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Author's Name : Massimo Tonolini, Roberto Bianco

Article Title : HIV-related/AIDS cholangiopathy: pictorial review with emphasis on MRCP findings and differential diagnosis 

Journal Name : Clinical Imaging Volume 37

1)   Bibliography
Tonolini, M., & Bianco, R. (2013). HIV-related/AIDS cholangiopathy: Pictorial review with emphasis on MRCP findings and differential diagnosis. Clinical Imaging, 37(2), 219–226. https://doi.org/10.1016/j.clinimag.2012.03.008

2)  Purpose of the Article
    This article is mainly to describe the role of MRCP and other different diagnosis for HIV/AIDS cholangiopathy. 

3)  Brief Description of Procedure and Findings/Results
Ultrasound
Universally, ultrasound becomes as an ideal and valuable modality in HIV patients to visualize the impacted organ like liver and pancreas, but, it has very limited ability to image biliary and pancreatic ducts. On contrary, the dilatation of intra and extra hepatic ducts are accurate findings reported in positive AIDS settings. Therefore, following ultrasound detection of biliary abnormalities in HIV patients, correlation with clinical and laboratory findings and appropriate further investigation should be suggested.
ERCP
Previously, AIDS cholangiopathy was diagnosed based on the visualization of cholangiographic defects through the standard ERCP. The demonstration had been classified according to their type: type I, type II and type III.
MRCP
MRCP of T2 weighted sequences utilize the essential contrast between fluid-filled structures difference.In this sequences, MRCP uses long relaxation time and also the adjacent structures to represent slow moving or static flow of bile duct and pancreatic secretion on a low intensity background. Also, MRCP depicts a cheaper and non-invasive procedure that act as an alternative to ERCP that will allow better visualization of intra and extrahepatic biliary tracts defect. 

4)   Conclusions and Comments
This article has emphasized clearly about AIDS cholangiopathy which can be best diagnosed by using certain modalities especially MRCP. In basis, biliary dilatation and jaundice are common causes of this pathology. It has been proved by magnetic resonance cholangiopancreatography (MRCP) due to its fundamental role in the study of biliary disorders. Thus, ERCP was replaced by MRCP in some conditions because it is quite invasive and becomes demanded when only interventional procedures are indicated. In comparison to ERCP, MRCP  is better in terms of the visibility of tight stricture; it is not opacified and easy to be seen. Also, it can even imaged the intra and extra-hepatic biliary tract clearly.

5)   Opinion of the Article
Personally, i think this article is at its best to describe briefly the pathology of AIDS cholangiopathy. It had justified some appearances on radiographic images that indicated a person to have this disease. At the same this, this article was compared different modalities used in the diagnosis directly set the gold standard to image AIDS cholangiopathy. Thus, I had rule out that MRCP is the best modalities as been mentioned in the article.



APPEARANCE OF PATHOLOGY ON RADIOGRAPHS/IMAGES


Figure 1: A 35-year-old woman with HIV–hepatitis C; (A) Ultrasound detects moderately dilated CBD with distal tapering, (B, and C) MRCP of CBD dilatation with papillary stenosis (arrowheads),(D) Contrast-enhanced MRI confirms absence of solid periampullary tissue


Figure 2: 44-year-old man with advanced AIDS; (A) thick-slab and (B) MIP-reformatted thin-slice MRCP images show irregular “beaded” appearance of the intrahepatic biliary tree. Pancreas divisum (main pancreatic duct in continuity with the Santorini) is noted as an incidental finding (arrowhead).

Figure 3: A 48-year-old HIV-positive man;(A) Axial T2-weighted MR image shows
irregular intrahepatic ductal dilatation, (B) Thick-slab and (C) MIP-reformatted thin-slice MRCP acquisitions detect segmental portions of the intrahepatic biliary tree of both lobes involved by multiple alternating stenosis and saccular dilatations.