Prevalence of sclerosing cholangitis in adults with AIH: Evaluating the role of routine magnetic resonance imaging.

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Prevalence

of sclerosing cholangitis

in adults with autoimmune hepatitis: Evaluating the role of routine magnetic

resonance imaging.

Abdalian R, Dhar P, Jhaveri K, Haider M, Guindi M, Heathcote EJ.

Department of Medicine, University

Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.

Large bile duct injury (that seen on cholangiography)

is not usually considered a feature of autoimmune hepatitis (AIH) in adults but

is present in up to 50% of children with AIH. The aim

of this work was to study the prevalence of large bile duct abnormalities

identified by magnetic resonance cholangiography

(MRC) in adults given a diagnosis of AIH. Seventy-nine

(n = 79) patients given a diagnosis of AIH (mean AIH score: 15.1 +/- 3.4) were

screened with MRC for evidence of sclerosing cholangitis (SC). Results were

reviewed by two radiologists. Clinical parameters were

correlated with MRC findings. A histological review of

available liver biopsies (n = 29) was performed. Of

the 79 patients surveyed, 8 (10%) had MRC findings consistent with primary sclerosing cholangitis (PSC). The interrater variability was

excellent (kappa = 0.87). Younger age at diagnosis

(24.3 +/- 11.9), higher baseline alkaline phosphatase

(186.4 +/- 98.3), higher bilirubin at time of MRC

(45.8 +/- 37.2), and greater lobular activity on initial liver biopsy were

significantly associated with the detection of this overlap of SC with AIH (P =

0.024, P = 0.037, P = 0.032, and P = 0.041, respectively), but not alkaline phosphatase/aspartate aminotransferase

ratio, time between the initial diagnosis of AIH and the MRC, or the presence

of cirrhosis on initial liver histology. Two cases with a normal MRC had

histological lesions typical of small duct PSC. Conclusion:

The presence of SC detected by MRC and from liver histology in adult patients

with AIH may not be clinically overt, and thus the prevalence of this AIH/SC

overlap may be higher than previously recognized. Our

data suggest that routine radiological evaluation of the biliary tree should be

performed in adults given a diagnosis of AIH, as in children the presence of

this overlap negatively impacts on survival. (HEPATOLOGY

2008.). PMID: 18200555

[PubMed - as supplied by

publisher]

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Thanks for posting this Barb. My son's Dr wants another MRI and he just had one six months ago.Right now we are checking to see if his insurance will pay for another one so soon.LeePrevalence of sclerosing cholangitis in adults with autoimmune hepatitis: Evaluating the role of routine magnetic resonance imaging.

[Guest guest]

Please note: this is an abstract, freely available at:

http://www.unboundmedicine.com/medline/ebm/record/18200555/abstract/Prevalence_o\

f_sclerosing_cholangitis_in_adults_with_autoimmune_hepatitis:_Evaluating_the_rol\

e_of_routine_magnetic_resonance_imaging_

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