MRI periportal halo sign as a diagnostic trigger in AMA-negative primary biliary cholangitis

A woman in her 60s with hereditary haemochromatosis, clinically asymptomatic, underwent liver MRI for quantification of iron overload. Despite normalised ferritin levels, she had persistent elevation of liver enzymes, predominantly cholestatic (aspartate aminotransferase 77 U/L (normal <31), alanine aminotransferase 49 U/L (normal <34), alkaline phosphatase 298 U/L (normal 30–120)). Previous autoimmune screening was negative.