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CT imaging comparison between intraductal papillary neoplasms of the bile duct and papillary cholangiocarcinomas

  • Hepatobiliary-Pancreas
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To identify imaging features that assist in discriminating intraductal papillary neoplasms of the bile duct (IPNBs) from papillary cholangiocarcinomas (PCCs).

Methods

This study was approved by the institutional review board. Using the recently proposed histological diagnostic criteria for biliary papillary neoplasms, IPNBs and PCCs were selected from 537 biliary neoplasms consecutively resected in a 12.5-year period. Clinical and imaging features were compared between the two groups.

Results

The histology review identified 19 IPNBs and 48 PCCs, representing an estimated prevalence of IPNBs among biliary neoplasms of 4%. Approximately one half of IPNBs were incidentally found on imaging conducted for other purposes. In terms of tumor location, 15/19 IPNBs (79%) developed in intrahepatic bile ducts, and 41/48 PCCs (85%) in the distal bile duct. Cystic appearance was highly suggestive for IPNBs (p < 0.001). Using these two parameters, 78% of papillary bile duct neoplasms could be classified into IPNBs or PCCs. Other imaging findings favoring IPNBs included frond-like mural nodule, downstream bile duct dilatation, and the lack of abnormal enhancement in the adjacent bile duct. Interestingly, two patients with non-invasive or microinvasive IPNB had undergone abdominal imaging studies > 3 years before, and a retrospective review of the previous images identified small nodular or cystic lesions, suggesting a less progressive nature of IPNBs than currently thought.

Conclusions

Imaging findings useful for discriminating IPNBs from PCCs appear to be tumor location, shape of tumor, appearance of mural nodules, duct dilatation at unaffected duct, and abnormal enhancement of the adjacent bile duct.

Key Points

• Intrahepatic location and cystic dilatation of the affected bile duct are the strong discriminators between IPNBs and PCCs.

• The shape of the mural nodule and appearance of the neighboring bile duct are helpful for distinguishing IPNBs and PCCs.

• The less aggressive behavior of IPNBs compared with PCCs may facilitate less invasive management in patients with IPNB.

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Abbreviations

CT:

Computed tomography

DP:

Delayed phase

EP:

Early phase

HU:

Hounsfield unit

IPMN:

Intraductal papillary mucinous neoplasm

IPNB:

Intraductal papillary neoplasm of the bile duct

MRI:

Magnetic resonance imaging

ROI:

Region of interest

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Kanazawa University Graduate School of Medical Science, 13-1 Takaramachi, Kanazawa, 920-8641, Japan

    Takahiro Komori, Dai Inoue, Norihide Yoneda, Azusa Kitao, Kazuto Kozaka, Akira Yokka, Fumihito Toshima, Takashi Matsubara, Satoshi Kobayashi & Toshifumi Gabata

  2. Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan

    Yoh Zen

  3. Department of Quantum Medical Imaging, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan

    Satoshi Kobayashi

Authors
  1. Takahiro Komori
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  2. Dai Inoue
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  3. Yoh Zen
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  4. Norihide Yoneda
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  5. Azusa Kitao
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  6. Kazuto Kozaka
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  7. Akira Yokka
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  8. Fumihito Toshima
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  9. Takashi Matsubara
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  10. Satoshi Kobayashi
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  11. Toshifumi Gabata
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Corresponding author

Correspondence to Dai Inoue.

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Guarantor

The scientific guarantor of this publication is Dai Inoue.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Case-control study

• Multicenter study

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Komori, T., Inoue, D., Zen, Y. et al. CT imaging comparison between intraductal papillary neoplasms of the bile duct and papillary cholangiocarcinomas. Eur Radiol 29, 3132–3140 (2019). https://doi.org/10.1007/s00330-018-5841-0

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  • DOI: https://doi.org/10.1007/s00330-018-5841-0

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