Sadraei Nazanin, Jafari Hamed, Sadraee Amin, Zeinali-Rafsanjani Banafsheh, Rastgooyan Hemmatollah, Zahergivar Aryan
Department of Radiology, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, IRN.
Department of Urology, Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, IRN.
Cureus. 2022 Apr 8;14(4):e23956. doi: 10.7759/cureus.23956. eCollection 2022 Apr.
The CT findings of cirrhosis caused by primary sclerosing cholangitis (PSC) differ from cryptogenic cirrhosis. PSC could become complicated with biliary cirrhosis and cholangiocarcinoma. This study aimed at augmenting the information on the role of the three-phasic-abdominopelvic CT scan in PSC.
A total of 185 CT scans were retrospectively reviewed, including 100 patients with cryptogenic cirrhosis and 85 patients with PSC-cirrhosis. Different morphologic criteria were compared, including segmental atrophy/hypertrophy, hepatic contour, portal-hypertension, perihilar lymphadenopathy, biliary tree dilatation, gallbladder appearance. Inflammatory-bowel-disease (IBD) and cholangiocarcinoma frequency, presence of perihilar lymph nodes (LNs), and their size during end-stage PSC cirrhosis are investigated.
Six findings occur more frequently with PSC than those diagnosed with cryptogenic cirrhosis. Modified caudate/right lobe (m-CRL) ratio >0.73, moderate and severe lobulated liver contour, lateral left lobe atrophy, over distended gallbladder (GB), biliary tree dilatation and wall thickening, and LN sizes were higher in PSC patients as compared to cryptogenic cirrhosis (P < 0.005). Ascites and portosystemic collateral formations were significant in cryptogenic cirrhosis compared to PSC patients (P < 0.005). Cholangiocarcinoma frequency in PSC patients was 14.7%, and the frequency of inflammatory bowel disease (IBD) was 57.6%. Further, 22.4% of the patients were diagnosed with IBD and PSC simultaneously. The LN number and size in PSC patients were not different between those with or without cholangiocarcinoma.
Using three-phasic CT scans and PSC characteristics could be considered as an additional suggestion besides pathology measures. Diagnosis of PSC based on histological findings could be a last resort due to its invasive essence and specific characteristics of PSC in imaging.
原发性硬化性胆管炎（PSC）所致肝硬化的CT表现与隐源性肝硬化不同。PSC可并发胆汁性肝硬化和胆管癌。本研究旨在增加有关三相腹部盆腔CT扫描在PSC中作用的信息。
回顾性分析185例CT扫描，包括100例隐源性肝硬化患者和85例PSC肝硬化患者。比较不同的形态学标准，包括节段性萎缩/肥大、肝脏轮廓、门静脉高压、肝门周围淋巴结病、胆管树扩张、胆囊外观。研究终末期PSC肝硬化时炎症性肠病（IBD）和胆管癌的发生率、肝门周围淋巴结（LN）的存在情况及其大小。
与诊断为隐源性肝硬化的患者相比，PSC患者出现六种表现的频率更高。与隐源性肝硬化相比，PSC患者的改良尾状叶/右叶（m-CRL）比值>0.73、中度和重度分叶状肝脏轮廓、左外侧叶萎缩、胆囊过度扩张（GB）、胆管树扩张和壁增厚以及LN大小更高（P<0.005）。与PSC患者相比，隐源性肝硬化患者的腹水和门体侧支循环形成更为显著（P<0.005）。PSC患者胆管癌的发生率为14.7%，炎症性肠病（IBD）的发生率为57.6%。此外，22.4%的患者同时被诊断为IBD和PSC。PSC患者中有无胆管癌的LN数量和大小无差异。
除病理检查外，使用三相CT扫描和PSC特征可作为额外的诊断依据。基于组织学结果诊断PSC可能是最后的手段，因为其具有侵入性本质以及PSC在影像学上的特殊特征。
