Imaging recommendation · Abdomen · Pelvis

Recurrent cholangitis + intrahepatic ductal dilation, suspected Caroli disease

Q: What's the alternative imaging for recurrent cholangitis + intrahepatic ductal dilation, suspected caroli disease when surveillance for cholangiocarcinoma?

MRI — Annual MRCP + CA 19-9 (no contrast).

Recommended: MRCP is the preferred imaging study for recurrent cholangitis + intrahepatic ductal dilation, suspected caroli disease. Congenital saccular intrahepatic biliary dilation.

Recommended study

MRCP

MRI No contrast Preferred Abdomen · Pelvis Outpatient Reviewed 2026-05

Congenital saccular intrahepatic biliary dilation. Caroli syndrome adds congenital hepatic fibrosis. Increased cholangiocarcinoma risk.

If the default doesn't apply

Surveillance for cholangiocarcinoma

MRI Annual MRCP + CA 19-9 No contrast

Watch-outs

Cholangiocarcinoma risk

~7% lifetime; annual MRCP + tumor markers; transplant for diffuse disease.

Associated with ARPKD

Look for renal findings.

Pearls

Central dot sign: enhancing portal radicles within dilated ducts on CT/MRI.
Distinguish from primary sclerosing cholangitis (segmental strictures, no saccular dilation).
Treatment: lobar resection (focal) or transplant (diffuse).