graphic appearance because only 2 of the 78 (3%) ''normal living patients. When hepatocellular carcinoma is complicated in cirrhosis, the cholangiography may show more ''cir-livers'' showed abnormal findings (mild dilation).
- Although no measurement of pressure of contrast me-rhotic'' or ''PSC-like'' changes by compressing the intrahepatic biliary tree, as evidenced by our report. 1 dium injection was performed, we thought that the injection pressure was almost similar in every case because injection It seems that the differences in cholangiography of cirrhosis between our study using autopsies and Drs. Altraif and was stopped when the common hepatic duct was filled moderately with contrast medium. We did not think that ante and Lewall's study using living patients can be explained by two critical aspects. The first critical thing is the interpretation postmortem changes led to the abnormal cholangiography, because no ''normal livers'' showed PSC-like appearance.
of the cholangiography (''cirrhotic change'' or ''PSC-like Although it may be true that the cholangiographic appearchange''). Secondly, the cholangiographic changes in cirrhosis ance of autopsied livers is different from that of the clinical seem to be more accentuated in autopsy livers than in living setting, we think that cirrhosis may show stricture and dilapatients, because autopsy livers generally show much more tion of intrahepatic bile ducts although the degree varies advanced stage of cirrhosis than do livers of living patients. from case to case. Cholangiography in cirrhotic livers may In this respect, cholangiographic appearance in autopsies is show minor changes (''cirrhotic change'') such as crowding, different from that in living patients, as pointed out by Drs. pruning, irregularities, and quick tapering of the intrahe-Altraif and Lewall. We are very grateful for the critical and patic biliary tree, as mentioned by Drs. Altraif and Lewall. important comments of Drs. Altraif and Lewall. LaRusso et al. 2 also mentioned that the PSC-like cholangiographic appearance may be present in cirrhosis. These chol-TADASHI TERADA, M.D. angiographic features in cirrhosis may be exaggerated as YASUNI NAKANUMA, M.D. ''PSC-like change'' in postmortem cholangiography. This may Second Department of Pathology also depend on the examiners' criteria on the degree of the Kanazawa University School of Medicine cholangiographic changes. We are sure that the Fig.
in our
Kanazawa, Japan report 1 represents the ''PSC-like changes.'' Because the 78 normal livers did not show the ''PSC-like change,'' we think REFERENCES that intrahepatic bile duct abnormalities including stricture 1. Terada T, Nakanuma Y. Intrahepatic cholangiographic appearance simuand dilation (beaded appearance) may be present in cirrhotic lating primary screlosing cholangitis in several hepatobiliary diseases: a livers to the extent that they may be called ''PSC-like.'' These postmortem cholangiographic and histopathological study in 154 livers at autopsy. HEPATOLOGY 1995;22:75-81. changes may be an extreme change of cirrhosis encountered 2. LaRusso NF, Wiesner RH, Ludwig J, MacCarty RL. Primary sclerosing in postmortem cholangiography, because cirrhotic livers at cholangitis. N Eng J Med 1984;310:899-903.