and sludge in the gallbladder. Prominent right cardiophrenic lymph node. SPLEEN: No significant abnormality noted. Small splenule is present. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter bilateral renal cysts. No hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable subcentimeter T2 hyperintense focus in the right T12 vertebral body, likely representing an atypical hemangioma. OTHER: No significant abnormality noted.
1.Persistent dilatation/stricturing of the intra and extrahepatic biliary tree as described above, compatible with primary sclerosing cholangitis. 2.New extensive soft tissue thickening along the course of the biliary catheter and diffuse circumferential thickening of the CBD and intrahepatic bile ducts, both of which demonstrate increased T2 weighted signal and delayed enhancement. Even though no discrete mass is seen, findings may represent peribiliary spread of tumor and further evaluation with ERCP/endoscopic biopsy is recommended. 