Abstract
Purpose
To evaluate MRI features of intraductal papillary neoplasm of the bile duct (IPNB) and to determine added value of diffusion-weighted MRI (DWI).
Methods
Twenty-three patients with surgically confirmed invasive (n = 12) and non-invasive (n = 11) IPNB, who underwent preoperative liver MRI were included. Two observers performed consensus review of gadoxetic acid-enhanced MRI and combined gadoxetic acid-enhanced MRI including DWI separately, with regard to conspicuity of intraductal tumor using five point scales, extent of tumors, and the presence of invasiveness.
Results
On MRI, there was no significant difference in the conspicuity of intraductal tumors between gadoxetic acid MRI (mean, 4.35) and combined MRI (mean, 4.65) (P = 0.09). However, addition of DWI led seven cases revealed excellent conspicuity as compared with good or moderate conspicuity on gadoxetic acid MRI. With regard to invasiveness, 11 cases (48 %) and 17 (74 %) were correctly diagnosed with gadoxetic acid MRI and combined MRI, respectively (P = 0.06). In invasive tumors, both of the two image sets did not help assess accurate extent of the tumor.
Conclusions
The addition of DWI to gadoxetic acid-enhanced MRI has a potency to improve conspicuity for intraductal tumors of IPNB and is helpful in determining tumor invasiveness, but not tumor extent.
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References
Chen TC, Nakanuma Y, Zen Y, et al. (2001) Intraductal papillary neoplasia of the liver associated with hepatolithiasis. Hepatology 34:651–658
Nakanuma Y, Sasaki M, Ishikawa A, et al. (2002) Biliary papillary neoplasm of the liver. Histol Histopathol 17:851–861
Shimonishi T, Zen Y, Chen TC, et al. (2002) Increasing expression of gastrointestinal phenotypes and p53 along with histologic progression of intraductal papillary neoplasia of the liver. Hum Pathol 33:503–511
Zen Y, Sasaki M, Fujii T, et al. (2006) Different expression patterns of mucin core proteins and cytokeratins during intrahepatic cholangiocarcinogenesis from biliary intraepithelial neoplasia and intraductal papillary neoplasm of the bile duct—an immunohistochemical study of 110 cases of hepatolithiasis. J Hepatol 44:350–358
Choi SC, Lee JK, Jung JH, et al. (2010) The clinicopathological features of biliary intraductal papillary neoplasms according to the location of tumors. J Gastroenterol Hepatol 25:725–730
Zen Y, Fujii T, Itatsu K, et al. (2006) Biliary papillary tumors share pathological features with intraductal papillary mucinous neoplasm of the pancreas. Hepatology 44:1333–1343
Lee SS, Kim MH, Lee SK, et al. (2004) Clinicopathologic review of 58 patients with biliary papillomatosis. Cancer 100:783–793
Lim JH, Jang KT (2010) Mucin-producing bile duct tumors: radiological–pathological correlation and diagnostic strategy. J Hepatobiliary Pancreat Sci 17:223–229
Lim JH, Zen Y, Jang KT, Kim YK, Nakanuma Y (2011) Cyst-forming intraductal papillary neoplasm of the bile ducts: description of imaging and pathologic aspects. AJR Am J Roentgenol 197:1111–1120
Lim JH, Jang KT, Rhim H, et al. (2007) Biliary cystic intraductal papillary mucinous tumor and cystadenoma/cystadenocarcinoma: differentiation by CT. Abdom Imaging 32:644–651
Lim JH, Jang KT, Choi D (2008) Biliary intraductal papillary-mucinous neoplasm manifesting only as dilatation of the hepatic lobar or segmental bile ducts: imaging features in six patients. AJR Am J Roentgenol 191:778–782
Lim JH, Yi CA, Lim HK, et al. (2002) Radiological spectrum of intraductal papillary tumors of the bile ducts. Korean J Radiol 3:57–63
Lim JH, Yoon KH, Kim SH, et al. (2004) Intraductal papillary mucinous tumor of the bile ducts. Radiographics 24:53–66
Edge SB, Byrd DR, Compton CC, et al. (eds) (2010) AJCC cancer staging manual, 7th edn. New York: Springer
Kim YK, Kim CS, Lee JM, et al. (2006) Value of adding T1-weighted image to MR cholangiopancreatography for detecting intrahepatic biliary stones. AJR Am J Roentgenol 187:W267–W274
Ukaji M, Ebara M, Tsuchiya Y, et al. (2002) Diagnosis of gallstone composition in magnetic resonance imaging: in vitro analysis. Eur J Radiol 41:49–56
Naganawa S, Kawai H, Fukatsu H, et al. (2005) Diffusion-weighted imaging of the liver: technical challenges and prospects for the future. Magn Reson Med Sci 4:175–186
Parikh T, Drew SJ, Lee VS, et al. (2008) Focal liver lesion detection and characterization with diffusion-weighted MR imaging: comparison with standard breath-hold T2-weighted imaging. Radiology 246:812–822
Vandecaveye V, De Keyzer F, Verslype C, et al. (2009) Diffusion-weighted MRI provides additional value to conventional dynamic contrast-enhanced MRI for detection of hepatocellular carcinoma. Eur Radiol 19:2456–2466
Yu JS, Chung JJ, Kim JH, et al. (2011) Detection of small intrahepatic metastases of hepatocellular carcinomas using diffusion-weighted imaging: comparison with conventional dynamic MRI. Magn Reson Imaging 29:985–992
Fukatsu H (2003) 3T MR for clinical use: update. Magn Reson Med Sci 2:37–45
Nasu K, Kuroki Y, Nawano S, et al. (2006) Hepatic metastases: diffusion-weighted sensitivity-encoding versus SPIO-enhanced MR imaging. Radiology 239:122–130
Boll DT, Merkle EM (2010) Imaging at higher magnetic fields: 3 T versus 1.5 T. Magn Reson Imaging Clin N Am 18:549–564
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This study was not supported by a grant and otherwise.
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All of the authors have no conflict of interests to disclose.
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Yoon, H.J., Kim, Y.K., Jang, KT. et al. Intraductal papillary neoplasm of the bile ducts: description of MRI and added value of diffusion-weighted MRI. Abdom Imaging 38, 1082–1090 (2013). https://doi.org/10.1007/s00261-013-9989-4
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DOI: https://doi.org/10.1007/s00261-013-9989-4