Bile duct enhancement can be seen in a number of biliary inflammatory conditions. The bile ducts are supplied by the hepatic artery, so enhancement is often best seen in an arterial phase, but enhancement can also be seen in a portal venous phase.
Smooth and long segment enhancement
This sort of enhancement is associated with inflammation and infection.
- ascending cholangitis
- recurrent pyogenic cholangitis (RPC)
-
primary sclerosing cholangitis (PSC)
- seen in 67% of cases
-
acute graft vs host disease (GVHD)
- after stem cell transplantation
The differential can be improved based on whether there is bile duct dilatation, and if present, the pattern.
Short and asymmetric enhancement
This sort of enhancement is associated with a variety of bile duct neoplasms, the most common and worrisome of which is cholangiocarcinoma. These processes are often associated with biliary stricturing and upstream bile duct dilation.
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