Do you or a loved one have suspected or diagnosed primary biliary cholangitis (PBC)? If so, your health care team may use imaging tests, called radiology studies, to help understand what’s going on or to track the progression of your PBC.

Radiology studies are imaging tests that create pictures of your body to help doctors spot medical problems. This article will explain six things you should know about common radiology procedures used for PBC.

1. Radiology Is Used To Help Evaluate PBC

PBC — once called primary biliary cirrhosis — is an autoimmune liver disease. Like other autoimmune diseases, PBC affects more females than males, according to StatPearls. The condition is rare, but its prevalence (how commonly it occurs) is rising. To diagnose PBC, your health care team will review your medical history, assess your risk factors, and run blood tests. In addition, your health care team may use one or more of the following radiology tests.

Abdominal Ultrasound

Abdominal ultrasound is a simple, noninvasive radiology test that can help evaluate PBC. This test uses an ultrasound wand to send high-frequency sound waves into the body, creating a picture of the organs. An abdominal ultrasound can help doctors check the liver for changes in structure and look for blockages in the bile ducts. While ultrasound can’t diagnose PBC, it can help rule out other related diseases.

Abdominal ultrasound is safe to repeat, so it can be a helpful tool in managing PBC. Unlike a regular ultrasound, this test can check for signs of cirrhosis (severe liver scarring) or cancer that can develop as PBC progresses. If more detailed images are needed, your doctor may use other radiology tests.

Liver Elastography Using Ultrasound

Ultrasound elastography is a test that measures liver stiffness. Unlike a regular ultrasound, elastography specifically focuses on the physical properties of the liver. FibroScan is a special type of ultrasound elastography. This test sends sound waves through the liver and measures how long it takes for the waves to pass through. When the liver becomes stiff, the sound waves move through it faster.

A computer can use this data to help measure the fat content and stiffness of the liver. Liver stiffness is a sign of cirrhosis of the liver. As PBC progresses to the end stage, liver cirrhosis also increases, making elastography a helpful tool for monitoring liver health over time.

Magnetic Resonance Imaging

Sometimes, doctors need higher-resolution images than an ultrasound can provide. In these cases, they may use magnetic resonance imaging (MRI) studies. MRI scans use magnets and radio waves to make detailed computer images of the inside of the body. These scans show larger areas than ultrasound, across multiple planes (from different angles). This allows doctors to look at more organs in better detail. A special MRI — called the magnetic resonance cholangiopancreatography (MRCP) — creates images of your bile ducts.

MRI images can be improved by adding contrast. The contrast agents are given intravenously (into a vein). These agents change the magnetic properties of water molecules in the body, making small changes in the structure of the liver easier to see. MRCP is especially helpful for telling apart PBC and other conditions, like primary sclerosing cholangitis (PSC).

Like ultrasound, MRI doesn’t use X-rays (radiation) — which can cause health risks when used repeatedly. This means MRI is safe for repeat use. The contrast agents used in MRIs are also safe and well-tolerated. MRI scans are valuable for monitoring PBC. These scans can also measure elastography (liver stiffness) as PBC progresses. Your health care team can also use MRI scans along with your medical history and lab results to determine if you need a liver transplant.

Liver Elastography Using Magnetic Resonance Imaging

Another elastography test health teams use is the magnetic resonance elastography (MRE). This test combines the sound waves used in ultrasound with the magnetic and radio waves from an MRI. Like ultrasound elastography, the MRE scan can measure liver stiffness. MRE is better at detecting early liver scarring than ultrasound elastography. Both tests help doctors track liver stiffness in people with PBC.

Computed Tomography Scan

Computed tomography (CT) scans are not usually the preferred imaging test for PBC but may be used in some cases. CT scans offer some of the same advantages as MRIs over ultrasound. Doctors might use these scans if you can’t have an MRI. For example, if you have metal implants or devices like a pacemaker or an insulin pump, you can’t have an MRI. Like MRI scans, CT scans make multi-plane images of large areas of the body. CT scans do this by taking many X-ray images of your body.

Even though CT scans use X-rays — unlike MRI and ultrasounds — they are safe procedures. However, doctors limit the number of CT scans you have to reduce your exposure to X-rays, so they’re done less often. MRIs offer better images of soft tissues — like the bile ducts — than CT scans. However, if you cannot have MRI scans you may have a CT scan instead. Your health care team can also use CT scans to check for cirrhosis which occurs when PBC progresses.

2. Radiology Helps Rule Out Other Conditions

The main role of radiology in early PBC is to rule out other conditions. Some other liver conditions cause symptoms that are similar to PBC, like jaundice (yellowing of the skin and eyes), pruritus (intense itching), and liver damage. Before diagnosing PBC, your health care team will first rule out other possibilities, such as:

• Bile duct blockages caused by stones, narrowing, or cancer
• Infectious cholangitis caused by bacteria or viruses
• Similar conditions, like PSC
• Toxin- or drug-induced cholangitis
• Congenital cholangitis (inherited liver disease)

These conditions often have different imaging features. Your health care team will use imaging, along with your medical history, physical exam, and lab tests, to tell PBC apart from other conditions. Your health care team will also look for signs of PSC, like bile duct dilation (expansion).

3. Radiology Helps To Track PBC Progression

In some cases, CT or MRI can help detect hepatomegaly (enlargement of the liver) or cirrhosis. These scans can also look for an enlarged spleen (splenomegaly) along with varices (large veins around your organs) and fluid in the abdomen (ascites) in some later stages of PBC. These imaging findings help doctors track how PBC is progressing. For example, they can use findings from elastography — such as liver cirrhosis — to see when PBC has reached its end stages.

The timing of follow-up imaging will depend on your case. It may happen as often as every six months, especially in cases with cirrhosis. Your health care team will let you know how often they will repeat imaging studies.

4. Other Tests Are Needed To Help Diagnose PBC

Imaging tests alone can’t diagnose PBC, especially in the early stages. That’s why doctors use radiology tests along with other laboratory tests and sometimes a liver biopsy. Some of the lab tests that can confirm a PBC diagnosis include:

• Antimitochondrial antibodies (AMAs)
• Alkaline phosphatase (ALP) and other liver enzymes
• Other blood tests like blood counts and lipid/cholesterol

You may still need a liver biopsy if your symptoms or lab results are unclear. This entails removing a small sample of the liver to study under a microscope. An enlarged liver or spleen, or a nodular liver (cirrhosis), isn’t unique to PBC, so your doctor may need more lab results to support your diagnosis. If you also have elevated AMA and ALP levels that support a PBC diagnosis, a biopsy may not be needed.

Your health care team can use noninvasive imaging studies to diagnose and track your PBC. These often rely on lab results in conjunction with radiology studies to confirm your condition. However, imaging studies still help with PBC case management. If you have questions about the tests, be sure to ask your health care team.

Find Others Who Understand

On myPBCteam, the social network for people with PBC and their loved ones, hundreds of members come together to ask questions, give advice, and share their stories with others who are navigating life with PBC.

Have you had radiology visits for PBC? How were the procedures and results explained to you? Share your experiences or questions in the comments below or start a conversation on your Activities page.