Starry sky appearance (MRI)

Last revised by Daniel J Bell on 9 Apr 2020

Starry sky appearance on MRI refers to the appearance of small innumerable T2 hyperintense bile duct hamartomas and biliary microhamartomas, scattered throughout the T2 hypointense hepatic parenchyma, which resembles a “starry sky”. The high T2 signal lesions represent Von Meyenburg complexes seen in multiple biliary hamartomas. It is best demonstrated on a 3D-T2 sequence on magnetic resonance cholangiopancreatography (MRCP).


This MRI sign should not be confused with the similarly named starry sky appearance (ultrasound) seen in a variety of liver pathologies and the milky way sign (MRI) seen in progressive multifocal leukoencephalopathy (PML)

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