Demystifying the imaging diagnoses of sclerosing cholangitis

Divij Agarwal; Shivani Sharma; Yashant Aswani; Rimlee Dutta; Rajesh V Helavar; Sai Krishna Gadwal; Chandan J Das

doi:10.1007/s00261-026-05397-1

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Demystifying the imaging diagnoses of sclerosing cholangitis

Journal article

Peer reviewed

Demystifying the imaging diagnoses of sclerosing cholangitis

Divij Agarwal, Shivani Sharma, Yashant Aswani, Rimlee Dutta, Rajesh V Helavar, Sai Krishna Gadwal and Chandan J Das

Abdominal radiology (New York)

03/26/2026

DOI: 10.1007/s00261-026-05397-1

PMID: 41885964

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Abstract

Sclerosing cholangitis encompasses a group of conditions eventually leading to chronic cholestasis, and are characterized by inflammation, fibrosis, and segmental strictures of the intrahepatic and/or extrahepatic ducts. These can be either primary or secondary in origin. Primary sclerosing cholangitis (PSC) has no identifiable cause, while secondary sclerosing cholangitis (SSC) has various causes, producing similar chronic progressive changes in the biliary ducts. It is vital to differentiate between the two, as PSC is difficult to treat (with liver transplantation being the definitive treatment), while many causes of SSC are treatable, and even reversible. Therefore, it is imperative to exclude secondary causes of sclerosing cholangitis before establishing the diagnosis of PSC. While MRCP is the non-invasive imaging gold standard, ERCP, clinical correlation, and biopsy are frequently required to establish a definitive diagnosis. This review article presents a systematic approach to the imaging-based differential diagnoses of sclerosing cholangitis, integrating key clinical, laboratory, and radiological features.

Jaundice

Biliary stricture

Sclerosing cholangitis

MRCP

Cholangiocarcinoma

Cholangitis

Details

Title: Subtitle: Demystifying the imaging diagnoses of sclerosing cholangitis
Creators: Divij Agarwal - All India Institute of Medical Sciences
Shivani Sharma - All India Institute of Medical Sciences
Yashant Aswani - University of Iowa
Rimlee Dutta - All India Institute of Medical Sciences
Rajesh V Helavar - Manipal Hospital
Sai Krishna Gadwal - All India Institute of Medical Sciences
Chandan J Das - All India Institute of Medical Sciences
Resource Type: Journal article
Publication Details: Abdominal radiology (New York)
DOI: 10.1007/s00261-026-05397-1
PMID: 41885964
NLM abbreviation: Abdom Radiol (NY)
ISSN: 2366-0058
eISSN: 2366-0058
Publisher: Springer
Language: English
Electronic publication date: 03/26/2026
Academic Unit: Radiology
Record Identifier: 9985149521302771

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