Radiologic Insights into Autoimmune Cholangiopathy: Diagnosis and Differentials

To review the imaging manifestations of autoimmune cholangiopathies, highlight key differential diagnostic considerations and disease-specific complications, summarize current surveillance strategies, and discuss recent advances in quantitative imaging. This review discusses the clinical and imaging features of primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), IgG4-related sclerosing cholangitis (IgG4-SC), and overlap syndrome, with emphasis on imaging-based differentiation, associated complications, surveillance, and quantitative imaging. Autoimmune cholangiopathies comprise a heterogeneous group of immune-mediated inflammatory disorders affecting the biliary tree. These disorders may demonstrate overlapping clinical, biochemical, and imaging features and can lead to complications including biliary obstruction, cirrhosis, and hepatobiliary malignancies. Recognition of characteristic imaging patterns and disease-specific complications facilitates diagnosis, differentiation, and appropriate surveillance. Imaging plays a central role in the diagnosis and management of autoimmune cholangiopathies. Familiarity with their characteristic and overlapping imaging manifestations, associated complications, surveillance strategies, and emerging quantitative imaging techniques can improve diagnostic assessment and management.