BiliaryIntraductalPapillary-MucinousNeoplasmManifestingOnlyasDilatationoftheHepaticLobarorSegmentalBileDucts:ImagingFeaturesinSixPatients

JaeHoonLim1,Kee-TaekJangandDongilChoi1

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Affiliations:1DepartmentofRadiologyandCenterforImagingScience,SamsungMedicalCenter,SungkyunkwanUniversitySchoolofMedicine,50Ilwon-dong,Kangnam-ku,Seoul,Korea.

DepartmentofPathology,SamsungMedicalCenter,SungkyunkwanUniversitySchoolofMedicine,Seoul,Korea.

Citation:AmericanJournalofRoentgenology.;:-78.10.14/AJR.07.

ABSTRACTChooseTopofpageABSTRACTIntroductionMaterialsandMethodsResultsDiscussionReferencesCITINGARTICLES

OBJECTIVE.Thepurposeofthisstudywastoevaluatetheimagingfeaturesofintrahepaticbiliaryintraductalpapillary-mucinousneoplasmmanifestingonlyasdilatationofthelobarorsegmentalbileductswithoutavisiblemasstodeterminewhetherthistypeofcholangiocarcinomacanberecognizedonthebasisofdistinctimagingfeatures.

CONCLUSION.Intrahepaticbiliaryintraductalpapillary-mucinousneoplasmcanspreadalongthemucosawithoutformingamassandcanproducealargeamountofmucin.Severedilatationofthelobarorsegmentalintrahepaticbileductswithcrowdingandsevereatrophyofthehepaticparenchymaarehelpfulimagingfindings.

Keywords:bileductdilatation,bileducttumor,CT,MRI,mucin-producingtumor

IntroductionChooseTopofpageABSTRACTIntroductionMaterialsandMethodsResultsDiscussionReferencesCITINGARTICLES

Tumorsofintrahepaticbileductsarisefromstemcellsofthebileductules,liningbiliaryepithelium,orepitheliumofperibiliaryglands[1].Althoughmostintrahepaticbileducttumorscauseluminalobliterationorstenosisduetotumornoduleformationorperiductalinfiltration,someexhibitintraductalpapillarygrowthandmucosalspreadalongthebileductlumen[].Growingorspreadingintraductalbiliarytumorshavebeenfoundinassociationwithchronicbiliarydisease,suchashepatolithiasisandclonorchiasis[1,3],buttheyalsooccurwithoutpreexistingbiliarydisease.Biliarypapillomatosisandintraductalmucin-producingpapillaryneoplasmsseemtobeinthiscategory[4–8].Mucinhypersecretionisafrequentmanifestationofbiliaryintraductalpapillaryneoplasia[6].Biliarymucosaldysplasiaandinsituandmicroinvasivecarcinomawithapapillaryconfigurationalsocanbeincluded[1].Becauseofmucinhypersecretion,affectedbileductsexhibitmarkeddilatation,andtumorsareconfinedwithinthedilatedpartofthebileducts[8–10].Partsofthebiliarytreenotaffectedbyneoplasiaalsosometimesaredilated.

Althoughmostintrahepaticbileducttumors,mostlycholangiocarcinomas,manifestasgrosslargeorsmallintrahepatictumors[4],insomecasesthetumorisnotvisibleonimagesoreveningrossspecimens,andseveredilatationofthehepaticlobarorsegmentalbileductsistheonlyfinding.Wehavefoundbiliaryintraductalpapillary-mucinousneoplasms(IPMNs)diagnosedonlyafterhepaticresectionforthemanagementofintrahepaticbileductdilatationofunknowncausation.ThepurposeofthisstudywastodiscerntheimagingfeaturesofintrahepaticbiliaryIPMNsmanifestingonlyaslobarorsegmentalbileductdilatationinsixpatientstodeterminewhetherthistypeofcholangiocarcinomacanberecognizedonthebasisofitsimagingfeatures.

MaterialsandMethodsChooseTopofpageABSTRACTIntroductionMaterialsandMethodsResultsDiscussionReferencesCITINGARTICLES

Patients

FromJanuarytoJanuary,thecasesof18patientswithpathologicallyprovenintrahepaticbiliaryneoplasmswereidentifiedinasearchofthepathologydatabaseatourhospital.Twenty-nineofthepatientshadbiliaryintraductalpapillaryneoplasms.Afterthoroughreviewofradiologyandpathologyreportsinconjunctionwithinformalreviewofpersonallogs,weidentifiedthecasesofsixpatientswithbiliaryIPMNwithonlydilatationofthelobarorsegmentalbileductswithoutagrossvisiblemassorthickeningofthebileductwall(fourwomen,twomen;meanage,60years;range,51–73years).Twenty-threepatientshadmeasurabletumorsinthebileducts.Hospitalrecords,photographsofresectedspecimens,andhistopathologicslideswereavailableinallcases.CTwasperformedonallsixpatients,MRIonfour,sonographyontwo,andcholangiographyonthree.

ImagingMethods

CT—CTscansoffivepatientswereobtainedonasingle-detectororanMDCTscanner(LightSpeedQX/i,LightSpeedUltra,orLightSpeed16,GEHealthcare;Brilliance,PhilipsHealthcare;Aquilion,Toshiba)beforeandafterIVadministrationofcontrastmaterial.Withbolus-triggeredtechnique,scanningwasstarted45and70secondsforthearterialandportalvenousphasesafterthestartofinjectionof10mLofnonioniccontrastmaterial(iopamidol,Iopamiro,Bracco)at4mL/sthroughanantecubitalvein.Imageswereobtainedwith.5-to5.0-mmslicethicknessand.5-to5.0-mmintervals.Foronepatient,thescannermanufacturerandscanningtechniquewereunknownbecauseCTwasperformedatahospitalotherthanours.

MRcholangiography—ThreepatientsunderwentMRcholangiopancreatographywitha3.0-TsuperconductingMRIunit(InteraAchieva,PhilipsHealthcare)withaphased-arraymulticoilsystem.CoronalT-andheavilyT-weightedsingle-shotfastspin-echoimageswereobtainedwiththefollowingparameters:TR/effectiveTE,shortest/80–;fieldofview,34×34cm;slicethickness,5mm;nointerslicegap;reconstructionmatrixsize,51×51;fatsaturation;numberofsignalsacquired,;acquisitiontime,approximately1minute10seconds;reductionfactor,.Coronalsingle-projectionimagesand3DheavilyT-weightedimageswereobtainedwithsingleshotfastspin-echosequencewiththefollowingparameters:TR/effectiveTE,shortest/;acquisitiontime,secondsinasingleprojection;slabthickness,5cm;nosensitivityencoding.Theotherparameterswerethesameasforthefastspin-echotechnique.Withcoronalmultislabfastspin-echoandsingle-shotfastspin-echosequences,sourceimageswereprocessedonaconsolewithmaximum-intensity-projectionreconstruction,includingtarget-volumemaximumintensityprojection.TheMRItechniqueforafourthpatientwasunknownbecauseimagingwasperformedatahospitalotherthanours.

CorrelationofImageFeaturesandPathologicFindings

TwogastrointestinalradiologistsreviewedCTscans,cholangiograms,andMRcholangiogramsinoneinterpretationsession.Decisionsregardingimagingfeaturesweredeterminedbyconsensus.Theradiologistsevaluatedtheimagesintermsofpresenceofamass,bileductdilatation,hepaticlobarorsegmentalatrophy,andmucininthebileductsoncholangiograms.Apathologistsub-specializedinexaminationsofthepancreatobiliarysystemreviewedphotographsofresectedspecimensandhistopathologicslides.Specialattentionwaspaidtothepresenceofanyvisiblemassinthebileducts,histopathologicdiagnosis,andgrowthpatternoftumorspread.Imagingfindingswerecorrelatedwithphotographicfindingsofresectedgrossspecimensbythetwointerpretingradiologistsandthepathologist.Thesmallnumberofcasesprecludedmeaningfulstatisticalanalysis.

ResultsChooseTopofpageABSTRACTIntroductionMaterialsandMethodsResultsDiscussionReferencesCITINGARTICLES

CT,MRI,andsonographydepicteddilatationoflobarandsegmentalbileductsinallsixpatients(Figs.1A,1B,1C,1D,1E,1F,1GandA,B,C,D,E).Inthreepatients,onlyaffectedlobarorsegmentalbileductsweredilated,probablyowingtopartialor







































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