Beading on cholangiography is a characteristic finding of which condition?

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Multiple Choice

Beading on cholangiography is a characteristic finding of which condition?

Beading on cholangiography comes from alternating narrowing and dilation of the bile ducts caused by chronic inflammation and fibrosis around the ducts. This pattern is classic for primary sclerosing cholangitis, a long-standing cholestatic liver disease that affects both intrahepatic and extrahepatic ducts with periductal (onion-skin) fibrosis. When you image the biliary tree with MRCP or ERCP, the scarred ducts create a string-of-beads appearance. Clinically, PSC often presents with cholestatic liver test abnormalities and pruritus, and it is strongly associated with inflammatory bowel disease, especially ulcerative colitis. There’s also an elevated long-term risk of cholangiocarcinoma. In contrast, primary biliary cholangitis involves autoimmune destruction of small intrahepatic ducts and does not characteristically produce biliary beading on cholangiography; imaging may be less specific and is complemented by antibodies and histology. Hepatic adenoma and focal nodular hyperplasia are focal liver lesions with distinct mass imaging features rather than a beaded bile duct pattern. So the beading pattern on cholangiography most strongly points to primary sclerosing cholangitis.

Beading on cholangiography comes from alternating narrowing and dilation of the bile ducts caused by chronic inflammation and fibrosis around the ducts. This pattern is classic for primary sclerosing cholangitis, a long-standing cholestatic liver disease that affects both intrahepatic and extrahepatic ducts with periductal (onion-skin) fibrosis. When you image the biliary tree with MRCP or ERCP, the scarred ducts create a string-of-beads appearance.

Clinically, PSC often presents with cholestatic liver test abnormalities and pruritus, and it is strongly associated with inflammatory bowel disease, especially ulcerative colitis. There’s also an elevated long-term risk of cholangiocarcinoma.

In contrast, primary biliary cholangitis involves autoimmune destruction of small intrahepatic ducts and does not characteristically produce biliary beading on cholangiography; imaging may be less specific and is complemented by antibodies and histology. Hepatic adenoma and focal nodular hyperplasia are focal liver lesions with distinct mass imaging features rather than a beaded bile duct pattern.

So the beading pattern on cholangiography most strongly points to primary sclerosing cholangitis.

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