Primary sclerosing cholangitis: + Patients present with progressive chronic and intermittent obstructive jaundice as well as, elevated alkaline phosphatase. Progressive downhill course leads to cirthosis, portal hypertension, and increased risk of cholangiocarcinoma. + Key point- Beaded appearance with alternating segments of dilatation and focal circumferential stricture. + CT demonstrates scattered, dilated intrahepatic ducts with skip dilatations, stenosis, beading, pruning, and thickening of the duct wall, There are cirthotic changes to the liver parenchyma with end stage PSC. ‘+ MR demonstrates decreased T1 and increased T2 weighted signal along the bile ducts and portal veins (periportal fibrosis), Focal areas of edema or hyperperfusion may be present secondary to inflammation. There are irregular strictures with segmental dilations of the intra and extrahepatic ducts on MRCP ‘+ ERCP demonstrates multifocal strictures, mural irregularity, and diverticula.Biliary ductal dilatation is common. ‘© Radiographic findings in AIDS cholangiopathy are very similar to PSC; however, this patient, has no history of HIV. Cholangiocarcinoma appears as an intraductal mass with more uniform dilatation of the biliary system due to obstruction and not inflammation as in PSC. ‘+ Patients with chemotherapy cholangitis also have dilated, beaded biliary dilatation; however, the gallbladder and cystic duct are more commonly involved and not the intrahepatic ducts asin PSC. + Ascending cholangitis demonstrates an irregular contour, branching pattern, and ductal latation; however, ascending cholangitis presents with clinical symptoms of a severe infection, + The treatment for PSC er transplantation. Findings: CT shows diffuse, irregular intrahepatic biliary dilatation left greater than right. There is scattered circumferential colonic wall thickening of the visualized colon. MR shows contour irregularity and attenuation of the central intrahepatic bile ducts with mild to moderate upstream ductal dilatation, most pronounced within the leftlobe. The ERCP shows irregular beaded appearance of the intrahepatic and extrahepatic biliary ducts. No visualized intraductal calcul. Differential diagnosis: Primary sclerosing cholan + AIDS cholangiopathy © Cholangiocarcinoma + Ascending cholangitis ‘+ Chemotherapy cholangitis