PANCE Gastrointestinal (GI) And Nutrition Practice Test

On MRCP, which finding is characteristic of Primary Sclerosing Cholangitis?

Beading of bile ducts with irregular narrowing and dilation Gallstones in gallbladder Diffuse hepatic steatosis Normal MRCP findings

Correct Answer:

Beading of bile ducts with irregular narrowing and dilation

Explanation:

Primary Sclerosing cholangitis produces scarring and inflammation of the bile ducts, leading to multiple areas of narrowing and dilation along the biliary tree. On MRCP this shows up as a beaded pattern—the irregular, short strictures with intervening dilations in both intrahepatic and extrahepatic ducts. That beading is the classic imaging hallmark of PSC. Other options reflect different liver conditions: gallstones in the gallbladder point to cholelithiasis, diffuse hepatic steatosis shows widespread fat in the liver, and a normal MRCP would not explain PSC findings (though imaging can be normal early in disease).

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