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Intraductal papillary neoplasm of the bile duct: diagnostic value of MRI features in differentiating pathologic subclassifications—type 1 versus type 2

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

A Commentary to this article was published on 04 January 2024

Abstract

Objectives

To identify MRI features for differentiating type 2 from type 1 intraductal papillary neoplasms of bile duct (IPNB) and assessing malignant potential of IPNB.

Methods

This retrospective study included 60 patients with surgically proven IPNB who had undergone preoperative MRI between January 2007 and December 2020. All surgical specimens were reviewed retrospectively to classify types 1 and 2 IPNBs and assess tumor grade. Significant MRI features for differentiating type 2 (n = 40) from type 1 IPNB (n = 20); and for IPNB with an associated invasive carcinoma (n = 43) from intraepithelial neoplasia (n = 17) were determined using logistic regression analysis.

Results

An associated invasive carcinoma was more frequently found in type 2 than in type 1 IPNB (85.0% [34/40] vs. 45.0% [9/20], p = 0.003). At univariable analysis, MRI features including extrahepatic location, no dilatation of tumor-bearing segment of bile duct, isolated upstream bile duct dilatation, and single lesion were associated with type 2 IPNB (all p ≤ 0.012). At multivariable analysis, significant MRI findings for differentiating type 2 from type 1 IPNB were extrahepatic location and no dilatation of tumor-bearing segment of bile duct (odds ratio [OR], 7.24 and 46.40, respectively). At univariable and multivariable analysis, tumor size ≥ 2.5 cm (OR, 8.45), bile duct wall thickening (OR, 4.82), and irregular polypoid or nodular tumor shape (OR, 6.44) were significant MRI features for differentiating IPNB with an associated invasive carcinoma from IPNB with intraepithelial neoplasia.

Conclusion

MRI with MR cholangiopancreatography may be helpful in differentiating type 2 IPNB from type 1 IPNB and assessing malignant potential of IPNB.

Clinical relevance statement

Preoperative MRI with MR cholangiopancreatography may be helpful in differentiating type 2 intraductal papillary neoplasms of bile duct (IPNB) from type 1 IPNB and assessing malignant potential of IPNB.

Key Points

• In terms of tumor grade, the incidence of invasive carcinoma was significantly higher in type 2 intraductal papillary neoplasm of the bile duct (IPNB) than in type 1 IPNB.

• At MRI, extrahepatic location and no dilatation of tumor-bearing segment are significant features for differentiating type 2 IPNBs from type 1 IPNBs.

• At MRI, large tumor size, bile duct wall thickening, and irregular polypoid or nodular tumor shape are significant features for differentiating IPNB with an associated invasive carcinoma from IPNB with intraepithelial neoplasia.

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Abbreviations

ADC:

Apparent diffusion coefficient

CER:

Contrast enhancement ratio

CI:

Confidence interval

DWI:

Diffusion-weighted imaging

GRE:

Gradient echo

IPMN:

Intraductal papillary mucinous neoplasm

IPNB:

Intraductal papillary neoplasm of the bile duct

MRCP:

MR cholangiopancreatography

OR:

Odds ratio

RFS:

Recurrence-free survival

WHO:

World Health Organization

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Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. NRF-2020R1A2C2006031).

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Authors and Affiliations

  1. Department of Radiology, Seoul National University Hospital and Seoul National University College of Medicine, 101 Daehangno, Jongno-Gu, Seoul, 03080, Korea

    Sun Kyung Jeon, Jeong Min Lee, Jeongin Yoo, I** Joo & Jeong Hee Yoon

  2. Department of Radiology, Konkuk University Medical Center, Seoul, South Korea

    Sungeun Park

  3. Department of Pathology, Seoul National University Hospital, Seoul, South Korea

    Kyoung Bun Lee

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  1. Sun Kyung Jeon
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Correspondence to Jeong Min Lee.

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The scientific guarantor of this publication is Jeong Min Lee.

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

This study was approved by the Institutional Review Board of Seoul National University Hospital (IRB No. H-1911–077-1078).

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Institutional Review Board approval was obtained.

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• retrospective

• observational

• performed at one institution

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Jeon, S.K., Lee, J.M., Yoo, J. et al. Intraductal papillary neoplasm of the bile duct: diagnostic value of MRI features in differentiating pathologic subclassifications—type 1 versus type 2. Eur Radiol 34, 4674–4685 (2024). https://doi.org/10.1007/s00330-023-10491-9

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